The medical insurance catalogue establishes the wind vane who will take advantage of the situation?

Before the Japanese medical network on May 7th, the National Medical Insurance Bureau officially announced the "2019 National Health Insurance Drug Catalogue Adjustment Work Plan" (the following text is referred to as "the program"). The "Clan" clearly stipulates that priority should be given to the treatment of major diseases such as national essential drugs, cancer and rare diseases, chronic diseases, children's drugs, first-aid rescue drugs, etc., ordinary drugs are subject to regular access, and the price is high or has a greater impact on medical insurance funds. The exclusive patented drug will be negotiated. The ultimate goal of this medical insurance catalog adjustment is to include more life-saving drugs in the medical insurance catalogue, which is a new opportunity and a challenge for related companies.
Advance the realization of "medical insurance funds for the expenditure of just-needed medicines"
The medical insurance drug list plays an important role as a key support for the operation of medical insurance. This catalogue adjustment is the first comprehensive adjustment after the establishment of the National Health Insurance Bureau, which has attracted the attention of the industry.
Regarding the practical significance of the adjustment of the national medical insurance drug list, Dong Jing, general manager of Guangdong Haiwang Pharmaceutical Group, said that this means adjusting the direction of the doctor's medication, so that the medication habits of hospitals and doctors gradually move closer to the direction of national policy encouragement. The current National Health Insurance Drug List was promulgated in 2017, including 2,598 Western medicines and Chinese patent medicines, including medicines for two medical insurance access negotiations in 2017 and 2018. Among them, many are auxiliary drugs that have no clear therapeutic effect. If these are removed, they will be closer to the drug use category of mainstream diseases in China under the new situation of medical reform, which can effectively alleviate the serious illness and common diseases of the people. Burden, use limited medical insurance funds for just-in-time drug expenditures.
According to the "Program", this medical insurance catalogue is targeted at Western medicines and proprietary Chinese medicines. Priority will be given to non-health insurance products, major diseases such as cancer and rare diseases, therapeutic drugs for chronic diseases such as hypertension and diabetes, and children's medications. Urgent rescue medicines, etc., similar drugs have priority to prove that they are clinically necessary, safe and effective, and the price is reasonable. The patent exclusive drugs with higher prices or greater impact on the medical insurance fund are negotiated.
Regarding this adjustment method, Dong Jing said that from 2018 to the present, from the national level to the local government, policies have been issued to prioritize the use of national essential drugs, and the proportion of hospitals using basic drugs has been formulated and included in performance appraisal. The "Opinions of the General Office of the State Council on Improving the National Essential Drug System" also clarified that it is necessary to increase efforts to promote the use of basic drugs. The priority use of national essential drugs is a consistent and continuous policy. The tilt of the medical insurance policy can better promote and improve the implementation of the national essential medicine system. In addition, a large part of the treatment of major diseases such as cancer and rare diseases is produced by imported or Chinese-foreign joint ventures, and the prices are generally high. The inclusion of such drugs in medical insurance can greatly reduce the economic burden of patients.
In addition, for Chinese herbal medicines, the "Proposal" stipulates the use of the admission method, and the national level adjustment is limited to the Chinese medicine decoction pieces prepared according to the national drug standards. In this regard, Dong Jing analysis pointed out that this is mainly due to two considerations. On the one hand, in recent years, the development of new Chinese medicine decoction pieces such as formula granules and broken wall pieces has been expensive, and the amount is large, which takes up a lot of medical insurance costs. Previously, many areas have cancelled medical insurance reimbursement for such products. The adjustment of the national medical insurance catalogue clearly limits the restrictions on such products, which helps to promote the cost of medical insurance and is used for better medical economics. On the other hand, the preparation of traditional Chinese medicine formula granules does not strictly enforce the standards of the pharmacopoeia. Compared with the processing of traditional decoction pieces, there is great controversy, and the processing methods such as broken wall pieces and ultrafine powder are mostly local standards. From a certain perspective, this adjustment is the original source of traditional Chinese medicine.
Dong Jing also stressed that in recent years, the state's supervision of Chinese medicine decoction pieces production enterprises has been continuously strengthened, and no less than one hundred enterprises have been recovered or revoked production licenses every year. At the same time, the company has also increased the operating costs of enterprises; The market space of traditional decoction pieces is constantly squeezed by new products such as formula pellets, and the survival is worrying. This adjustment is a major positive for Chinese medicine decoction production enterprises.
In this regard, the former president of the Anhui Medical Union, Shen Daming, also agreed. He believes that if it is loosely managed, it will crowd out more health insurance funds. At the national level, the total amount is controlled, and the qualifications for the production of pharmaceutical enterprises are strictly controlled. It is good for enterprises with the “Pharmaceutical Production License”, which means that “cakes” are growing, and for those enterprises that want to enter the field of Chinese medicine decoction pieces, The approval of the "Pharmaceutical Production License" has undoubtedly increased the difficulty.
Who should go in and who should avoid the discretion of the supervisor
The "Plan" also clarifies the principle of recall: the original drugs in the drug list, if they have been banned from production, sale and use by the national drug regulatory authorities, should be transferred; after the expert review, there are other requirements and conditions that do not meet the medical insurance requirements. Will be called out by program.
For such a principle, some insiders said that this would mean that the expert review team has greater discretion. In this regard, Dong Jing and Shen Daming both experts unanimously stated that the medical insurance catalogue should be transferred and recalled. Objective conditions and standards should be set up on the basis of big data to avoid the expert's habitual experience and cognitive differences, and reduce subjectively. At the same time, a supervisory group composed of the Commission for Discipline Inspection and enterprises should be established and a complaint channel should be established.
In principle, the over-the-counter drug (OTC) will not be added in this adjustment. The "Program" states that such drugs are generally not reimbursed internationally. Shen Daming said that this shows that the National Health Insurance Bureau is more cautious in the adjustment of the medical insurance catalogue, but it should be based on China's actual national conditions to formulate an over-the-counter drug (OTC) management system, completely copying foreign practices, which is obviously unscientific. . Dong Jing believes that non-prescription drugs are not reimbursed, and the nature of the drugs and the level of the disease are related. This is reasonable. The medical insurance fund should be used for major diseases, first aid and chronic diseases. However, he also said that with the increase in national GDP and people's living standards, the proportion of expenditures for health care will gradually increase, and the market prospects and potential of over-the-counter drugs are still huge.
As we all know, negotiation access is a major innovation in the way of access to medical insurance drugs in recent years. In 2017 and 2018, the medical insurance department included 36 and 17 drugs in the medical insurance drug list through negotiation. It has played a very important role in ensuring the level of personnel medication and ensuring the smooth operation of the fund. The "Program" will be divided into two types: regular access and negotiation access. Which products will be included in the regular or negotiated access? Shen Daming analyzed that the drugs included in the negotiations should be large-volume products, special products, imported products, or products with significant growth in the amount. Dong Jing predicted that cancer drugs, blood diseases and rare diseases and other therapeutic drugs and emergency rescue drugs are more likely to be included in the negotiation.
Let the medicine return to the source of treatment
According to the "Proposal", the medical insurance drug list is transferred to the relevant basic data based on the drug information approved by the State Food and Drug Administration, and the drug is reviewed. The enterprise does not accept the application or recommendation, and does not charge the evaluation fee and other various expenses.
In this regard, Shen Daming said that this reflects the fact that the medical insurance department completely avoids the factors of human interference from the perspective of patient treatment. The no-charge also highlights the purpose and fairness of the review. However, Dong Jing believes that this move has advantages and disadvantages: "profit" is more efficient, standards are relatively uniform, and avoid interference; "disadvantages" can only co-ordinate general issues, and can not take into account some special circumstances.
In any case, the adjustment of the national medical insurance catalogue is clearly welcomed by all parties. Previously, the National Medical Insurance Bureau stated that it would establish a dynamic adjustment mechanism. For pharmaceutical companies, the increasingly frequent dynamic adjustment will undoubtedly increase their research and development motivation. Some insiders also said that the adjustment will bring about a big change in the national drug use structure. Those drug companies with strong research and development capabilities and good clinical effects will surely benefit, and the auxiliary drugs with unclear clinical efficacy may face crisis.
Shen Daming concluded that the market is constantly changing, and the so-called rationality of medical insurance catalog adjustment must be dynamic. It is recommended that pharmaceutical companies do not have to pay too much attention to the frequency of adjustment, but should practice internal strength. Whether it is producers, operators, or users, we must follow the trend and plan and adjust our business direction through strategic forecasting. In short, drugs should eventually return to the root cause of treatment.