2021 National Medical Insurance Drug List Adjustment Results Announced

On December 3, the National Medical Security Administration held a press conference to announce the results of the 2021 National Medical Insurance Drug List
.
A total of 74 drugs were added to the catalog and 11 drugs were removed from the catalog
.
The total number of drugs in the National Medical Insurance Drug List in 2021 will be 2,860, which will be implemented on January 1, 2022
.
After the adjustment, the total number of drugs in the National Medical Insurance Drug List is 2,860, of which 1,486 are Western medicines and 1,374 are Chinese patent medicines
.
There are still 892 kinds of Chinese herbal medicines
.
During the adjustment, the National Medical Security Administration has always adhered to the functional positioning of "guarantee basic", regarded fund affordability as the "bottom line" that must be adhered to, and strived to meet the basic drug needs of the majority of insured persons
.
After review, 7 kinds of non-exclusive drugs outside the catalog were directly transferred, 11 kinds of drugs with low clinical value, strong substitutability, and small purchases on the national recruitment platform in recent years were transferred from the original catalog, and 117 drugs Be included in the scope of negotiations
.
From the results of the negotiation, 94 drugs (67 out of the list and 27 in the list) were negotiated successfully, with an overall success rate of 80.
34%
.
The average price of 67 drugs outside the catalogue was reduced by 61.
7%
.
The adjusted "National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Pharmacist Catalog (2021)" contains a total of 2,860 types of medicines, including 1,486 types of Western medicines and 1,374 types of Chinese patent medicines
.
There are still 892 kinds of Chinese herbal medicines in the catalogue without adjustment
.
Notice of the Ministry of Human Resources and Social Security of the National Medical Insurance Administration on Printing and Distributing the "National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug Catalog (2021)" Medical Insurance Fa [2021] No.
50 Medical Security Bureau of all provinces, autonomous regions, municipalities and Xinjiang Production and Construction Corps , Human Resources and Social Security Department (Bureau): In order to implement the decision and deployment of the Party Central Committee and the State Council, and to further improve the level of drug security for insured persons, in accordance with the "Interim Measures for the Administration of Drugs for Basic Medical Insurance" (Order No.
1 of the National Medical Security Administration) In addition to the requirements of the National Medical Insurance Drug List Adjustment Work Plan for 2021, the National Medical Insurance Bureau and the Ministry of Human Resources and Social Security organized experts to adjust and formulate the National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug List (2021) (hereinafter referred to as " 2021 Drug Catalogue), which is now to be printed and distributed, please comply with it
.
The relevant matters are notified as follows: 1.
Make timely adjustments to the scope of payment The "2021 Drug Catalog" contains a total of 2,860 types of Western medicines and proprietary Chinese medicines, including 1,486 types of Western medicines and 1,374 types of proprietary Chinese medicines
.
In addition, there are 892 kinds of Chinese medicine decoction pieces that can be paid by the fund
.
All localities must strictly implement the "2021 Drug Catalog" and are not allowed to adjust the limited payment scope and classification of drugs in the catalog
.
It is necessary to adjust the information system in a timely manner, update and improve the database, and include the drugs transferred in this adjustment into the scope of fund payment according to regulations, and the transferred drugs must be transferred out of the scope of fund payment at the same time
.
2.
Standardize payment standards During the agreement period, the negotiated drugs (hereinafter referred to as the negotiated drugs) shall implement the nationally unified medical insurance payment standards.
Each coordinating area shall determine its self-payment ratio and reimbursement ratio according to the fund's affordability, and no second bargaining shall be conducted during the agreement period
.
During the validity period of the agreement, if the negotiated drug has specifications that are not specified in the National Medical Insurance Drug Catalog and need to be included in the scope of medical insurance payment, the enterprise must apply to the National Medical Insurance Bureau.
The National Medical Insurance Bureau will determine the payment standard according to the terms of the agreement and implement it nationwide
.
During the agreement period, if there is a drug with the same generic name as the negotiated drug on the market, the direct online price of the same generic name shall not be higher than the negotiated medical insurance payment standard for the same specification
.
If the negotiated drug has the same generic name on the market or included in the centralized procurement of drugs (centralized procurement organized by the state and centralized procurement at the provincial level including inter-provincial alliances) during the agreement period, the provincial medical insurance department may follow the market Adjust the medical insurance payment standard for the drug due to competition, the price of the drug with the same generic name, or the selection result of the drug's centralized and large-scale procurement
.
"2021 Drug List" in the Medicare payment standards with "*" logo, around the health care and human resources and social security department issued a document may not open, publicly available news and propaganda published its Medicare payment standard
.
3.
Solid advancement to promote the implementation of negotiated drugs "The 2021 Drug Catalog" will be officially implemented on January 1, 2022
.
The "Notice of the National Medical Insurance Administration and the Ministry of Human Resources and Social Security on Printing and Distributing the National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug Catalog" (Medical Insurance Fa [2020] No.
53) shall be repealed simultaneously on January 1, 2022
.
All provinces (autonomous regions, municipalities directly under the Central Government) drug centralized procurement agencies shall directly purchase the negotiated drugs on the provincial centralized drug procurement platform before the end of December 2021
.
Local medical insurance departments shall, in conjunction with relevant departments, instruct designated medical institutions to rationally allocate and use drugs in the catalog, and make reasonable adjustments to their annual total amount based on the actual use of drugs in medical institutions
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It is necessary to strengthen the management of medical insurance designated medical institutions, work-related injury insurance agreement medical institutions, and work-related injury rehabilitation agreement institutions, incorporate the reasonable deployment of medical institutions and use the negotiated drugs in the "2021 Drug Catalog" into the content of the agreement, and actively promote the implementation of the new version of the catalog
.
Provincial-level medical insurance departments shall follow the "Guiding Opinions on Establishing and Improving the "Dual Channel" Management Mechanism for National Medical Insurance Negotiation Drugs" (Yibaofa [2021] No.
28) and "Regarding the Normalization of National Medical Insurance Negotiations and Continue to Do a Good Job in the Implementation of Negotiated Drugs" The “Notice” (Medical Insurance Letter [2021] No.
182) requires that, in light of the situation of the province, timely update the province’s list of drugs included in the “dual-channel” management, strengthen the management of “dual-channel” pharmacies, and effectively improve the supply guarantee level of negotiated drugs
.
Continue to improve the monitoring mechanism for the implementation of negotiated drugs, and regularly report to the National Medical Insurance Bureau on the use and payment of negotiated drugs in the "2021 Drug Catalog" as required
.
4.
Complete the digestion task on time.
The provincial medical insurance department should speed up the digestion of the original self-added varieties to ensure that all digestion tasks are completed before June 30, 2022
.
At the same time, do a good job in policy publicity and interpretation, and rationally guide public opinion
.
5.
Standardize the management of ethnic medicines, preparations of medical institutions, prepared pieces of traditional Chinese medicines and granules of traditional Chinese medicines.
The provincial medical insurance department shall, in accordance with the requirements of the "Interim Measures for the Administration of Basic Medical Insurance Medications", improve procedures, refine standards, and make scientific calculations to ensure compliance with clinical requirements, Medicines with reasonable prices and definite curative effects are included in the scope of medical insurance payment
.
Where conditions permit, medical insurance payment standards can be determined simultaneously
.
It is necessary to establish a dynamic adjustment mechanism to transfer drugs that do not meet the requirements out of the payment scope in a timely manner
.
During the implementation of the "2021 Drug Catalog", any major issues should be reported to the National Medical Insurance Bureau and the Ministry of Human Resources and Social Security in a timely manner
.
Attachment: National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug List (2021) 1.
General Regulations 2.
Western Medicine Part 3.
Traditional Chinese Medicine Part 4.
Drugs Part 5 Negotiated During the Agreement Period 5.
Policy Interpretation of Traditional Chinese Medicine Decoction Pieces Part 1.
Country in 2021 The general idea and goal of the adjustment of the medical insurance drug catalogue? Carry out the spirit of the important instructions of General Secretary Jinping, do your best and do what you can, and build the improvement of social security on the basis of sustainable economic and financial growth
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This adjustment has always adhered to the functional positioning of "guarantee basics", strived to better meet the basic drug needs of the majority of insured persons, and continued to adhere to the adjustment ideas of "highlighting key points, filling shortcomings, optimizing structure, and encouraging innovation"
.
Give full play to system advantages, policy advantages, and market advantages, release reform dividends, strive to achieve a more optimized drug catalog structure, more efficient use of medical insurance funds, and a higher level of basic medical insurance drug protection capabilities and levels to help solve the people’s worries about medical treatment and improve The sense of gain of the broad masses of people
.
2.
How does this adjustment reflect the functional positioning of "basic preservation"? First, in the adjustment process, we will always consider the current level of China's economic and social development, medical insurance funds, and the affordability of insured personnel, and resolutely prevent "expensive drugs" from entering the catalog, and ensure that the negotiated payment standards meet the "basic guarantee" positioning
.
The second is to keep a close eye on the clinical rational use of drugs, and strive to make up for the shortcomings of basic drug protection, more "sending charcoal in the snow" and less "icing on the cake"
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The third is to free up fund space by guiding moderate competition for drugs in the same therapeutic field and further reducing the prices of drugs in the catalog, so as to promote the realization of the upgrade of basic drug security
.
3.
What are the considerations for this adjustment of the setting of drug declaration conditions outside the catalogue? The main consideration is set outside Drug catalog reporting conditions: First, to better meet the clinical needs, such as the new crown pneumonia drug treatment, medicines and other indications of change occurs
.
The second is to better link up with new drug approval work, to achieve a "seamless connection" between drug approval and medical insurance review, and to reflect the orientation of encouraging innovation, such as newly launched drugs in recent years
.
The third is to link up with relevant drug management policies, considering that essential drugs are widely deployed and used in primary medical institutions, and to ensure the continuity and accessibility of clinical drugs, all national essential drugs are included in the scope of adjustment
.
4.
What is the negotiation success rate and price reduction rate for this adjustment? What are the areas of drug treatment that have been successfully negotiated? In this adjustment, a total of 117 drugs were negotiated, 94 of which were successfully negotiated, and the overall success rate was 80.
34%
.
Among them, 85 exclusive drugs out of the catalog were negotiated into 67, with a success rate of 78.
82% and an average price reduction of 61.
71%.

.
The 74 new drugs outside the catalog involve 21 clinical groups, including 20 drugs for chronic diseases such as hypertension, diabetes, hyperlipidemia, and psychosis, 18 drugs for tumors, 15 drugs for hepatitis C and AIDS, and 7 drugs for rare diseases.
There are two kinds of drugs for the treatment of new coronary pneumonia, and 12 kinds of drugs for other fields, and patients benefit from a wide range
.
5.
There are 11 kinds of drugs in the catalog.
Will it affect the drugs used for the treatment of related diseases? After expert review, a total of 11 drugs have been brought out of the catalog, all of which have low clinical value and are replaceable, or have been purchased in small quantities on the national recruitment platform in recent years
.
The transfer of these drugs has been carefully and rigorously demonstrated by experts and determined according to procedures
.
During the review process, experts regard substitutability as an important indicator, and the drugs that are called out have drugs with equivalent or better efficacy in the catalog for replacement
.
At the same time, the release of these drugs has made room for more new and good drugs to be included in the catalog
.
6.
What is the impact of this adjustment on the medical insurance fund and patient burden? By transferring drugs or lowering the prices of drugs in the catalog, a certain amount of space can be made for the fund
.
In this year's adjustment process, we strictly grasp the economics of medicines.
According to preliminary calculations, the additional fund expenditures for 74 new medicines are expected to increase in 2022, which is basically equivalent to the fund space vacated by the price reduction of drugs in the catalog
.
Therefore, on the whole, there will be no significant increase in fund expenditures in the near future
.
From the perspective of patient burden, compared with the original market price, through negotiation of price reduction and medical insurance reimbursement, this negotiation is expected to reduce the burden of patients by more than 30 billion yuan in 2022
.
7.
What are the innovations in this adjustment? In order to further enhance the scientificity, transparency and standardization of the catalogue adjustment work, we maintain continuous improvement of relevant technical details and work processes
.
The first is to improve the scientific nature.
Based on the extensive solicitation of opinions from experts and enterprises, the expert review index system and scoring rules have been formulated and improved to promote the review work "from subjective to objective"
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The second is to increase transparency, declare drug-related information to the public for the first time, and actively accept supervision from all walks of life
.
Through linkage with relevant departments, verify the authenticity of the information submitted by the company, expand the sources of expert review information, and improve the objectivity of the review
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The third is to strengthen standardization, improve pharmacoeconomics and medical insurance fund measurement rules, and provide technical support for the scientific and standardization of pharmaceutical economics and fund measurement
.
A number of medical experts have conducted "back-to-back" calculations on the same drug according to the calculation guidelines to improve the accuracy and fairness of the calculation results
.
The fourth is to highlight the application of informatization.
For the first time, the electronic information system for enterprise application and expert review and scoring was developed, which effectively improved the efficiency of drug catalogue adjustment
.
8.
When will the new version of the National Medical Insurance Drug List be implemented? The "Notice" requires that the new version of the National Medical Insurance Drug List will be officially implemented on January 1, 2022
.
At present, medical insurance departments in various regions are intensively carrying out information system adjustments, policy linkages, and personnel training, and strive to negotiate the implementation of drugs as soon as possible
.
9.
What measures does the National Medical Insurance Bureau plan to take to promote the implementation of the new version of the catalog? In order to promote the new version of the catalog to benefit the people as soon as possible, one is to implement measures such as directly linking the negotiated drugs to the Internet to ensure that the negotiated drugs are adjusted according to the agreement on the payment standard
.
The second is to guide designated medical institutions to strengthen linkages, and according to clinical treatment needs, timely add new drugs, especially negotiated drugs, to the institution's list of equipment to improve the level of drug protection
.
The third is to guide all localities to implement the "dual-channel" management mechanism, and increase the availability of negotiated drugs through channels such as designated retail pharmacies
.