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    Home > Medical News > Latest Medical News > Weigh! Health Insurance Bureau publishes the work plan of national medical insurance drug catalog adjustment in 2019

    Weigh! Health Insurance Bureau publishes the work plan of national medical insurance drug catalog adjustment in 2019

    • Last Update: 2019-04-17
    • Source: Internet
    • Author: User
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    The work plan for the adjustment of the national medical insurance drug catalogue in 2019 (Draft for comments) was open to the public from March 13 to 26, 2019 As of 24:00 on March 26, 2019, a total of 4438 comments had been received Our bureau has carefully studied the opinions and suggestions of all parties, and now it will publish the revised work plan of national medical insurance drug catalog adjustment in 2019 Appendix: work plan of national medical insurance drug catalog adjustment in 2019 work plan of national medical insurance drug catalog adjustment in 2019 In order to implement the decision-making and deployment of the Party Central Committee and the State Council, further improve the drug use guarantee level of the insured personnel, and standardize the management of medical insurance drugs, according to the social insurance law of the people's Republic of China and relevant documents, we hereby formulate the adjustment work plan of the national basic medical insurance (including work injury insurance and maternity insurance) drug catalog (hereinafter referred to as the drug catalog) in 2019 1、 Target task Guided by Xi Jinping's socialist ideology with Chinese characteristics in the new era, we carried out the spirit of the nineteen and nineteen second plenary session of the Third Plenary Session of China's Central Committee and the central economic work conference, and adhered to the development thought of people's health as the center, focusing on establishing and improving a more equitable and sustainable medical insurance system, adjusting the catalogue scope appropriately according to the fund's ability to pay, and working hard to achieve drug knot We will further optimize the structure and standardize the management, further improve the use efficiency of medical insurance funds, improve the level of medical insurance drug security, and effectively alleviate the difficulty and cost of drug use 2、 Basic principle (1) adhere to the basic starting point of maintaining the health of the insured On the basis of fund affordability, we should highlight the clinical value, make up the short board of guarantee, improve the effect of guarantee, adjust the scope of catalogue appropriately, better meet the basic clinical drug demand of the insured, and effectively safeguard the health rights and interests of the majority of the insured (2) Adhere to the basic positioning Based on the level of China's economic and social development, taking into account the bearing capacity of medical insurance fund, the burden level of the insured and the clinical drug demand, we should adhere to the basic medical insurance positioning, not only do our best, but also do what we can, reasonably determine the scope and level of drug use, and achieve the matching between the scope and the guarantee capacity (3) Adhere to the open, fair and just expert evaluation system The drug catalogue shall be reviewed and determined by experts in accordance with the scientific and standard procedures, and the administrative department shall not interfere with the results of expert review We will listen to opinions and suggestions from all sides on the adjustment plan Standardize and publicize the review procedures, strictly discipline, take the initiative to accept discipline inspection and supervision, social and other supervision, and ensure openness, fairness and justice (4) Adhere to overall planning Give full play to the advantages of Western medicine and traditional Chinese medicine, establish and improve targeted evaluation methods according to their respective basic theories, and take into account the structure, quantity and growth of Western medicine and traditional Chinese medicine as a whole Comprehensive consideration should be given to the basic theories and norms of clinical drug use, the basic laws and management requirements of medical insurance, and the policies and regulations of drug supervision, health care, traditional Chinese medicine and other departments 3、 The content of the adjustment involves three aspects: Western medicine, Chinese patent medicine and Chinese herbal pieces, specifically including drug transfer in and drug transfer out Based on the drug information approved for listing by the State Food and drug administration, the company will not accept the application or recommendation of the enterprise, and will not charge the review fee and other various fees The transferred western medicine and Chinese patent medicine shall be the drugs registered and listed by the State Food and drug administration before December 31, 2018 (inclusive) Priority should be given to national essential drugs, drugs for treatment of major diseases such as cancer and rare diseases, drugs for chronic diseases, drugs for children, first aid drugs, etc According to the field of drug treatment, pharmacological action, functional indications and so on, organize experts to review by category According to the principles of pharmacoeconomics, the same kind of drugs should be compared, and the ones with sufficient evidence to prove that they are clinically necessary, safe, effective and reasonable in price should be preferred Transfer in can be divided into two ways: regular access and negotiation access Under the premise of meeting the effectiveness and safety, if the price (expense) is equal to or lower than the existing varieties in the drug catalog, it can be included in the catalog through regular way; the exclusive drugs with high price or great impact on the medical insurance fund should be admitted through negotiation (the determination time of exclusive drugs is based on the selection voting day The day before) The access method is adopted for the management of Chinese herbal pieces, and the objects of adjustment at the national level are only those processed according to the national drug standards If the original drugs in the drug catalog have been prohibited from production, sale and use by the national drug regulatory authorities, they shall be transferred out; if there are other drugs that do not meet the requirements and conditions of medical insurance after the evaluation of experts, they shall be transferred out according to the procedures Meanwhile, we will adjust and improve the management methods for the use of the drug catalogue, standardize the name and dosage form of the drug, and appropriately adjust the category A and B of the drug, the classification structure of the catalogue, and the remarks, etc In the process of category A and B adjustment, priority should be given to basic drugs 4、 Organizational form (1) the establishment of working group for drug catalog adjustment is led by the state health insurance bureau, which, together with the Ministry of industry and information technology, the Ministry of finance, the Ministry of human resources and social security, the state health and Health Commission, the State Food and Drug Administration and the State Administration of traditional Chinese medicine, studies and determines the principles and procedures for catalog adjustment, and coordinates policy issues Set up a working group in the state health insurance bureau to undertake daily work (2) Experts are divided into consultation experts, selection experts, calculation experts and negotiation experts, mainly clinical medicine and pharmacy experts, including a certain number of medical insurance experts and pharmacoeconomics experts, who are respectively responsible for the specific review work such as drug consultation, selection and negotiation drug calculation There is no intersection between consulting experts and selection experts Consulting experts: about 300 people It is composed of experts and scholars recommended by relevant academic groups and industry associations who have a positive style, strong business, are familiar with and enthusiastic about medical security, and voluntarily participate in catalog review It is divided into two groups: Western medicine group and traditional Chinese medicine group The main task is to provide consultation on drug classification and data analysis, demonstrate the technical points of drug review, demonstrate and propose the range of alternative drugs, etc Selection experts: about 25000 It is recommended by relevant local academic groups and industry associations organized by medical security departments of all provinces (autonomous regions and municipalities directly under the central government), including clinical medicine, pharmacy and medical insurance management experts of different regions, different levels of medical institutions, different departments and specialties, and a certain number of experts of primary medical and health institutions A certain number of experts were randomly selected from them for consultation and investigation as well as for voting on the list of alternative drugs Calculation experts: about 30 people It is composed of experts in medical insurance management and pharmacoeconomics recommended by local medical insurance departments and relevant academic groups Experts are divided into fund calculation group and pharmacoeconomics group, respectively, from the impact analysis of medical insurance fund and drug economy to put forward evaluation opinions on negotiated drugs Negotiation expert: it is composed of representatives of national medical insurance agency, local medical insurance department and relevant experts, and is responsible for on-site negotiation with negotiation drug enterprises (3) The negotiation group is composed of representatives of national medical insurance agencies, local medical insurance departments and relevant experts to conduct on-site negotiation with the negotiation drug enterprises The negotiated drugs shall be included in the drug catalog, and the unified national medical insurance payment standard and management policy shall be determined (4) A supervision group shall be set up in the Discipline Inspection Commission of the organ directly under the state health insurance bureau, which shall be responsible for the whole process supervision of the adjustment work and accept social complaints and reports 5、 The adjustment of work procedure drug catalog can be divided into five stages: preparation, review, release of regular access catalog, negotiation and release of negotiation Access Catalog: (1) preparation stage (January March 2019) 1 Formulate the work plan and solicit the opinions of the Ministry of industry and information technology, the Ministry of finance, the Ministry of human resources and social security, the national health and Health Commission, the State Drug Administration, the State Administration of traditional Chinese medicine and other relevant departments and the society 2 Establish a working organization, a database of review experts, a basic database of review, and regulations on integrity and confidentiality (2) Review stage (April July 2019) 1 Medical insurance medication consultation survey A certain number of experts were randomly selected from the selection database to vote on all varieties (dosage forms) to understand the medical insurance drug demand nationwide The voting area shall be no less than 2 / 3 of the provinces in the country; the number of voting experts shall be no less than 30% from secondary and below medical institutions; in principle, the number of experts in each drug group shall be no less than 50 2 Determine the alternative list Consulting experts demonstrate and determine the technical key points of drug review, and according to the key points and the results of medical insurance drug consultation and investigation, review by professional groups to determine the list of alternative drugs transferred in (including negotiation) and transferred out For the drugs out of the medical insurance catalog in the national essential drug catalog in 2018, it is proposed to consult experts for key consideration 3 Select experts to vote From the selection expert database, according to the difference between the expert's region, the medical institution's category and level, the professional department and the reported drug evaluation classification group, the experts participating in the selection are randomly selected by level and level No less than 2 / 3 of the provinces in China participate in the selection; no less than 30% of the experts from secondary and below medical institutions participate in the selection; in principle, no less than 50 experts from each drug group participate in the selection 4 Confirm the list of transferred drugs According to the voting results of the selection experts and the number of varieties to be included, the consulting experts determine the list of transferred (including negotiated) drugs, discuss some drugs that need to be strengthened management, and study and propose corresponding management measures 5 Solicit the opinions of relevant enterprises on the list of negotiated drugs and confirm the intention of negotiation (3) Regular catalog release stage (July 2019) 1 Prepare the notice on printing and distributing the drug catalog and publishing the list of negotiated drugs 2 Solicit opinions from relevant departments on the draft notice and report the catalog adjustment 3 Printing and distributing the new version of the drug catalogue and publishing the list of drugs to be negotiated (4) Negotiation stage (August September 2019) 1 Organize enterprises to provide negotiation materials according to the specified format and time limit 2 Organize measurement experts to carry out assessment through big data analysis of medical insurance and pharmacoeconomics, and put forward assessment opinions 3 The negotiation experts shall negotiate with the enterprise according to the evaluation opinions to determine the unified national medical insurance payment standard and management policy (5) Release the negotiation Access Catalogue (September October 2019) The state health insurance bureau issued a document to include the negotiated drugs in the drug catalogue, and simultaneously clarify the management and implementation requirements 6、 The supervision mechanism (1) actively accepts the supervision of all parties The Commission for Discipline Inspection, an organ directly under the state health insurance bureau, has set up a supervision group and arranged special personnel to participate in the whole process of catalog adjustment The work plan and work procedure shall be widely consulted with the opinions and suggestions of relevant departments and the whole society (2) Improve the internal control mechanism Clarify the responsibilities of Posts and personnel, improve information confidentiality, interest avoidance, accountability and other system measures, and ensure that the catalog adjustment is fair, safe and orderly (3) Strengthen the supervision of experts Establish the system of expert responsibility, interest avoidance, responsibility investigation, etc., leave marks in the whole process of all review and selection work, and ensure that the experts put forward review opinions independently and fairly.
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