A new round of medical insurance negotiations is imminent, 19 rare disease drugs have passed the preliminary review, can the bargain be successful?

【Pharmaceutical Network Market Analysis】The number of patients with rare causes is small, the R&D costs of pharmaceutical companies are high, and many rare disease drugs produced are "sky-high drugs", which brings a heavy cost burden
to the majority of patients and patients' families.
At the end of 2021, the medical insurance negotiation cut the rare disease drug of up to 700,000 yuan a shot to more than 30,000 through soul bargaining, and was included in the medical insurance catalog, and after proportional reimbursement, the individual patient only needs to pay a few thousand yuan or even less, making the patient feel hope
.
Up to now, 2,860 kinds of drugs in China have entered the national medical insurance catalog, and 67% of the listed drugs for rare diseases in China are among them
.
At present, a new round of medical insurance negotiations in 2022 is imminent, and 19 rare disease drugs have passed the preliminary review list, including Novartis' ofatumumab, Roche's lipolan, Takeda's ranalilumab, etc.
, and whether these drugs can be successfully negotiated has attracted much attention from
patients.
Some analysts believe that these 19 rare disease drugs that have passed the preliminary examination have been included in the national encouragement list, so it is very
likely to be included in the medical insurance directory.
However, before the start of a new round of price negotiations, on October 12, the National Health Insurance Bureau responded to the relevant recommendation: a small number of particularly expensive rare disease drugs obviously exceed the basic medical insurance protection level, and cannot be included in the scope of
medical insurance payment.
Nor does it support local governments to explore the guarantee mechanism
for high-value rare disease drugs alone.
This also means that some particularly expensive drugs for rare diseases cannot be included in medical insurance coverage if the price cannot be negotiated in the medical insurance negotiation
.
It is understood that the cost of drugs for most rare diseases cannot exceed 300,000 yuan a year, otherwise it is difficult to have the hope
of medical insurance.
In order to improve the success rate of entering medical insurance, many rare disease drug companies have actively reduced prices, both domestic and multinational pharmaceutical companies
.
For example, in June this year, when the national medical insurance catalogue adjustment plan was still in the consultation stage, many pharmaceutical companies such as Roche, Zai Lab, and AbbVie first cut prices
.
As of August this year, Zai Lab's repatinib (30 tablets) has voluntarily decreased by 60%, from the original annual cost of treatment of 1.
198 million to 479,000.

Roche also lowered the price of rispolan (60mg), and the price of the product in Shandong has been reduced to 14,500 per bottle, and the annual cost of treatment has dropped to 450,000.

AbbVie is also in action
.
In June this year, the price of venetoclax (100mg/14 tablets) has dropped from 4860 yuan to 3835 yuan, a decrease of 21%.

The industry said that the national medical insurance has its own payment threshold, and pharmaceutical companies take the initiative to reduce prices, showing their sincerity
in negotiation.
At present, most of the drugs for rare diseases that have not been included in medical insurance are drugs with an annual treatment cost of more than one million, including imisidase, verasidease α, arabinase α, nitisinone, etc.
, of which the treatment cost of laroninosese adults is as high as 5.
37 million yuan
.
The industry is generally aware that medical insurance alone cannot completely solve the problem of
expensive medical treatment for patients with rare diseases.
Some people believe that the field of rare diseases also needs favorable policy support, encourage enterprises to continue to overcome, so that rare diseases are no longer rare
.
According to Frost & Sullivan, China's rare disease drug market will increase to 25.
9 billion US dollars by 2030, and a large number of pharmaceutical companies including Hengrui, Shanghai Pharmaceutical, Hansen Pharmaceutical, and CP Tianqing have laid out this track, and good news
may come in the future.
In addition, in addition to medical insurance negotiations, enterprises can also establish special assistance, social donations, the introduction of commercial insurance, and individual patient payments
through various channels.
By gradually establishing a multi-party payment mechanism for rare diseases, we can solve the dilemma that patients cannot afford drugs and improve the accessibility of
drugs for patients with rare diseases.
Disclaimer: Under no circumstances does the information or opinions expressed in this article constitute investment advice
to anyone.