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Recently, the Jiangsu Provincial Medical Insurance Bureau issued the Notice on Standardizing the Procurement of Drugs with Quantity and Payment Management Related Matters, which clarifies the listing and payment management matters of Jiangsu drug centralized procurement and expired renewal procurement, which deserves the attention
of enterprises.
1.
For unselected products purchased by the state with quantity, the price of the hanging net shall meet the gradient price reduction requirements of the national joint procurement and shall not be higher than the lowest price among the existing listed prices at the provincial level in the country (hereinafter referred to as the national lowest price).
Among them, the price of generic drugs that have not passed the consistency evaluation shall not be higher than the lowest price
of the same variety in the "National Drug Centralized Procurement (Jiangsu) Selected Varieties List".
For products whose prices do not meet the above requirements and are not selected, the network will be suspended and resumed after it is adjusted to meet the requirements
.
2.
The price of the sunshine hanging net of the unselected products purchased by the province shall not be higher than the lowest price in the country, and the upper limit of the bargaining price shall be adjusted according to the following methods:
1.
The highest price product of the same variety that has not been selected shall be divided into three levels according to the price difference between its national lowest net price and the highest selected price of the same variety, sorted from largest to smallest, and is divided into three levels respectively, which are reduced by 15%, 10% and 5% on the basis of the national lowest net price, forming the upper bargaining limit of the product (if the adjusted bargaining limit is less than 0.
1 yuan, it is calculated as 0.
1 yuan).
The highest-priced products of the same variety that have not been selected will be reduced by 15%, 10% and 5% respectively on the basis of the lowest national online price
2.
For the remaining products of the same variety that are not selected, the listing price shall not be higher than the adjusted bargaining limit
of the unselected highest-priced product.
The remaining products of the same variety that are not selected,
For unselected products that have not adjusted the price (upper limit of negotiation) as required, their procurement and use will be included in the scope of key monitoring, and the procurement situation of medical institutions will be regularly reported
.
3.
In the national and provincial procurement of the originally selected but unselected products (hereinafter referred to as the original selected products), 6 months from the implementation of the completion of the successive procurement results is the transition period, and they are separately marked
.
During the transition period, the original selected enterprises will still supply at the original selected price and will not be included in the key monitoring scope
for the time being.
After the expiration of the transition period, if the original selected products continue to be supplied at a price not higher than the original selected price, they shall be managed with reference to the requirements of the transition period, otherwise the upper limit
of the negotiation shall be adjusted in accordance with Article 2 of this article.
Among them, if the upper bargaining limit of the original selected product should be adjusted is lower than the original winning price, the original winning price shall be used as the upper limit of the negotiation and will not be lowered; If the adjusted bargaining ceiling is higher than the original winning price, its procurement situation will be included in the key monitoring scope
.
4.
If the products purchased in the same variety that are not within the scope of procurement are within the scope of medical insurance payment, the medical insurance payment standards shall be implemented
in accordance with the Notice of Jiangsu Provincial Medical Security Bureau on Further Improving the Payment Standards for Selected Drugs and Unselected Drugs in Centralized Drug Procurement (Su Medical Insurance Fa [2022] No.
49).
This notice shall be implemented from the date of issuance, and the centralized procurement of products that have been listed on the provincial platform and the successive purchase of products upon expiration shall be implemented
in accordance with the requirements of this notice.
According to the spirit of the document No.
49 of Su Medical Insurance Fa [2022], here is a summary of the medical insurance payment standards of unselected varieties:
Original drugs, reference preparations, and over-evaluated generics
The medical insurance payment standard in the first year is temporarily based on the selected price or average price (multiple enterprises of the same drug are selected), and the medical insurance payment standard
is formulated according to the extent of the enterprise's active price reduction.
If the price of the net before the dynamic price adjustment is more than 2 times higher than the selected price, and the price reduction rate of the enterprise actively reduces the price reaches 30% or more, the price of the net after the price reduction shall be used as the payment standard;
More than 2 times higher than the selected priceIf the reduction rate is 20%-30%, the current listing price will be reduced by 5 percentage points as the payment standard;
The reduction is between 20% and 30%.If the reduction rate is 10%-20%, the current online price will be reduced by 10 percentage points as the payment standard
.
If the price of the net before the dynamic price adjustment is within 1-2 times (including 2 times) of the selected price, in principle, the selected price shall be the payment standard
.
If it is lower than the selected price, the actual listing price shall be used as the payment standard
.
In the following year, in accordance with the principle of "gradual and gradient adjustment", the medical insurance payment standard will be gradually adjusted, and in principle, the adjustment period shall not exceed 3 years
.
Drugs that have not passed the consistency evaluation of quality and efficacy
There is no transition period, and the payment standard is not higher than the selected price or average price (multiple companies of the same drug are selected).
For drugs that have been suspended or withdrawn from the network: the payment standard
shall be calculated according to the above rules based on the price before the suspension or withdrawal of the listing.
For unlisted prices:
The payment standard of drugs that pass the consistency evaluation of quality and efficacy is determined according to the winning price or average price of the selected drug (selected by multiple enterprises of the same drug);
Drugs that have passed the consistency evaluation of quality and efficacyThe payment standard for drugs that have not passed the consistency evaluation of quality and efficacy is determined
by 5 percentage points lower than the selected price or average price (multiple enterprises of the same drug).
