Recently, the 2019 version of the national medical insurance catalogue was unveiled, and some 'magic drugs' were removed from the new version of the national catalogue. A total of 150 varieties have been transferred out of the medical insurance catalogue, of which about half are drugs whose document number has been revoked by the State Drug Administration, and the remaining 79 varieties are mainly drugs with low clinical value, obvious abuse and better substitution.
'medical insurance fund space is changing from & lsquo; Divine Medicine & rsquo; This part can be given innovative drugs, so that more patients can use new anti-tumor drugs that are urgently needed and have definite curative effects. " On August 21, a person in charge of a listed pharmaceutical enterprise told the 21st Century Business Herald reporter.
Xiong Xianjun, director of the medical service management department of the state medical insurance administration, said that considering the regular growth of the medical insurance fund, as well as the reform of "4 + 7" bidding and procurement, the reform of payment method and the varieties transferred out of this catalog adjustment, the State Medical Security Administration will take out a certain amount of fund to negotiate drugs under the condition of ensuring the safety of the fund, Strive to negotiate as many varieties as possible, so that the masses can enjoy the dividends of reform as much as possible.
At the same time, the National Medical Insurance Bureau has explicitly cancelled the local supplement authority of the medical insurance catalogue, requiring all localities not to formulate the catalogue or increase the drugs in the catalogue by flexible methods, nor to adjust the limited payment scope of the drugs in the catalogue. In this regard, Guojin Securities believes that this is the performance of the national medical insurance bureau to further strengthen the overall management.
Catalog adjustment
After the establishment of the National Medical Insurance Bureau, the medical insurance catalogue has been comprehensively adjusted for the first time, and it is also the first comprehensive combing of the catalogue varieties since the release of the first version of the medical insurance catalogue in 2000.
In the new catalogue, there are 150 varieties and 148 transferred varieties. Although the total quantity of drugs has not changed a lot, the structure of drugs has changed greatly.
Xiong Xianjun said that the adjustment of the medical insurance catalogue adheres to "optimizing the structure and entering and leaving", adding drugs with accurate curative effect and reasonable price; Drugs with low clinical value and better substitutes were transferred out. It is particularly noteworthy that more than 20 drug varieties that were just listed in the key monitoring list by the National Health Commission last month have been pulled out of the directory this time.
It is reported that the relevant experts involved in the catalogue adjustment, after focusing on the first batch of national key monitored rational drug use catalogue released by the National Health Commission in July, unanimously decided to transfer all these key monitored drugs out of the medical insurance catalogue after special demonstration.
On July 1 this year, the general office of the National Health Commission and the office of the State Administration of traditional Chinese medicine jointly issued a notice announcing the list of the first batch of rational drug use drugs under national key monitoring. There are 20 kinds of drugs, all of which are biological and chemical agents. Among them, 12 varieties belong to neuroprotective agents, 3 belong to cytoprotective agents, 3 are immune modulators, and energy supplements.
According to the intranet database, the total sales of these 20 varieties in China's public hospitals in 2018 reached 65.282 billion yuan, involving more than 170 enterprises, including Fosun medicine, Shuanglu pharmaceutical, Lizhu group and other listed companies. This also includes gangliosides recently exposed to paralyze many patients.
At the same time, some drugs with definite curative effect and reasonable price have been added to the new drug catalogue. The new drugs cover the national essential drugs, drugs for the treatment of major diseases such as cancer and rare diseases, drugs for chronic diseases, drugs for children, etc.
Among them, Novo Nord diabetes drug de Gu insulin was also included in the national health insurance directory. In this regard, Zhou Xiaping, global senior vice president and President of Greater China of Novo Nordisk, said that the access of this excellent long-term insulin to medical insurance can benefit more Chinese patients. The state has taken a series of positive measures to promote Chinese patients to use innovative drugs as soon as possible, from accelerating drug registration to timely adjustment of the medical insurance catalogue, These favorable policies have further enhanced the confidence of innovative pharmaceutical enterprises.
A person in charge of a multinational pharmaceutical company told the 21st Century Business Herald reporter that by sniping 'Divine medicine', replacing high priced original research drugs or reducing the price of original research drugs, it will free up $20 billion to $30 billion for the medical insurance fund, and patients can better benefit from innovative drugs.
In fact, in order to enter the national medical insurance catalogue, many pharmaceutical enterprises have reduced prices before adjustment to strive for the last fight. In April 2019, Roche took the initiative to down regulate yamero for the treatment of rheumatoid arthritis and systemic juvenile idiopathic arthritis in Liaoning and Hubei, from 1923 yuan / box to 830 yuan / box, a decrease of 56.8%.
In May 2019, the global "drug king" xiumeile also took the initiative to reduce the price in Jiangxi, Beijing and other places, from 7600 yuan / piece to 3600 yuan / piece; In July 2019, Lilly also decided to reduce the price of its classic antitumor drug pemetrexed disodium for injection by about 30% nationwide; Hengrui pharmaceutical has adjusted the price of aido, an innovative drug that will only be listed in 2019, from 6800 yuan to 3680 yuan per bottle, with a price reduction rate of 45.9%. Lenalidomide of Qilu pharmaceutical has reduced its price for many times. At present, it has dropped to 3980 yuan, only 1 / 5 of the original drug.
Block the local port
In order to better coordinate, the National Medical Insurance Bureau has explicitly cancelled the local supplementary authority of the medical insurance Catalogue: all localities shall not formulate the catalogue or increase the drugs in the catalogue by flexible methods, nor adjust the limited payment scope of the drugs in the catalogue. Class B drugs added according to regulations in the original provincial drug catalogue shall be gradually digested within 3 years. In the process of digestion, all provinces should give priority to adjusting the drugs included in the national key monitoring scope out of the scope of payment.
This means that for some drugs that fail to enter the national medical insurance catalogue, including many new drugs, pharmaceutical enterprises hope to enter the local catalogue through negotiations with local medical insurance departments. This road will be blocked, which also means blocking the mouth of local relevant interests.
Previously, in the process of adjusting the national medical insurance catalogue, all provinces had 15% adjustment (transfer in and transfer out) authority for class B drugs in the medical insurance catalogue, and all provincial capitals transferred the varieties of drugs widely used by medical institutions in the province with 'reasonable prices' into the catalogue. Because of the differences in the overall planning ability of local medical insurance funds, the previous medical insurance catalogue gave provinces, regions and cities a certain range of independent adjustment rights, so as to better meet the medical security needs of local patients.
In 2009, at the beginning of the establishment of the essential drug system, provincial additions were also allowed. When the catalogue was adjusted again in 2012, provincial additions were no longer encouraged. Zeng Yixin, deputy director of the National Health Commission, once pointed out: "allowing local governments to supplement drugs is a transitional measure in the early stage of system construction."
During this period, some rent-seeking problems also occurred, because entering the national medical insurance directory is equal to sales guarantee. A pharmaceutical agent told the 21st Century Business Herald reporter that in the previous popular corruption case of basic drugs in a province, some enterprises spent money to buy additional quota of basic drugs, which is actually the protection of local varieties and is not conducive to fair competition in the market.
An executive of a drug sales enterprise pointed out that for a long time, local medical insurance supplement is easy to overhead the national medical insurance directory. Local medical insurance supplement tends to protect local enterprises, and the winning price will be higher than the national medical insurance, which leads to excessive expenditure of national medical insurance funds. More than 2 / 3 of the first batch of 20 varieties in the catalogue of drugs for rational drug use under national key monitoring belong to the local supplementary catalogue.
"The fundamental purpose of canceling local supplements is to control fees, which has a common direction with the national key monitoring catalogue, the provincial key monitoring catalogue, paying by disease, and restricting the prescription right of Chinese patent medicine of Western medicine." The above executives pointed out.