Why is it difficult to enter the hospital after the "soul bargaining" of innovative medical insurance drugs?

A few days ago, a set of data showed that as of the third quarter of 2020, among the 1,420 sample hospitals, about 25% of the oncology innovative drugs included in the national medical insurance catalogue were admitted to the hospital
.
This set of data has sparked heated discussions about "difficulty of innovative drugs entering hospitals
.
" How to get this set of data? Why are innovative drugs "difficult to enter the hospital"? What factors affect the provision of medicines in medical institutions? How to get through the "last mile" into the hospital? The reporter interviewed experts and industry insiders
.

Is the admission rate reasonable?
After learning from the Chinese Pharmaceutical Association, the calculation method of the data is unreasonable, and it includes all grades and types of hospitals into the statistical scope
.
In fact, many hospitals do not have the ability to provide medical services and therapeutic drugs for cancer patients, such as some grassroots hospitals and non-tumor specialty hospitals.
Therefore, the proportion of innovative cancer drugs that they draw into hospitals is relatively low
.
Hu Shanlian, a professor at the School of Public Health of Fudan University, believes that within an appropriate sample hospital, the proportion of hospital admissions of drugs can show the admission and use of drugs, but it cannot be used as the only criterion for evaluating the availability of drugs
.
"Different drugs will have different hospital admission rates
.
" Hu Shanlian said that each drug has a hospital admission rate that matches its own characteristics.
Even if some drugs have been on the market for a long time, their admission rate will remain low
.

　　Why are innovative drugs "difficult to enter the hospital"?
"Drugs entering the hospital need to be screened by the Pharmaceutical Affairs Committee
.
" Fan Jia, academician of the Chinese Academy of Sciences and dean of Zhongshan Hospital affiliated to Fudan University, said that since the 2018 medical insurance catalogue began to be adjusted, many innovative drugs have been included in medical insurance, but entering medical insurance does not mean Go to the hospital immediately
.
So, what are the factors that affect the provision of medicines in medical institutions? ——The degree of clinical demand for drugs
.
"Whether a certain kind of medicine can be equipped by the hospital depends mainly on the hospital's demand for the medicine in terms of clinical treatment
.
" Hu Shanlian believes that in general, the more extensive the hospital's strong professional treatment fields, the more urgent the clinical needs, and the corresponding drug allocation rate Higher
.
——Consideration of the hospital's own cost
.
After the implementation of the drug "zero price difference" policy, objectively drug distribution, storage, and loss have become hospital costs
.
——The pressure of the hospital's assessment
.
Although relevant national departments have issued policies, individual regions still include negotiated drugs in the assessment indicators of "drug proportion" in the assessment of public hospitals, which affects the enthusiasm of public hospitals to equip innovative drugs
.
——The hospital has been equipped with a stock of types of medicines
.
"For some hospitals that have been equipped with drugs in full, new drugs mean that the same number of varieties must be transferred
.
" Hu Shanlian introduced that public hospitals with more than 800 beds should not be equipped with more than 1,500 drugs
.
——Competition of similar drugs
.
In the same treatment field, there are many drugs with the same treatment mechanism and from different manufacturers, and the provision of drugs is facing competition in hospitals, which will ultimately affect the provision of drugs
.
"In the past three years, the list of medical insurance drugs has been adjusted every year
.
" said Ding Jinxi, a professor at China Pharmaceutical University.
It is precisely because the frequency of adjustments has accelerated and the number of drugs in the new access list has increased, the pressure of admission to the hospital and the slow progress have gradually become problems.
Appear
.
It can be said that the "difficulty in entering the hospital" is the "throttle" that has occurred after the reform of medical insurance
.

　　Innovative drugs "inhospitals" are not overnight.

Experts say that compared with drugs with a long clinical time, newly-marketed innovative drugs will take more time to enter the hospital, which is a gradual process
.
-It takes time to accept new drugs
.
"Innovative drugs in medical insurance can not only fill the gap in medication, but also increase the range of choices for patients
.
"Ding Jinxi said, but it takes time for a new drug to be accepted and used from the market.
Factors including clinicians' understanding of the new drug, the formation and revision of clinical drug guidelines and specifications, etc.
, will all have an impact on the admission of a new drug to the hospital
.
"Admission is also a kind of hospital.
Competition
.
"The general manager of Junshi Biology, Li Ning, said that some drugs were collected and used by hospitals before they entered the medical insurance.
It is relatively easy to enter the hospital after entering the medical insurance.
However, if the hospital has never purchased a certain brand of drugs, enter the hospital.
There will be more factors to consider
.
——The deployment of new drugs will be advanced in tiers
.
Experts say that compared with drugs not included in the medical insurance list, the hospital deployment of drugs included in the medical insurance list will be significantly faster
.
From the scale of the institution, the level of technology is high.
Hospitals are equipped first, followed by small and medium-sized hospitals; in terms of geographical distribution, large cities with concentrated medical resources take the lead
in providing them, followed by the central and western regions .
The number and the number of patients taking medication will increase
.
"National Insurance Bureau official said, the negotiations with the new 2019 70 drugs, for example, in the fourth quarter 2020, drug trips rose over 1 times more drugs than the first quarter, up 61
.

　　How to get through into the hospital.
" "The last mile"? In
order to solve the problem of the insured’s difficulty in medication, many places have begun to explore feasible methods
.
Sichuan Province implements single-line drug management for national negotiated drugs, which is expensive, drug-specific, and medication indications.
Limited-dose drugs are included in the single payment management
.
In the latest version of the medical insurance drug catalog, Sichuan Province has included 88 drugs in the single payment management, including the treatment of rare diseases of pulmonary hypertension, pertuzumab, etc.

"Due to the small number of rare disease patients, the clinical use of rare disease drugs and hospital equipment will remain at a low level.

.
"Ding Jinxi said that special drug management can be implemented for such drugs to ensure that people have channels to buy drugs
.
At the same time, the flexibility of retail pharmacies is fully utilized in many places , and medical insurance drugs are jointly supplied in designated hospitals and designated pharmacies to ensure participation in the insurance.
Accessibility of medicines for personnel
.
Fan Jia believes that opening up the “last mile” of innovative drugs into hospitals requires the joint efforts of the government, hospitals, and pharmaceutical companies
.
It is necessary to further improve policies to loosen medical institutions; pharmaceutical companies should also strengthen clinical The guidance of doctors allows them to become familiar with innovative drugs as soon as possible; at the same time, hospitals should also promote the optimization and upgrading of the drug structure in the hospital , and promote the improvement of diagnosis and treatment capabilities with the level of drug protection
.