The national health insurance negotiation list is out! Reduce personal burden by 95%; reshape the value of the new era

In 2019, the major event affecting the pharmaceutical industry is the adjustment of the national medical insurance catalogue This time, the adjustment of medical insurance catalogue will rewrite the adjustment mechanism of China's medical insurance catalogue, and also mark the coming of the new era of medical insurance On March 4, director Hu Jinglin, head of the National Health Insurance Bureau, said in the channel of the NPC and CPPCC that "more good drugs for life and emergency should be included in the medical insurance" In the same way, on the eve of the release of the national regular access medical insurance catalogue, director Hu published the signed article "promoting the reform and development of medical security at a new historical starting point" in the learning times, pointing out that "to promote the medical security cause in the new era to overcome difficulties and develop innovation." This shows that the adjustment of the new medical insurance catalogue in 2019 is of great significance to the establishment of the medical insurance system in the new era Just now, the list of drugs negotiated by the National Health Insurance Bureau has been released, and 97 drugs have been successfully negotiated In this negotiation, the price of 70 new drugs has dropped by 60.7% on average, and the price of 27 drugs renewed has dropped by 26.4% on average The patients' personal burden is reduced by more than 80% and the individual drug burden is reduced by more than 95% The new version of the medical insurance catalog has two major features: low price and high value On November 28, 2019, the national medical insurance negotiation catalog was released, which marks the end of the eight and a half months' adjustment of the medical insurance catalog and the beginning of the preparatory work for the implementation of the medical insurance catalog in 2020 Two characteristics can be seen from the new medical insurance Catalogue: the control of medical insurance cost and the inclusion of high-value varieties The rapid growth of medical insurance cost is a problem faced by the vast majority of countries in the world At the same time, it has become a key area for medical security institutions to explore Different countries have different measures for cost control The United States mainly controls the rapid growth of medical insurance costs in three aspects: institutional cost control, capital source control and payment method control In addition to the control of payment methods, the UK is more prominent in controlling medical costs through referral and general practitioner responsibility system For China, China's national conditions are different, and the complexity of the establishment of medical insurance system is far better than that of European and American countries, and at present, there is no long-term mechanism fundamentally formed In 2019, especially in the process of national centralized mining mode and new medical insurance catalog negotiation and access, the rapid growth of medical expenses was fully and effectively controlled At the regular policy briefing of the State Council on November 27, the leaders of relevant departments introduced that according to the statistical data, the excessive growth momentum of medical expenses was initially curbed, and the proportion of personal health expenditure continued to decline, down to 30% Following In particular, it is worth paying attention to the directory of entry judgment of this medical insurance negotiation According to previous experience, the decline of the directory of medical insurance negotiation should be between 40% and 50% In 2015, the national drug price negotiation was led by the health and Family Planning Commission, with an average decrease of 59% In 2017, the access of the national medical insurance negotiation directory led by the Ministry of human resources and social security decreased by 44% In 2018, the implementation of the special negotiation on access of anticancer drugs by the medical insurance bureau decreased by 60.7% on average, while in 2019, the decline of the national medical insurance negotiation directory was The average decrease of the national medical insurance catalog adjustment is 80% For example, the self paid sales price of Ou Lexin of GSK before entering the medical insurance is 660 yuan, and the payment price of the medical insurance after entering the medical insurance is 219 yuan, a decrease of 67% However, the decrease of Novartis JIERUN of the same kind of product is not like the cliff cut of Ou Lexin, and perhaps the clinical value is also an important assessment point in the medical insurance evaluation This also means that from the implementation of national centralized procurement mode to the negotiation of medical insurance catalog access, at this stage, in the context of incomplete medical system reform, direct drug price reduction will be the most effective and fastest way to curb the rapid rise of medical costs Secondly, the inclusion of high-value varieties is another feature of this access medical insurance catalogue The access of medical insurance is defined as the basic condition for the products that are clinically necessary, safe, effective and economically applicable to enter the medical insurance catalogue For example, the latest PD-1 has successfully entered the medical insurance catalog, and the PD-1 cindilimab injection of Cinda biology has entered the medical insurance at a price of 96000 yuan / year The indications included in the medical insurance are relapsed / refractory classic Hodgkin's lymphoma The treatment cost of the year before the price cut is about 260000 In the world, drugs negotiated by the state are usually included in the medical insurance reimbursement catalogue and new drugs on the market, and Japan is no exception In Japan, the drugs involved in the negotiation are mainly expensive new drugs on the market, such as patents and exclusive drugs that may bring certain risks to the fund if they are included in the catalogue according to the existing market price In Japan, there are many kinds of medical insurance catalogue, including almost all prescription drugs on sale in the Japanese market, and price negotiation is needed to enter the medical insurance catalogue In other words, it is a long-term mechanism for negotiating access to the medical insurance catalog In 2017, Japan updated up to 16000 varieties of the medical insurance catalog In China, due to the large population and the limited medical insurance fund, we have restrictions on the types, coverage and payment standards At present, we can only guarantee that safe, effective, exclusive and innovative varieties are limited in the catalogue As patients, we can enjoy the medical value brought by innovative drugs, meet the needs of patients in time, and promote the proportion of diseases to be cured In addition, the medical insurance negotiation Access Catalogue greatly reduces the medical insurance payment fees and provides innovative varieties with preferential prices for patients In this medical insurance negotiation Access Catalogue, many products must be the lowest price in the world Therefore, the benefits of the majority of patients in the new round of medical insurance catalog are significant, and the guiding ideology of medical insurance adjustment needs to improve the well-being and sense of gain of patients For the country, through the establishment of the adjustment mechanism of the medical insurance catalog and the release of the negotiation access catalog, we have gradually explored a medical insurance security system suitable for China's national conditions, and won the stage victory in the battle of new medical reform In the past, pharmaceutical enterprises used to take entering the national health insurance catalog as a magic weapon to win new products Under the background of continuous price reduction, whether the entry of the new national health insurance catalog can continue to help enterprises succeed is worth our thinking? In the past, according to statistics, the ratio of market sales and medical insurance sales of a drug listed in the medical insurance catalog was as high as 2:8 If a new drug can enter the medical insurance catalog smoothly and take advantage of new drug protection and market opportunities, it can take more than 60% of the market share In 2017, the Ministry of human resources and social security led the access products of the national medical insurance catalog After six products entered the medical insurance catalog, the sales volume did not rise but declined This also shows that entering the medical insurance catalog will pay a huge price for enterprises, but with the dynamic adjustment and continuous price reduction, will enterprises still take entering the medical insurance as an important part of their access strategy? Because medical insurance involves many subjects such as medical service provider, demander, insurance institution and government, the control of medical expenses is relatively complex There are still some aspects to be improved in the cost control mechanism of social medical insurance in China Therefore, it is necessary to learn from the effective experience and methods of foreign countries in the field of medical insurance cost control on the basis of theoretical research on medical insurance cost, combined with the actual situation of our country, at the same time of curbing the excessive growth of medical insurance cost, synchronous global innovation of treatment programs, taking into account the interests of the country, enterprises and patients, which can be regarded as the value reconstruction of medical insurance catalog Appendix: 1.97 list of successful drugs for negotiation.pdf 2 Updated catalogue of drugs for national basic medical insurance, work injury insurance and maternity insurance "part of negotiated drugs during the agreement period" PDF click the link "http://www.nhsa.gov.cn/art/2019/11/28/art% HTML" to enter the official website and download appendix ~ 37 Statement: this opinion only represents the author, not the position of yaozhi.com, welcome to exchange and supplement in the message area; if you need to reprint, please be sure to indicate the author and source of the article.