The payment problem to be solved, where is the breakthrough in paying for innovative medicine?

Since the establishment of the National Medical Insurance Bureau in 2018, the medical insurance catalog has been dynamically adjusted every year.

Review of the 2021 medical insurance negotiation: more innovative drugs enter the scope of basic medical insurance

Shorten the time from approval for marketing to medical insurance access, and improve access to innovative drugs

The areas involved in medical insurance negotiations reflect the urgent clinical needs and guide the direction of research and development

After this negotiation, the number of drugs in the 2021 version of the National Medical Insurance List has reached 2,860, and the number and level of coverage have reached a new high.

First, nearly 40% of the successfully negotiated drugs are imported drugs.

Second, how to guarantee high-value innovative drugs

Resolutely move towards high-quality pharmaceutical innovation

The rise of China's pharmaceutical ability to create energy stems from a series of reforms on the drug approval side

However, with the transformation of China's pharmaceutical innovation, the phenomenon of homogeneity has gradually become prominent

The Center for Drug Evaluation (CDE) of the State Food and Drug Administration released the "Annual Report on the Status of Clinical Trials of New Drug Registration in China (2020)" on November 10.

In early July, CDE released a draft of the "Guidelines for Clinical Research and Development of Antitumor Drugs Oriented to Clinical Value" for comments.

To cope with this anxiety, we should grasp the underlying logic of pharmaceutical innovation investment, that is, based on China, meet unmet clinical needs, actively benchmark against international standards, and firmly move towards high-quality innovation

High-quality innovation in medicine requires the support of a multi-level payment system

In February 2020, the national level issued the "Opinions on Deepening the Reform of the Medical Security System", requiring that by 2030, the basic medical insurance should be the main body, medical assistance should be the foundation, and supplementary medical insurance, commercial health insurance, charitable donations, medical The multi-level medical security system of mutual assistance and common development has clarified the system positioning of supplementary medical insurance and commercial health insurance

Looking back at the current commercial insurance, the “urban inclusive insurance” guided by the relevant local departments has been rapidly promoted across the country.

The industry generally believes that urban inclusive insurance is still in the exploratory period, and there is still great uncertainty as to whether it can become a long-term guarantee

Throughout the international experience, governments of various countries have adopted "legislation" for commercial insurance, and through cross-department and cross-industry collaboration, they have managed and guided commercial insurance to varying degrees to deal with the problem of "market mechanism failure", such as high Subsidies for risk groups, semi-mandatory insurance for high-income groups, and guaranteed renewal of insurance guarantee the development of health insurance and long-term health insurance for healthy people

In addition to medical insurance and commercial insurance, there are other innovative forms of payment security in China, such as mutual aid models, financial installments, and payment for therapeutic effects, but none of them have formed a systematic and stable payment security system

The author believes that for high-value innovative drugs, we should explore the formation of a co-payment model in which a small proportion of medical insurance pays, a large proportion of commercial insurance pays, pharmaceutical companies make partial profits, and individuals undertake a small amount of money.
It can also continue to encourage the innovation and development of pharmaceuticals, leaving room for development for the commercial insurance industry to achieve coordinated development.
While reducing the burden of personal medication, enterprises can also be able to continue to innovate with reasonable returns
.

A stable and sustainable payment guarantee is crucial for the development of innovative drugs
.
If high-value innovative drugs do not have a corresponding payment guarantee mechanism, they cannot be applied to clinically reflect their value, which will undoubtedly be a major loss to patients.
For enterprises and investors, they will not be able to recover the cost or get the corresponding return on investment.

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[Summary] Recently, Song Ruilin, executive chairman of the China Pharmaceutical Innovation Promotion Association, published the article "Steady and Steady, Return to the Origin of Innovation, and Promote Pharmaceutical Innovation to a New Level" in "NEJM Frontiers of Medicine".
"Brighten the hidden worries", and put forward corresponding suggestions for promoting the high-quality development of innovation and forming a benign closed loop, which is worth pondering
.

"The country urgently needs to establish a diversified medical security system, and guide the establishment of commercial insurance and charitable drug donation mechanisms, so as to determine the price based on clinical value, and formulate the payment ratio based on the ability to pay
.
From multiple dimensions, ensure that the majority of patients can share Chinese medicine.
Innovation achievements, improve accessibility and affordability, and establish a sound policy-led, market-oriented ecosystem for encouraging innovation
.
" - Song Ruilin

2021 is the year that China's pharmaceutical innovation industry will move towards high-quality and innovative development, and it is also a year in which commercial health insurance actively explores the integration and development of pharmaceutical innovation
.
Only by establishing a payment guarantee mechanism for innovative drugs can the closed-loop business of innovative drugs be realized from launch to landing, which is the key support for the high-quality development of the pharmaceutical innovation industry
.

References:

Song Ruilin: In the first year of "Clinical Value-Oriented" Chinese Innovative Drugs

Zhou Siyuan, Deputy Director of the Drug Evaluation Center of the State Food and Drug Administration: Clinical Value-Oriented Drug R&D and Scientific Supervision (China Association for the Promotion of Pharmaceutical Innovation)

"Building China's Pharmaceutical Innovation Ecosystem - The Third Report of the Series: Multi-level Medical Security System Helps People's Health and High-Quality Development of the Industry" released (China Pharmaceutical Innovation Promotion Association)

In-depth reveal of the results of the national medical insurance negotiation in 2021 (Xinkangjie)

Shanghai "Huxibao" paid 220 million in 4 months of operation, and nearly 50% of the compensation for people over 65 years old (China Times)