Who is the big winner in health care negotiation? PD-1 negotiation results show that the average price of imported new hepatitis C drugs is reduced by 85%
Last Update: 2020-06-19
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On November 28, 2019, the list of drugs in the national health insurance negotiation was officially announced! < br / > e drug managers have learned from the national health insurance bureau that among the 128 candidate list of negotiated drugs selected through expert review and voting, 119 varieties of drugs are finally determined as new negotiated varieties after the negotiation intention is confirmed by the enterprise, of which 70 are negotiated, with an average decrease of 60.7% in price, more than 85% in three hepatitis C drugs, and about 65% in cancer, diabetes and other drugsAmong the 31 renewed drugs, 27 were negotiated and 4 failed, with an average price drop of 26.4%< br / > according to the calculation of Haitong Pharmaceutical Co., Ltd., among the 27 negotiated renewal varieties, according to the new medical insurance payment standards of some varieties that have been published, the highest drop was ginkgolide injection and ginkgolide glucosamine injection, with 75% and 70% respectivelyFor some more concerned varieties, such as apatinib, alisartan ester and sidabamide, the price reductions are 15%, 14% and 11%, respectively< br / > figure: on November 28, the state medical insurance bureau held a press conference to introduce the list of drugs to enter the national medical insurance negotiation in 2019 < br / > as a whole, 97 negotiated drugs were successfully listed in the national medical insurance category B directoryAccording to a press conference held by the National Health Insurance Bureau on August 28, most of the drugs successfully negotiated in this negotiation are newly marketed drugs with high clinical value in recent years, involving cancer, rare diseases, multi drug resistant tuberculosis, rheumatism immunity, cardiovascular and cerebrovascular diseases, hepatitis, diabetes, digestion and other clinical treatment fieldsAmong them, 5 basic drugs were all negotiated, 22 anticancer drugs, 7 drugs for rare diseases, 14 drugs for chronic diseases and 4 drugs for children were negotiated successfully< br / > according to the state health insurance bureau, four achievements have been achieved through medical insurance Negotiation: < br / > first, the structure of drugs in the medical insurance catalog has been significantly optimized, and the guarantee ability has been significantly improvedA batch of drugs with high recognition, new listing and high clinical value have been transferred into the catalog, and the guarantee ability of cancer, rare disease, full use or children's drug use has been significantly improved< br / > Second, the cost of drugs has been significantly reducedBy playing the role of "strategic buyer" in the medical insurance sector, the price of drugs has been greatly reduced by volume exchangeMany world-famous "noble drugs" have issued "civilian price", and the imported drugs have basically given the lowest price in the worldIt is conservatively estimated that after the negotiation of price reduction and medical insurance reimbursement, the individual burden of patients is reduced to less than 20% of the original level, and the individual drug is reduced to less than 5%< br / > the third is to highlight the guidance of encouraging innovationEight of the 12 domestic major innovative drugs have been negotiatedMost of the drugs successfully negotiated in this negotiation are the varieties that have been on the market in recent years, many of which are new ones in 2018The new drugs were quickly catalogued, sending clear signals of support for innovation < br / > Fourth, we have made progress in exploring the way to adjust the medical insurance catalogue in line with the actual situation in China On the one hand, it actively explored ways such as introducing competitive negotiation and playing the role of pharmacoeconomics evaluation, which greatly improved the scientificity, standardization and effectiveness of the negotiation On the other hand, in order to help guide enterprises to reduce prices substantially, it also tried to introduce the method of price confidentiality, and promised that some drug transaction prices would not be open to the public But after next year's catalog is launched, the majority of insured people will have their own experience < br / > Q: how to form the negotiation reserve price? < br / > A: National Health Insurance Bureau: select authoritative experts and backbone forces in Pharmacoeconomics and health insurance management nationwide, establish pharmacoeconomics group and fund measurement group respectively, and calculate in groups and parallel according to measurement technical points to form negotiation base price < br / > Q: how to communicate with enterprises? < br / > A: state health insurance bureau: organize two rounds of centralized communication, introduce the overall arrangement of negotiation work, consideration elements of specific drug negotiation calculation, negotiation rules, and submission requirements to negotiation enterprises, guide them to form reasonable expectations, and fully listen to the opinions and suggestions of enterprises Establish a communication mechanism, respond to the concerns of the enterprise in time, and organize experts to demonstrate when necessary < br / > Q: the renewal of four products is not successful How to reduce these burdens? < br / > A: National Health Insurance Bureau: the drug negotiation is not the expected goal, there will be certain uncertainty The negotiation is the purchase and sale of both parties, and there may also be rupture It may have an impact on patients, but there are similar or better drugs in the catalog that can be replaced, which will enable medical institutions to do a good job in linking up Meanwhile, for patients who still use the original drugs in a short period of time, a short transition period will be given < br / > Q: how to determine the payment standard of negotiated drugs? < br / > A: the sum of medical insurance fund and individual payment made by the state medical insurance bureau together with the enterprise Each region pays the fee according to the negotiated standard The payment is valid for two years, i.e from January 1, 2020 to December 31, 2021 After the expiration of the two years, adjust according to the relevant regulations Negotiate the drugs within the validity of the agreement, and supply the price to the retail drugstore not exceeding the medical insurance payment standard, That is to say, the supply price of the enterprise to the designated institutions and pharmacies of medical insurance shall not exceed the payment standard During the validity period, other manufacturing enterprises will be listed with the common name products, and will be automatically included in the medical insurance The medical insurance bureau has the right to adjust the payment standard of medical insurance according to the generic drugs, and also has the right to incorporate the generic drugs into the centralized procurement After the expiration of the time limit, the medical insurance department will adjust the payment standard according to the relevant provisions < br / > 01 the competition pattern of PD-1 has come to an end, and only Xinda has been shortlisted < br / > which exceeds the previous industry expectation According to the list of successful drugs in the negotiation released this time, only one PD-1 product of Xinda has been shortlisted, while K drug, O drug and terripril monoantibody of the same domestic enterprise have not been shortlisted < br / > in terms of price, the difference of annual treatment fee of several PD-1 products before negotiation is not small It can be seen that the price of drug K, drug O and trepril is lower than 50% of the initial price If the drug donation is cancelled after the negotiation, the actual price reduction range needs to be reconsidered < br / > according to the final results, only one PD-1 of Cinda's cindilimab has entered the medical insurance catalogue, which also meets the expectation of the previous industry Previously, according to the analysis of Minsheng securities, sindelimab had a greater willingness to enter the medical insurance through price reduction On the one hand, the competition of Chl indications is fierce Cinda is facing the strong sales ability of Hengrui medicine and Baiji Shenzhou, and the price of cindilimab after drug donation is nearly 50% higher than that of Hengrui's carrizumab, which is under pressure in price and sales Under the influence of these factors, it is more likely that sindili mAb will enter the medical insurance market through price reduction and occupy the market first, and the price is likely to be lower than that of Hengrui's carrelizumab According to a material released today, the medical insurance payment price of sindilimab is set at 2843 yuan (10ml: 100mg / bottle) < br / > Junshi's PD-1 treprizumab has the lowest annual treatment cost, and the probability of entering into the medical insurance negotiation from the perspective of pharmacoeconomics is relatively higher However, one of the reasons for the failure to enter the medical insurance this time may be that its current indication is melanoma, the market space is not large, and there are strong competitors K medicine in the competition, and the substantial price reduction is not necessarily proportional to the improvement of the market space Therefore, Junshi is not willing to reduce the price < br / > another significance of the negotiation results of PD-1 product health insurance is the impact on Hengrui and Baiji Shenzhou In addition to Xinda, other PD-1 is still not included in the medical insurance catalog, and the biggest uncertainty of Hengrui and Baiji in Shenzhou can be eliminated, which is good for both to some extent < br / > 02 the most special hepatitis C drug: creatively introducing competition mechanism, with an average decrease of more than 85% < br / > in addition to PD-1, another drug field of great concern is hepatitis C According to the results, three imported hepatitis C drugs have been successfully entered, namely, Gilead's two drugs: sophosuvapatavir tablets (propranolol), laidipivofosfovir tablets (Chardonnay), and mosadon's one: elbawegrarevec tablets (sebeida) As a whole, the average decline of the three imported hepatitis C drugs was over 85% < br / > it is worth noting that the most special link in the health insurance negotiation is the competitive negotiation in the form of hepatitis C drugs Xiong Xianjun, director of the Department of medical service management of the state medical security administration, said at a press conference on the 28th that "in view of the significant universal efficacy, considerable therapeutic effect and high price of six hepatitis C drugs (more than 50000 yuan for the course of treatment), it is difficult to guide enterprises to reduce the price to a reasonable range by relying on pharmacoeconomic calculation and conventional admission negotiation, We creatively introduced a competitive negotiation method, which explicitly allowed only two drugs with the lowest cost in the whole course of treatment to enter the catalogue, and promised not to include new drugs of the same kind within two years, so as to guide enterprises to fully compete Through competitive negotiation, the quotation of the enterprise has been greatly reduced, and the expected goal has been achieved " < br / > CCTV's program on the 28th also announced the situation of the negotiation scene at that time According to the rules, four negotiation enterprises directly calculate the quotation on site, and each enterprise talks about the calculation decision in an independent space The quotation of each drug should be accurate to two decimal places In 20 minutes, four enterprises gave the final quotation, and then the negotiation team announced the quotation on site under the supervision of the supervision of the supervision team According to the rules, if the enterprise's quotation is within the willingness to pay for medical insurance, then select two according to the quotation from low to high If they are not willing to pay, they need to quote again In the end, the prices of the four companies are all within the willingness to pay for medical insurance According to the price, the final products are Gilead's laidipei weisuophosphor Buwei tablets and mosadon's elbawegraravi tablets < br / > as a star product that has been added to the list of basic drugs but not included in the list of medical insurance before, whether propionosa of Gilead can enter the medical insurance through negotiation this time is also concerned by many people Specifically, the approved bingtongsha in May 2018 is the first pan genotype, once a day, single tablet for chronic hepatitis C virus approved in China, which is suitable for adult patients with genotype 1-6 HCV The average cure rate of bingtongsha was 98% after 12 weeks of treatment, and it greatly simplified the treatment of hepatitis C It is understood that the price of bingtongsha in China is 23200 yuan / 28 tablets, and the cost of a course of treatment is 69600 yuan That's less than 15% of what the United States is pricing < br / > in 2018, the clinical use of new oral anti HCV drugs in public hospitals in key provinces and cities was 14.45 million yuan, an increase of 745.03% over the previous year Of the 8 drugs, the top 3 varieties, suofebuvir (suoferdi), obipali (vectorol) and suofebuvir (pretongsha), accounted for 88.58%, in addition, dalatavir (Blitzer), elbawegrarevir (sebida), dasebway (yichri), danoreway (gonoway) and ashureway (swipp) accounted for 11.42% < br / > Chart: anti HCV oral antiviral drugs approved for marketing in China Source: minenet < br / > 03 antineoplastics: Roche, AZ, etc continue to follow up, Weicai is reluctant to lose the list < br / > among the imported antineoplastics, Roche's aleatinib hydrochloride (ansanza) and patozumab, AstraZeneca's PARP inhibitor olapari, Novartis' Jak1 / JAK2 inhibitor lucotinib; among the local anti-cancer drugs, Huji Huangpu's furquitini, The heavy anti-cancer drugs approved in recent two years, such as letitrexed for injection of Zhengda Tianqing, 19K of Hengrui and pyrrolidine maleate, have all been successfully negotiated and entered the medical insurance catalogue < br / > it is worth noting that Novartis has made "great achievements" in this healthcare negotiation In addition to tumor drugs, seven of its products have entered the 2019 version of the national medical insurance drug catalog through this medical insurance negotiation, including novinol for the treatment of chronic heart failure patients, leizhumab, an anti VEGF drug, and so on < br / > in the early stage, the "troika" will be reduced in the special negotiation of 17 anticancer drugs
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