What has been adjusted in the work plan of national health insurance catalog adjustment in 2019

Yesterday (April 17), the State Medical Insurance Bureau officially announced the work plan for 2019 national medical insurance catalog adjustment (hereinafter referred to as the "work plan") on its official website Previously, on March 13, the state medical insurance bureau published the draft of the work plan on its website According to the state health insurance bureau, during the period of soliciting opinions (March 13-26), a total of 4438 opinions were received According to the opinions and suggestions of all parties, the state health insurance bureau carefully studied and revised them, and published a formal work plan The author compares the formal draft with the previous draft, and finds that there are some major changes as follows: 1 This year, we may see that there are drugs transferred out of the medical insurance catalog In the target tasks and basic principles, the two places will change the "properly expand the scope of the catalog" to "properly adjust the scope of the catalog" "Expand" to "adjust" In addition, in the category of adjustment content, "if there are other non-conforming drugs and conditions, they can be transferred out after corresponding review procedures" is changed to "if there are other non-conforming drugs and conditions after expert review, they can be transferred out according to procedures" These two changes are likely to make preparations for drug transfer out of the medical insurance catalog The first amendment, "expansion" means that more drugs that were not originally in the medical insurance catalog may be included in the medical insurance catalog, while "adjustment" means that, on the one hand, new drugs enter the medical insurance catalog, on the other hand, it may be seen that some drugs that were originally in the catalog have been adjusted out of the catalog The second modification is to clarify the procedure of transferring out the medical insurance catalog The modified procedure is more clear The transfer out needs to be "reviewed by experts" and has a specified "procedure" 2 It is clarified that the deadline for approval of medical insurance negotiation and selection is "patent and exclusive drugs with high price or great influence on medical insurance fund shall be admitted through negotiation" in the draft for comments, and added a supplementary note, "the identification time of exclusive drugs shall be subject to the day before the voting date of selection" The national health insurance negotiation in 2017 and 2018 is undoubtedly one of the events attracting attention in the industry Whether the newly approved drugs can quickly enter the selection scope of health insurance negotiation and the deadline have always been the concern of pharmaceutical companies, which has not been clearly stated before Now, the official work plan clearly states that the time is the day before the selection voting day Therefore, as long as the exclusive varieties waiting for approval from the drug regulatory bureau are approved before the selection, even the day before, they are also expected to be included in the medical insurance this year This supplement shows the determination of the state to encourage the rapid integration of innovative drugs into health insurance 3 The Ministry of human resources and social security, the Ministry of finance, the State Health Commission, the State Food and Drug Administration and the State Administration of traditional Chinese medicine have added a new "Ministry of industry and information technology" to the original Ministry of human resources and social security, the Ministry of finance, the State Health Commission, the State Food and Drug Administration and the State Administration of traditional Chinese medicine The Ministry of industry and information technology is mainly responsible for formulating and implementing industry plans, industrial policies and standards, monitoring the daily operation of the industry, promoting the development of major technical equipment and independent innovation, managing the communication industry, guiding the promotion of information construction, coordinating the maintenance of national information security, etc The Ministry of industry and information technology has the function of monitoring the data of various industries and releasing various economic indicators of the pharmaceutical industry The Ministry of industry and information technology has been added to the working group, and the operation of medical insurance data may also be included in the monitoring scope, providing data support for the management and more effective use of subsequent medical insurance funds IV The official release of the medical insurance catalog was postponed to October This year's access catalog will be released in August The official documents postpone it for two months to October The specific adjustment of each stage is as follows: it can be seen that the largest adjustment is in the review stage, with the time increased from the original two months to more than three months This is inseparable from the further refinement of the process in this stage V pay more attention to the needs of the grassroots in the review The extension of the review stage is related to the process modification In the draft, the review process includes four steps: consulting experts to determine the alternative list → selecting experts to vote → consulting experts to determine the list of drugs transferred in and out → soliciting the opinions of relevant enterprises on the list of drugs to be negotiated and confirming the negotiation intention On the basis of this process, the first step is added in the official draft Firstly, the medical insurance medication consultation survey is carried out Specifically, "select a certain number of experts randomly from the expert database, 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; and the number of experts in each drug group shall be no less than 50 in principle " In this new step, the author pays attention to two key points First, the voting area is no less than 2 / 3 of the provinces in the country; second, the number of voting experts from secondary and below medical institutions is no less than 30% Moreover, compared with the draft, the official document also revised the conditions and number of experts selected It may be that the number of experts to be selected has increased from 20000 to 25000 due to the need to select two batches of experts, carry out consultation survey and vote on the list of drugs to be selected More importantly, the official document added a requirement to "ensure a certain number of experts in primary medical and health institutions" "No less than 2 / 3 of the provinces in the voting area", "no less than 30% from secondary and lower medical institutions", "ensure a certain number of experts in primary medical and health institutions", these new requirements indicate that in the adjustment of the medical insurance catalog, the medical demand from the primary level will be paid more attention, and the basic goal of medical insurance will be emphasized Link to the work plan of national medical insurance drug catalog adjustment in 2019: http://www.nhsa.gov.cn/art/2019/4/17/art_37_.html