Why is the supplement of provincial medical insurance catalogue so slow? ——Analysis of alternate varieties

Source: Medical magic cube data: on August 15, 2017, the supplementary schemes of provincial medical insurance catalog were implemented one by one, which was a long-awaited issue Other provinces directly issued the interim notice of "implementing the 2017 national catalog", stating that their provincial work will be handed in later In fact, this lag has always existed After the national health insurance catalog was published in 2009, the latest provinces did not complete this task until 2012 There are also provinces that wait for their own adjustment to be implemented together with the national catalog In this time difference, the common people are eager to see the new catalog and can't claim for reimbursement, so they will soon come up with a temporary plan for the benefit of the people However, why is the provincial catalog adjustment always so slow? There is only one answer, that is, in the case of limited adjustment of category B varieties, the provinces are facing the pressure of enterprises' access Especially this year, the Ministry of human resources and social security's requirements for the number of provincial supplements are within 292, which seems to be quite small, but knowing which teams are competing for 292 places, we know how much pressure there is This paper lists several teams waiting outside the provincial medical insurance catalog with license plates, and gives a brief analysis of the team 1: the last round of provincial medical insurance supplement varieties From 2009 to 2012, the provinces successively completed the task of supplementing category B varieties in the 2009 medical insurance catalog Most provinces transferred about 243 varieties according to the requirements of the Ministry of human resources and social security, while some provinces exceeded the standard seriously, such as the actual number of supplements in Guangdong Province reached 323, and some provinces increased less than 243, such as 193 in Zhejiang Province Therefore, the size of this team is determined by the coincidence of the historical supplementary varieties of each province and the 2017 version of the national medical insurance catalogue Biru, take a look at the three eastern provinces: the coincidence of the added varieties in the three northeastern provinces and the 2017 national catalog, which have been added in the provincial catalog before, do you still need to take the number plate to compete for the qualification again? At present, some provinces have introduced specific programs, most of which are good for the varieties of this team In Beijing's supplementary plan, it has been made clear that "the principles of drug varieties in the reimbursement scope of the current 2010 version of the drug catalogue in this city shall be retained", which seems to be a direct release In addition, other provinces have also pointed out that priority should be given to these historical supplements In this trend, which varieties will win? The following table shows the varieties (some) of the last round of provincial supplements that have entered more than 15 provinces but have not entered the 2017 national health insurance catalog In the last round, more than 15 varieties (parts) were added to the provincial medical insurance catalog In the last round, more than 30 varieties were added to the provincial medical insurance catalog Almost one clear water is an injection, mainly for the treatment of cardiovascular and cerebrovascular diseases, antibiotics and nutritional supplements The market scale is often several billion Although many varieties have been put into the list of key monitoring drug products in some provinces and cities, as long as these varieties remain in the provincial medical insurance catalogue in the future, there will not be a diving market share change Whether these varieties are retained in the new round of provincial health insurance catalog adjustment depends on the extent to which the restrictions on auxiliary drugs will be strict Team 2: half of the provinces and cities in China have successively completed the task of urban and rural medical insurance integration The new rural cooperative medical insurance system has gradually withdrawn from the historical stage and replaced by the basic medical insurance system for urban and rural residents The new rural cooperative medical system has its own reimbursement catalog before the merger, and the state has given appropriate lenient guidance in the catalog merger In this spirit, some varieties that do not coincide with the original provincial medical insurance catalog will be included in the medical insurance catalog, which is also the main member of the second small pair Take Hunan for example, the integration of urban and rural medical insurance can be regarded as an absolute leniency standard, which has brought about a great deal in the industry Last week, Hunan Medical Insurance supplement program was implemented, and inevitably mentioned these varieties - "during the transition period, the 171 quota quantities of drugs and dosage forms added by integrating urban and rural medical insurance catalogue and not included in the national drug catalogue are not included in the total adjustment temporarily" At that time, Xiaobian was also surprised to think that Hunan would boldly put aside the national quantity limit and directly include 171 varieties beyond the 292 quota But it turns out that's not the case First of all, the word "in the transitional period" is mentioned In fact, after the completion of the integration of the urban and rural directory, Hunan Medical Insurance Department has mentioned that "this adjustment is a transitional policy to ensure the unified treatment after the integration of the urban and rural medical insurance system After the new version of the medical insurance directory is formulated and issued by the state, our province will update and adjust the medical insurance and drug use policy of our province in accordance with the relevant provisions of the state in a timely manner Secondly, in the period of establishing the basic database, Hunan Province specially emphasizes "collecting and sorting out the drugs (including the drugs and dosage forms supplemented by the document" Xiang Ren she Fa [2016] No 83) ", which is the notice document of urban and rural directory integration So it seems that the 171 varieties still need to be PK with other varieties Team 3: the policy of compound medicine and compound medicine within the reimbursement scope can be described as twists and turns, from the initial quota of medical insurance catalog (version 04 medical insurance catalog) to the self adjustment of each province (version 09 medical insurance catalog), and then back to the quota to enter the catalog before reimbursement (version 17 medical insurance catalog) Many varieties failed to catch the trend of policy change and were also out of the game in the 2017 national health insurance catalog adjustment, so we can only seize the opportunity of provincial supplement According to the policy of 2009, as long as the single party is in the catalog, this kind of composite drugs can be reimbursed after filing in each province, so many provinces have issued the composite drug reimbursement catalog in batches This situation is the craziest in Anhui Province, where more than 90 composite drugs have been reimbursed, while Hainan Province is the most diligent Province, which has been included in ten batches of such composite drugs, and the latest list was released in January 2016 However, in 2017, the number of composite drugs included in the national health insurance catalog was not large Given the continuity of the drug use, those compounds that are not included in the national health insurance catalogue but have been included in the reimbursement scope in each province may be considered Team 4: reimbursement varieties under the local negotiation mechanism are mostly tumor targeted drugs and drugs for rare diseases Some statistics and analysis have been done in the previous articles (see: after the national negotiation, does the history of drug reimbursement for local medical insurance negotiation still continue?) If these varieties can continue to be reimbursed, or continue to implement according to the negotiation mechanism at that time, or they will occupy the quota adjusted to enter the provincial medical insurance category B At present, there are few plans issued by the provinces to mention these local negotiation varieties However, in the notice issued by the last version of Guangdong Provincial catalog, there is a paragraph to explain: those provinces that have included drugs not listed in the national catalog through negotiation may also evolve the negotiation history in this way in the future This small team is really fresh, waiting for the detailed rules of each province Team 5: some of the new varieties listed in the past seven years are seven years away from the last round of provincial medical insurance catalog supplement During this period, there are many new drugs with certain advantages in efficacy, safety and economy In fact, these varieties should be the focus of this provincial supplement, but the actual situation is always helpless It is reported that in 2010, when Beijing completed the supplement of the last edition of the catalogue, the number of historical varieties occupied the majority of places, and only 20 new varieties were actually added This generation lag reduces the time for many new varieties to be included in the medical insurance catalog, which is a double loss for patients and enterprises At this time, it is necessary to update the dynamic adjustment of the medical insurance catalog Under the siege pressure of various small teams outside, how can provincial capitals complete the task of updating the medical insurance catalogue? How to keep the continuity of drug use and meet the new drug demand with the times? We will wait for the supplementary plans of other provinces to be introduced and then analyze them.