20 provinces announce the adjustment plan of medical insurance catalogue

Source: according to the preliminary statistics of the reporter of the economic reference newspaper 2017-08-29, there are 20 provinces, districts and cities in China that have published the new version of the adjustment scheme of the medical insurance catalogue or implemented the national version of the medical insurance scheme Among the 20 provinces, regions and cities, Shanxi, Qinghai, Ningxia, Hubei, Sichuan, Guizhou, Hainan, Beijing, Hunan, Shaanxi, Jilin, Shandong and other 12 regions have issued supplementary adjustment plans; among the seven regions, Jilin, Anhui, Jiangsu, Liaoning, Henan, Xinjiang, Fujian and other seven regions, except for Fujian, the other six regions are clear, and the empty window before the new version of the catalog comes out Period, the national version of the directory and the old version of the directory One region (Guangdong) answered the questions related to the supplement of medical insurance After the introduction of the national health insurance catalogue, the supplement of the provincial health insurance catalogue is the biggest imagination left to medical enterprises and patients According to the regulations, each province adjusts its authority to 15% of the national class B drugs Industry insiders said that for the provinces that announced the supplementary plan, the transfer in of the provincial drug catalog generally focused on the existing varieties in the previous version of the province's medical insurance catalog, while the transfer out of the drug catalog mainly considered the existence of safety problems, not suitable for clinical needs, nutritious drugs, etc However, there are also differences in the number of supplements and ideas among different regions For example, the Beijing plan puts forward that "in principle, the varieties of drugs in the reimbursement scope of the current 2010 version of the drug catalog in this city should be retained" In the previous national negotiations on medical insurance drug access, 36 of the 44 varieties that entered the drug price negotiations were successfully shortlisted and 8 were out According to the regulations of the Ministry of social security, the competent social insurance departments of each province (District, city) shall not transfer the negotiated drugs out of the medical insurance catalogue or adjust the limited payment scope However, prior to the announcement of the negotiation results, some provinces have issued the supplementary scheme or draft for comments on the medical insurance catalog, so the implementation results of the successful varieties of the negotiation will be published in succession The formal version of the plan for adjusting the medical insurance catalogue published by Jilin Province deleted the item "drugs that are not negotiated and agreed by the Ministry of human resources and social security when the state organizes drug negotiations" in the previous draft for comments The insiders believe that this means that the drugs that fail in the national negotiations are expected to enter the local medical insurance However, for the eight varieties that failed in the national drug price negotiation, Qinghai, Shanxi, Hainan, Jilin and Hubei provinces have made it clear that they will not be considered when they are supplemented at the provincial level, that is, the drugs that have not been successfully negotiated with the Ministry of human resources and social security will not be included in the list of local supplements At the same time, many provinces have made clear the medical insurance payment standard of drugs in drug price negotiation For example, Henan Province has made it clear that all new class B drugs including 36 national negotiated varieties are included in Henan Medical Insurance, and has determined that the proportion of personal self payment for these 36 varieties is 20%, which is the first province in China to make clear the proportion of national negotiated drugs Recently, Xinjiang has also included the national negotiated drugs in the payment scope of medical insurance, all of which are paid according to class B drugs Changqing, deputy director of the medical insurance office of the people's Hospital of Xinjiang Uygur Autonomous Region, introduced that taking the trastuzumab (Herceptin) for breast cancer as an example, before, the average price of a 440mg trastuzumab was 24500 yuan, and at least 14 trastuzumabs needed to be injected in a treatment cycle for breast cancer patients, all of which were paid by themselves After the drug price negotiation was successful and included in the medical insurance, the payment standard was determined to be 7600 yuan, and the cost of a treatment cycle was reduced from more than 343000 yuan to more than 106000 yuan, which will be reimbursed according to a certain proportion of medical insurance payment For example, the highest reimbursement proportion of class B drugs for medical insurance of Urumqi employees is 90%, so the original cost was more than 340000 yuan, and now the patients only need to spend more than 10000 yuan Experts believe that the new version of the drug catalog reflects the policy thinking of "filling the gaps, selecting the best, supporting innovation and encouraging competition", and gives priority consideration and support to the drugs for work-related injury insurance, children's medicine, innovative medicine, treatment of major diseases and ethnic medicine The new version of the drug catalog has significantly expanded the scope of drug use guarantee of basic medical insurance, improved the level of drug use guarantee, helped to reduce the burden of drug costs outside the catalog for the majority of insured personnel, helped to support the progress of clinical drug use technology, and also helped to promote the innovation and development of China's pharmaceutical industry Experts interviewed by the economic reference said that the adjustment of the new medical insurance catalogue is undoubtedly a major policy trend for pharmaceutical enterprises Some pharmaceutical enterprises' products can enter the medical insurance catalogue, which will bring benefits to pharmaceutical enterprises to a certain extent However, in recent years, the expansion capacity of the medical insurance catalog is huge, but the medical insurance fund is limited, and the catalog can not be expanded indefinitely The contradiction between a large number of drugs that need to be supplemented and the limited adjustment quota is the biggest difficulty for all regions to carry out catalog adjustment In addition, the next step of dynamic adjustment of medical insurance catalog will become a reality The three versions of the 2017 version of the medical insurance catalog were adjusted and released in 2000, 2004 and 2009 respectively The adjustment lasted for 8 years, with a long period In this regard, the relevant person in charge of the Ministry of human resources and social security said that the next step would be to speed up the negotiation of drug access, guide the human resources and social sectors of all provinces (regions, cities) to adjust class B drugs; on the other hand, it would start to study and improve the management methods of medical insurance drug use, establish a normal and dynamic medical insurance drug access mechanism, and do a good job in the organic aspects of directory access, payment standards, use management, etc Link up, gradually realize the whole process management of medical insurance medication, so that the scope of security can adapt to clinical medication practice and medical technology progress, while providing better security for the majority of insured personnel, further play the role of medical insurance in supporting innovation and promoting development.