More than 20 western medicines are used to properly kill the drug list.

The first batch of national key monitoring and rational drug list was announced on July 1. 20 varieties including ganglioside and oxiracetam were included, involving 470 drug batches of 176 enterprises, with a total market size of about 50 billion yuan.
The catalogue announced this time echoes a notice from the National Health and Health Commission six months ago. On December 12, 2018, the National Health and Health Commission issued a letter requesting that each of the two or more medical institutions must report no less than 20 auxiliary drug varieties, and after being summed up by the provinces, they will report to the National Health and Health Commission before December 31. To publish a national catalogue of auxiliary medicines.
After half a year of negotiations, a catalogue of medications involving 20 varieties was finally released. However, contrary to market expectations, the catalogue name has been changed from “assisted medication” to “reasonable medication”. What is more unexpected is that none of the traditional Chinese medicines that were previously considered to be strictly controlled by the drug use were included in the catalogue.
At the end of last year, the National Health and Health Commission’s “collection order” was always interpreted by the market as a “decapitation action” for auxiliary Chinese patent medicines. This is because all kinds of traditional Chinese medicine injections have long occupied the head of hospital prescriptions. They are the main products of many domestic pharmaceutical companies and “cash cows”. They are also “l(fā)arge consumers” of local medical insurance funds, and they are repeatedly banned drug rebates. The hardest hit. However, the first batch of catalogues announced this time, not to mention the name of "assisted medication", nor the list of proprietary Chinese medicines, why?
From auxiliary medication to rational medication, the definition is more scientific
What is ancillary medication? The more consistent view in the industry is that the lack of evidence-based medical evidence is widely questioned, and the sales of gold are more common, which boosts the growth of medical expenses for patients, resulting in unreasonable expenditures for medical insurance funds. However, due to the wide range of clinical applications and the large number of pharmaceutical companies involved, adjuvant medicine has always been regarded as one of the most difficult hard bones in the deep water area.
The idea of a national drug list has been around for a long time. On the one hand, the government hopes to control the reimbursement share of auxiliary drugs in medical insurance and reduce unreasonable expenditures; on the other hand, in the context of medical reform, the government requires that medicines be separated and the proportion of medicines reduced, and auxiliary medicines must be the focus of reduction.
Despite the fact that the division is well-known, the industry has been controversial about whether to develop a list of supplementary medications. The biggest controversy is what kind of medicine is an auxiliary medication. "Auxiliary medications are not as well defined as medical consumables. I don't think it is possible to accurately identify which drugs are auxiliary medications." A general surgeon at a large public hospital in Shanghai told the author.
In fact, such cockroaches have long appeared in various places. After the National Health and Health Commission issued a notice to clarify that it is necessary to establish a national auxiliary drug list as soon as possible, the definitions of “assisted drug use” are different in many provinces and municipalities that responded to the issue.
Fujian Province, which is the most devastating of the “killing” of supplementary drugs, has already mentioned in the relevant regulations issued in February 2017: Auxiliary drugs refer to the “auxiliary treatment” clearly stated in the drug label, or issued by the relevant state departments. The clinical guidelines, the drugs mentioned in the expert consensus for adjuvant therapy.
The Xinjiang Health and Health Commission stated in the "Notice" issued in December 2018 that adjuvant medication refers to a drug that clearly plays a supporting role in the role of a disease in the instructions or clinical diagnostic guidelines. The use of this drug alone can not achieve the purpose of treating the disease.
Until May 31 this year, the National Health and Health Commission issued the "National Three-Level Public Hospital Performance Appraisal Operation Manual (2019 version)", after the official prescription of the auxiliary drugs, "help to increase the role of the main therapeutic drugs. , or a drug that affects the absorption, mechanism of action, or metabolism of a major therapeutic agent to increase its efficacy; or a drug that contributes to the prevention and treatment of a disease or dysfunction based on conventional treatment of the disease."
Even so, because the different drugs have different effects in different clinical applications, the above conclusions still cannot give a clear definition of "auxiliary drugs." For example, the immunomodulatory drug thymosin is considered an adjuvant in general hospitals in many places, but it is a therapeutic drug in cancer hospitals. In the complicated medical application scenarios, such examples are numerous.
“This means that if you rush to include a certain class of drugs in the auxiliary drug list, it is likely to trigger a series of chain reactions. The most serious consequence is that such drugs are discontinued and delisted.” An unnamed drug The person in charge of the enterprise told the author that “the stigma of auxiliary drugs has been in existence for a long time, and this possibility exists completely.”
Fortunately, the 20 kinds of drugs listed in this catalogue were not listed as “auxiliary drugs” and were collectively referred to as “national key monitoring and rational drug use drugs”. Guo Yunpei, president of the China Pharmaceutical Enterprise Management Association, greatly appreciated this. He believes that the change in the name of the catalogue is a major step forward.
"This is two concepts. Originally we called the auxiliary drug list, and the pharmaceutical company was monitored. Now it is called the rational drug list. The eyes of the monitoring have been seen from the enterprise to the hospital, from the pharmaceutical sales staff of the enterprise to the doctor. That pen, don't open the medicine, don't open a big prescription, this is a big improvement."
Is it a good idea to keep a handful of Chinese medicine?
Why did Chinese patent medicines not appear in the first batch of key monitoring and rational use of drugs?
In February of this year, a pre-selected version of the National Auxiliary Drugs List was published on the Internet, involving a total of 73 varieties. The Chinese medicines category is absolutely dominant, and the Chinese medicine injections are the most.
The authors have found that the traditional Chinese medicine injections included in the preliminary selection catalogue are mainly for cardiovascular and cerebrovascular drugs and tumors, and other auxiliary drugs are mainly for immunomodulation, neurotrophic agents, and cardiovascular and cerebrovascular drugs. In particular, Chinese medicine for promoting blood circulation and removing blood stasis accounts for six of the top ten auxiliary drugs.
Due to the strong public relations ability of the market, these drugs are listed in the forefront of the sales list all year round. They are called "Chinese medicine" and are the main problem of medical insurance control fees. Varieties such as injection thrombus, Danhong injection, and Xiyanping injection are monopolized by a single pharmaceutical company, and annual sales are billions of dollars. According to the statistics of the medical think tanks in the past, the amount of "Chinese herbal medicine" wasted up to 960 billion yuan per year.
"Either from clinical efficacy or sales data, these drugs should go into the regulatory directory. But in fact, the country has just published a catalogue that does not involve any Chinese medicine products. Our understanding is that the country is merciless. "The head of a pharmaceutical company said.
In this regard, Guo Yunpei, president of the China Pharmaceutical Enterprise Management Association, has different views. "We have been calling for not to directly sentence Chinese medicine to death. All medicines of Chinese medicine, its construction principle, the most basic is called cure. The treatment of illness is to start from prevention, it is to go to the doctor; Treatment is Chinese medicine and lower medicine. If you follow the practice of the upper doctor, it is all auxiliary medicine, so this is extremely unscientific."
It is worth noting that even if it is not in the catalogue, the document supplements the Chinese medicine category from the perspective of doctors. The document is clear that for doctors outside the Chinese medicine category, it is necessary to go through the systematic study of Chinese medicine expertise for at least one year, and only after passing the examination, can the Chinese medicine prescription be issued; and if the prescription for Chinese medicine is to be prescribed, the conditions are stricter. Harsh.
The power of this rule needs to be combined with other data to appear. By the end of 2017, there were 527,000 practitioners in the Chinese medicine category, accounting for only 15% of the total number of practicing doctors nationwide. According to previous media reports, about 70% of proprietary Chinese medicines are prescribed by Western medicine. This also means that if it is to be strictly enforced, the prescriptions for proprietary Chinese medicines in most hospitals will not be available for at least one year.
Perhaps the above-mentioned restraint means of catching the doctor's source of medicine is more lethal to the market of Chinese medicine-based auxiliary drugs than placing the specific Chinese medicines directly on the monitoring list. What's more, the first batch of catalogues were not included in proprietary Chinese medicines, and the second and third batches of catalogues are likely to be imported into proprietary Chinese medicines.
Both catalogues have different emphasis
A list of complementary medications is bound to provide a reference for the national health insurance catalogue that will be dynamically adjusted this year. For all related pharmaceutical companies, this is the real killing trick.
The National Health Insurance Catalogue was officially released in 2000. It has been adjusted three times in 2004, 2009 and 2017. Each adjustment will guide the formulation of medical insurance catalogues in various provinces and cities, which will directly affect the survival of pharmaceutical companies.
The authors have found that the 20 varieties that have been included in the national key monitoring and rational drug list are basically in the national or local medical insurance catalogue. For example, gangliosides with annual sales of tens of billions of dollars have been included in the medical insurance catalogue in 17 provinces because of the wide range of indications. The calf blood deproteinized extract is also suitable for a variety of symptoms and has been included in the medical insurance catalogue in 28 provinces across the country. There are also brain protein hydrolysates in the medical insurance catalogues of 27 provinces across the country.
These drugs generally have problems of inaccurate efficacy and serious adverse reactions, but because of the medical insurance, sales are hot, it is a frequent visitor in the key drug monitoring catalogues.
"First out of the auxiliary medication list, and then adjust the medical insurance catalog, this process is set by the top management, the intention is already very obvious. The country is determined this time, to treat all treatments with no effect or no economic advantage. Controlled, this piece is probably a waste of 30% of Medicare payments. This payment will be saved and left for meaningful major disease medications, such as tumors." A person close to the core of policy development told the author.
This argument is not groundless. Previously, several documents have indicated the thinking of the National Health Insurance Bureau: priority is given to the treatment of major diseases such as national essential drugs, cancer and rare diseases, chronic diseases, children's drugs, and emergency rescue drugs, etc., and continue to highlight the status of clinically needed drugs.
In March of this year, the State Medical Insurance Bureau issued the "2019 National Health Insurance Drug Catalogue Adjustment Work Plan (Draft for Comment)", which clarified the adjustment rules and negotiation routes. Hu Jinglin, director of the National Medical Insurance Bureau, said at the National "Two Sessions" this year: The medical insurance fund must not be made a new "Tang Yu meat." Catalogue adjustments cannot be made only. For those drugs that have been strictly reviewed by experts and are not qualified, they must be removed from the catalogue.
What is more practical is that many places in China have already implemented the "strictly controlled auxiliary drugs into medical insurance".
In Sanming City, Fujian Province, which is famous for its “medical reform”, the first knife is the auxiliary medicine. By kicking out the supplementary medication and paying for medical insurance, Sanming City saved 200 million yuan of medical insurance funds in the same year to improve doctors' salaries and rationalize the reform ideas.
Under the impetus of “Sanming Experience”, in 2017, Fujian Medical Insurance Office set the medical insurance settlement price of common drugs such as Danshen, Xueshuantong and Xuesaitong and the common varieties in the key monitoring list to only 50% of the highest sales price of medical insurance. The medical insurance settlement price of Xiangdan injection and Danshen injection (freeze-dried) is zero, which is equivalent to no reimbursement.
In 2018, the medical insurance payment standard formulated by the Anhui Provincial People's Social Welfare Department was outflowed. It is recommended that the varieties in the “Key Laboratory of Key Monitoring Drugs in Anhui Province” (key monitoring category B) be included. The payment standard can be included in the policy scope to compensate the expenses according to the coefficient of 0.5. Subsequently, Jiangsu Province also quickly followed up, clearly identifying drugs that are mainly used as ancillary treatment or easy to abuse, should appropriately increase the proportion of personal self-pay, open the proportion of payment with other Class B drugs, and establish a dynamic adjustment mechanism.
What about pharmaceutical companies?
Policy pressures have already spread to the market.
China Resources Sanjiu 2018 mid-year report shows that the company is adjusting the structure of prescription drugs and gradually extending to both health and rehabilitation. At present, the sales of traditional Chinese medicine injection products accounted for 8% of the company's total revenue.
The situation of the Livzon Group is even more severe. Its main variety, Shenqi Fuzheng Injection, has been listed as an auxiliary drug. In the middle of 2018, the drug's revenue decreased by 34% from the same period last year. In the third quarter, sales fell to 36%.
Jiuzhitang also disclosed in the 2018 performance forecast that the company’s prescription drug sales fell sharply due to the impact of policies including the use of drugs in the provinces, which had a significant impact on profits.
In the wind and the market, Liu Yuehua, an associate researcher at the Health Technology Evaluation Center of the National Health and Wellness Research Center of the National Health and Health Research Center, gave his suggestion. "Two ways out, one is to quickly make evidence, and to make money from the past." I clearly understand that I will go out and make a re-evaluation through evidence-based medicine to make up the debts. Second, I will hold the thighs and hold the thighs for treatment. As long as I can solve the complications caused by these treatments, I believe there will be opportunities."
In this regard, Shanghai Pharmaceutical President Zuo Min quite agree. As a manufacturer of auxiliary drugs, Zuo Yan admits that he does not care about the company's drugs into the catalog. He believes that as long as the pharmacological mechanism can be clearly stated, the market will give a positive response. "We have a drug called Muxiang Baoxin Pills. It took 8 years to invest more than 1 billion and did more than 2,700 randomized double-blind trials. This drug sold 2 billion last year. No hospital has proposed this time. I will put it into the auxiliary medicine. Basically, I also agree to engage in this catalogue, which will force our company to take some curative effects and re-evaluate it to become a first-line medication."
"Our goal is always to rationally use drugs, to squeeze out the unreasonable ingredients of this cost, to save the cost, to adjust the price of medical services, to reform the salary system, to mobilize the enthusiasm of medical staff. At the same time, to reduce the people The burden of medication, the national medical insurance funds are also guaranteed to be used in the blade." Jiao Yahui, deputy director of the Medical and Health Administration of the National Health and Wellness Commission concluded.