The new version of the medical insurance catalogue begins to implement 119 national talks about the difficulty of entering the hospital

412　202031，119——，，

 

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2020，119（96，23），73.
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The main points of the medical insurance work in 2021 will be further clarified.
This year, the 2020 version of the medical insurance drug catalog will be implemented and the monitoring of the negotiated drugs will be organized.
At the same time, designated medical institutions shall not influence the allocation and use of medicines negotiated during the agreement period on the grounds of total medical insurance control, restrictions on the number of medicines used in medical institutions, and the proportion of medicines.

 

Why can't negotiate drugs enter the hospital?

 

The National Medical Insurance’s payment for the current round of negotiated drugs will continue until December 31, 2022.
For the 119 negotiated drugs, they have passed an average reduction of more than 50% and obtained a two-year medical insurance payment period.
It can be said that the time is money.

 

　　So on the basis that the price has fallen, how to better increase the quantity and how to promote the availability of patients' medicines has become the most concerned issue of pharmaceutical companies.

 

　　Since the medical insurance level intends to promote the rational allocation and use of drugs in the new version of the medical insurance catalogue by medical institutions, what is the problem of negotiating drugs that cannot enter the hospital?

 

　　According to Cybelan, the latest three-level public hospital performance evaluation method has proposed "replace the evaluation of the proportion of drugs with rational drug use indicators" to reduce the hospital's one-size-fits-all management tendency.

 

　　The National Health Commission, the competent department of hospitals, also issued a document that “hospitals shall not use the general control of medical expenses, total control of medical insurance costs, the proportion of medicines and the restriction on the number of medicines to influence the supply of negotiated medicines and the demand for rational use of medicines”.

 

　　However, the data shows that the hospital 's provision of negotiated drugs is still not ideal.
According to the statistics of the Chinese Pharmaceutical Association for 1,420 sample hospitals , only less than 20% of the innovative tumor drugs included in the National Medical Insurance List in 2018 have been completed by the end of 2019 Was admitted to the hospital.
As of the third quarter of 2020, only about 25% of the types of medical insurance included in 2019 have been admitted to the hospital, and 75% of hospital patients cannot obtain regular prescriptions from the hospital.

 

　　Why do hospitals still lack the enthusiasm for taking medicine?

 

　　At the scene of the above-mentioned symposium, an industry expert told Cyberlan that public hospitals cancel the drug markup, and the cost of the drug is the cost of the hospital; the proportion of drugs is restricted; the total amount of medical insurance is limited; the process of hospitals for new drugs is complicated; Limitations on the number of drugs; based on the existing in-hospital drugs, hospitals have vested interests and other reasons, which have affected the enthusiasm of hospitals to introduce drugs for negotiation.

 

　　According to a regulation issued by the former General Office of the Ministry of Health in 2011, the current performance appraisal indicators for public hospitals have clear regulations on drug product regulations, with no more than 1,500 tertiary hospitals and no more than 1,200 second-level hospitals—according to the above It is stipulated that if medicines come in, medicines must go out.

 

　　The above-mentioned person stated to Cyberland that there are no more than 1,500 kinds of medicines in tertiary hospitals, including a certain proportion of self-paid medicines.
Compared with medical insurance medicines, self-paid medicines are more freely priced and may have a certain space.
There are not so many supervisions.
Hospitals may be willing to use them.
Among them, there are many supplementary and nutritional drugs at their own expense.

 

　　According to Cyberlan’s understanding at the seminar, Cao Zhuang, an associate researcher at the National Medical Security Research Institute of Capital Medical University, believes that the relevant factors of the negotiated drugs themselves may also affect the hospital’s equipment.

 

　　The first is the level of demand for drugs in clinical treatment, and the availability of drugs with a wide range of treatment fields and urgent clinical needs is usually high; the second is that the types of drugs (indications) will affect their deployment in different types of medical institutions, such as large general hospitals and specialties.
The types of medicines equipped by hospitals and primary medical institutions will be quite different; the third is the competition of similar medicines.
When medicines with the same treatment field and the same mechanism of action are entered into the hospital, there is a competitive relationship, which will affect their provision; the fourth is the listing of medicines.
Time, the newly approved drugs need to go through a process of market promotion, clinical data accumulation, and clinical expert approval, which objectively affects the time it takes to be deployed in medical institutions.

 

　　It can be seen that the value of the drug itself (safety and effectiveness), the degree of clinical demand for the drug, the number of patients approved for indications, whether to fill the clinical gap, whether the treatment field is extensive, and whether the treatment needs of patients are all affected.
The hospital’s allocation rate of a medicine.

 

　　Pharmaceutical companies need to increase academic promotion and doctor education

 

　　What still needs to be noticed is that according to the research report of Southwest Securities Pharmaceutical Du Xiangyang's team "Reviewing the Five National Talks, Continue to Be Optimistic about Leading Innovative Pharmaceutical Companies", medical insurance negotiations have a very significant effect on the sales of innovative drugs.

 

　　In 2017, a total of 17 successfully negotiated varieties achieved a substantial increase in sales, and the total sales in the first year after entering the medical insurance increased by 251%.
AstraZeneca's osimertinib increased from 92 million yuan to 1.
004 billion yuan.
Merck's cetuximab sales increased from 216 million yuan to 498 million yuan.

 

　　The above-mentioned people told Cyberlan that many rapid-volume varieties are often mature in clinical use, while slow-volume drugs are often newly marketed varieties.
They lack sufficient clinical experience and doctors also lack the corresponding To understanding.

 

　　Song Ruilin, executive chairman of the China Pharmaceutical Innovation Promotion Association, also mentioned at the seminar that pharmaceutical companies should actively promote the academic promotion of negotiated drugs, strengthen communication with clinicians, and make preparations to promote the landing of negotiated drugs within their ability.
.

 

　　As one of the first partners of PD-1 Sintilimab injection to enter the medical insurance through negotiation, Ji Liwen, President and General Manager of Eli Lilly China, in an interview with Cyberlane a few days ago, negotiated the final conclusion of the drug’s admission to the hospital.
One kilometer, said to Cyberland that the most important thing is to do a good job in doctor education.
Of course, the basis of doctor education is whether the product is good or not, and it is also based on evidence-based medicine, followed by a mature commercial team that responds quickly.

 

　　In addition to the corresponding efforts of pharmaceutical companies, regarding the difficulty of negotiating drugs to enter the hospital, some experts believe that there are already more successful local exploration programs for reference.

 

　　One is the practice of Sichuan Province-through the implementation of single payment for drugs negotiated by the national medical insurance, so that they will not be restricted by indicators such as the proportion of medicines and fees; the other is the use of a more extensive dual-channel policy in practice.

 

Leng Jiahua, director of the Medical Insurance Office of 　　Peking University Cancer Hospital , proposed that external prescriptions + designated pharmacies can form a second channel beyond hospital admission.

 

　　A set of data provided by Chen Hao, director of the Center for Pharmaceutical Policy and Management, Tongji Medical College, Huazhong University of Science and Technology, shows that the sales channels of innovative drugs that have been on the market in the past two years are mainly in DTP pharmacies (up to 90% of sales) rather than hospitals .
Compared with hospitals, in DTP pharmacies, the time from the approval of the drug on the market to the first prescription has been shortened to one to two months.

 

　　In addition, policies are introduced at the national level to encourage medical institutions to open up green channels for the admission of Class 1 new drugs, reduce unnecessary procedures and restrictions; encourage commercial insurance to increase payment for innovative drugs, etc.
, are all related to the negotiation of drugs.
Useful exploratory experience.

 

　　Attached:

 

　　Negotiated drugs during the agreement period (Western medicine)

Negotiated drugs during the agreement period (Chinese patent medicine)

　　Medical Network, April 12, the new version of the 2020 medical insurance catalogue has been officially implemented on March 1 this year, but the issue of the landing of 119 negotiated drugs has caused heated discussions in the industry.
According to multiple media reports, many negotiated drugs have entered the market.
No hospital, the patient can’t buy it in the hospital

 

　　The new version of the medical insurance catalogue has been implemented

 

　　On April 9, the China Medical Insurance Research Association held a seminar on the theme of "Negotiating the Landing of Drugs".
Many experts expressed their views on the issue of negotiated drug admission.

 

　　Reviewing the 2020 version of the medical insurance catalog, a total of 2,800 Western medicines and Chinese patent medicines were included, and 221 medicines were negotiated during the agreement period.

 

　　After the 2020 medical insurance negotiations, a total of 119 drugs (including 96 exclusive drugs and 23 non-exclusive drugs) were successfully negotiated and included in the scope of medical insurance payment category B.
The success rate of this round of medical insurance negotiations reached 73.
46%, with an average price reduction of 50.
64%.

 

　　While publishing the medical insurance catalog, the National Medical Insurance Bureau requires that local medical insurance departments, in conjunction with relevant departments, guide designated medical institutions to rationally allocate and use the drugs in the catalog, and make reasonable adjustments to their annual total based on the actual drug use of medical institutions.
Strengthen the agreement management of designated medical institutions, and include the reasonable deployment and use of drugs in the "2020 Drug Catalog" into the content of the agreement.

 

　　Innovate working methods and methods, and promote the implementation of the "2020 Drug Catalog" by improving outpatient guarantee policies, opening medical insurance designated pharmacies channels, and rationally adjusting total control.

 

　　The main points of the medical insurance work in 2021 will be further clarified.
This year, the 2020 version of the medical insurance drug catalog will be implemented and the monitoring of the negotiated drugs will be organized.
At the same time, designated medical institutions shall not influence the allocation and use of medicines negotiated during the agreement period on the grounds of total medical insurance control, restrictions on the number of medicines used in medical institutions, and the proportion of medicines.

 

　　Why can't negotiate drugs enter the hospital?

 

　　The National Medical Insurance’s payment for the current round of negotiated drugs will continue until December 31, 2022.
For the 119 negotiated drugs, they have passed an average reduction of more than 50% and obtained a two-year medical insurance payment period.
It can be said that the time is money.

 

　　So on the basis that the price has fallen, how to better increase the quantity and how to promote the availability of patients' medicines has become the most concerned issue of pharmaceutical companies.

 

　　Since the medical insurance level intends to promote the rational allocation and use of drugs in the new version of the medical insurance catalogue by medical institutions, what is the problem of negotiating drugs that cannot enter the hospital?

 

　　According to Cybelan, the latest three-level public hospital performance evaluation method has proposed "replace the evaluation of the proportion of drugs with rational drug use indicators" to reduce the hospital's one-size-fits-all management tendency.

 

　　The National Health Commission, the competent department of hospitals, also issued a document that “hospitals shall not use the general control of medical expenses, total control of medical insurance costs, the proportion of medicines and the restriction on the number of medicines to influence the supply of negotiated medicines and the demand for rational use of medicines”.

 

　　However, the data shows that the hospital 's provision of negotiated drugs is still not ideal.
According to the statistics of the Chinese Pharmaceutical Association for 1,420 sample hospitals , only less than 20% of the innovative tumor drugs included in the National Medical Insurance List in 2018 have been completed by the end of 2019 Was admitted to the hospital.
As of the third quarter of 2020, only about 25% of the types of medical insurance included in 2019 have been admitted to the hospital, and 75% of hospital patients cannot obtain regular prescriptions from the hospital.

 

　　Why do hospitals still lack the enthusiasm for taking medicine?

 

　　At the scene of the above-mentioned symposium, an industry expert told Cyberlan that public hospitals cancel the drug markup, and the cost of the drug is the cost of the hospital; the proportion of drugs is restricted; the total amount of medical insurance is limited; the process of hospitals for new drugs is complicated; Limitations on the number of drugs; based on the existing in-hospital drugs, hospitals have vested interests and other reasons, which have affected the enthusiasm of hospitals to introduce drugs for negotiation.

 

　　According to a regulation issued by the former General Office of the Ministry of Health in 2011, the current performance appraisal indicators for public hospitals have clear regulations on drug product regulations, with no more than 1,500 tertiary hospitals and no more than 1,200 second-level hospitals—according to the above It is stipulated that if medicines come in, medicines must go out.

 

　　The above-mentioned person stated to Cyberland that there are no more than 1,500 kinds of medicines in tertiary hospitals, including a certain proportion of self-paid medicines.
Compared with medical insurance medicines, self-paid medicines are more freely priced and may have a certain space.
There are not so many supervisions.
Hospitals may be willing to use them.
Among them, there are many supplementary and nutritional drugs at their own expense.

 

　　According to Cyberlan’s understanding at the seminar, Cao Zhuang, an associate researcher at the National Medical Security Research Institute of Capital Medical University, believes that the relevant factors of the negotiated drugs themselves may also affect the hospital’s equipment.

 

　　The first is the level of demand for drugs in clinical treatment, and the availability of drugs with a wide range of treatment fields and urgent clinical needs is usually high; the second is that the types of drugs (indications) will affect their deployment in different types of medical institutions, such as large general hospitals and specialties.
The types of medicines equipped by hospitals and primary medical institutions will be quite different; the third is the competition of similar medicines.
When medicines with the same treatment field and the same mechanism of action are entered into the hospital, there is a competitive relationship, which will affect their provision; the fourth is the listing of medicines.
Time, the newly approved drugs need to go through a process of market promotion, clinical data accumulation, and clinical expert approval, which objectively affects the time it takes to be deployed in medical institutions.

 

　　It can be seen that the value of the drug itself (safety and effectiveness), the degree of clinical demand for the drug, the number of patients approved for indications, whether to fill the clinical gap, whether the treatment field is extensive, and whether the treatment needs of patients are all affected.
The hospital’s allocation rate of a medicine.

 

　　Pharmaceutical companies need to increase academic promotion and doctor education

 

　　What still needs to be noticed is that according to the research report of Southwest Securities Pharmaceutical Du Xiangyang's team "Reviewing the Five National Talks, Continue to Be Optimistic about Leading Innovative Pharmaceutical Companies", medical insurance negotiations have a very significant effect on the sales of innovative drugs.

 

　　In 2017, a total of 17 successfully negotiated varieties achieved a substantial increase in sales, and the total sales in the first year after entering the medical insurance increased by 251%.
AstraZeneca's osimertinib increased from 92 million yuan to 1.
004 billion yuan.
Merck's cetuximab sales increased from 216 million yuan to 498 million yuan.

 

　　The above-mentioned people told Cyberlan that many rapid-volume varieties are often mature in clinical use, while slow-volume drugs are often newly marketed varieties.
They lack sufficient clinical experience and doctors also lack the corresponding To understanding.

 

　　Song Ruilin, executive chairman of the China Pharmaceutical Innovation Promotion Association, also mentioned at the seminar that pharmaceutical companies should actively promote the academic promotion of negotiated drugs, strengthen communication with clinicians, and make preparations to promote the landing of negotiated drugs within their ability.
.

 

　　As one of the first partners of PD-1 Sintilimab injection to enter the medical insurance through negotiation, Ji Liwen, President and General Manager of Eli Lilly China, in an interview with Cyberlane a few days ago, negotiated the final conclusion of the drug’s admission to the hospital.
One kilometer, said to Cyberland that the most important thing is to do a good job in doctor education.
Of course, the basis of doctor education is whether the product is good or not, and it is also based on evidence-based medicine, followed by a mature commercial team that responds quickly.

 

　　In addition to the corresponding efforts of pharmaceutical companies, regarding the difficulty of negotiating drugs to enter the hospital, some experts believe that there are already more successful local exploration programs for reference.

 

　　One is the practice of Sichuan Province-through the implementation of single payment for drugs negotiated by the national medical insurance, so that they will not be restricted by indicators such as the proportion of medicines and fees; the other is the use of a more extensive dual-channel policy in practice.

 

Leng Jiahua, director of the Medical Insurance Office of 　　Peking University Cancer Hospital , proposed that external prescriptions + designated pharmacies can form a second channel beyond hospital admission.

 

　　A set of data provided by Chen Hao, director of the Center for Pharmaceutical Policy and Management, Tongji Medical College, Huazhong University of Science and Technology, shows that the sales channels of innovative drugs that have been on the market in the past two years are mainly in DTP pharmacies (up to 90% of sales) rather than hospitals .
Compared with hospitals, in DTP pharmacies, the time from the approval of the drug on the market to the first prescription has been shortened to one to two months.

 

　　In addition, policies are introduced at the national level to encourage medical institutions to open up green channels for the admission of Class 1 new drugs, reduce unnecessary procedures and restrictions; encourage commercial insurance to increase payment for innovative drugs, etc.
, are all related to the negotiation of drugs.
Useful exploratory experience.

 

　　Attached:

 

　　Negotiated drugs during the agreement period (Western medicine)

Negotiated drugs during the agreement period (Chinese patent medicine)