Health insurance catalog adjustment: What are the opportunities for Chinese medicine to be released? What are the limitations?

Medicine Network December 18th, December 17th, 2020 health insurance catalog access negotiations closed, the results of the negotiations have yet to be officially announced.
According to the "2020 National Health Insurance Drug Catalog Adjusted through formal examination of the list of declared drugs" published by the State Health Insurance Administration, through the form of examination of the list of declared drugs, there are 551 western medicines listed outside the list, 177 Chinese medicine.
include new generic drugs approved for sale by the State Drug Administration between 1 January 2015 and 17 August 2020 (154 Western medicines and 17 Chinese medicines); Recently, entered 5 (including) or more provincial-level the latest version of the basic medical insurance drug catalog of drugs, but the main active ingredients included in the "first batch of national key monitoring of rational drug use drug catalog (chemical and biological products)" except (338 Western medicine, 155 Chinese medicine) and so on.
How much Chinese medicine will eventually participate in the negotiations is not yet known, and according to the first day of negotiations (December 14) from the scene of the news, Chinese medicine enterprises first started, there is an exclusive variety of price reduction of 34%.
this paper focuses on the dynamic adjustment of the 2020 medical insurance catalog, and discusses the opportunities and limitations of Chinese traditional medicine in the medical insurance drug market.
From the research and development situation, between January 1, 2015 and August 17, 2020, only 17 newly approved Chinese medicines were approved for market, the motivation is not obvious; In terms of access, before December 31, 2019, there were not less than 155 Chinese medicines entering the list of 5 provincial-level medical insurance drugs, and the driving force was relatively strong;
it is well known that the list of basic drugs in primary health care institutions equipped with the highest proportion of requirements, which may lead to limited use of drugs in primary health care institutions, the function is not complete.
only 11 base drugs are on the list of declared drugs that have been reviewed through formal review, which will be dynamically adjusted to the 2020 Health Insurance Drug Catalog.
the sale and use of Chinese medicine at all levels of hospitals face a similar situation.
On the one hand, the construction of Chinese medicine departments and Chinese pharmacies in general hospitals is often in a relatively weak environment, and on the other hand, the patients' masses are swinging between "traditional" and "happy news", which is the biggest uncertainty factor.
chinese medicines in the catalogue to be supported by policy at present, the industry has a concern: drugs into the list of essential drugs, gold content decline, the market outlook is uncertain.
, along with the health care reform, the catalog of Chinese medicine in order to give full play to its due role, but also need payment methods, payment standards of policy support.
Recently, Shandong Province issued "Several Measures to Promote the Innovation and Development of Traditional Chinese Medicine", proposing that "by 2022 to cultivate 10 provincial-level specialty hospitals of Chinese medicine, all community health service stations to provide Chinese medicine services, by 2022 the government-run general hospital set up a full Chinese medicine department, community health service center reimbursement ratio is not less than 85%."
" and put forward "to improve the characteristics of Chinese medicine payment methods, according to the provisions of the appropriate Chinese medicine diagnosis and treatment projects and approved by the provincial Drug Administration of therapeutic medical institutions Chinese medicine preparations into the scope of basic medical insurance payment."
by the end of 2020, the number of dominant diseases paid for by disease has expanded to more than 20.
to explore the establishment of day consultation centers within qualified Chinese medicine medical institutions, and to pay the settlement of the costs of Chinese medicine consultation and treatment in accordance with the provisions of the outpatient chronic diseases or inpatient policies.
, Shandong Province, health insurance and other departments jointly issued "on strengthening medical security to support the development of Chinese medicine measures", effective October 17, 2020.
Through 20 specific measures, the policy strengthens the support of the original medical insurance policy for Chinese medicine, and expands the new support function based on the field of medical insurance, and further enhances the comprehensive support role of the policy through sectoral linkage, which is considered to be the most extensive, systematic and supportive Chinese medicine health care policy document in Shandong's history.
At present, under the long-term mechanism of the state advocating to combat gold sales in the field of drug circulation, the sales cost of Chinese medicine production enterprises is still high, and after gradually digesting the provincial medical insurance supplement catalogue, the Chinese medicine into the national medical insurance catalogue is even less channel.
On the other hand, those Chinese medicines that have entered the national medical insurance drug catalogue have not experienced the purchase of volume, there is still a problem of inflated sales prices at the end of the hospital, there is no basis for clinical use of the volume, which comes with the objective conditions of volume procurement? There needs to be a quantity of price reduction.
In the author's opinion, if there is no payment method, payment standards for the clinical use of Chinese medicine reasonable amount of demand to meet, the re-integration of Chinese medicine into the volume of procurement may bring some adverse effects on the development of the industry, but also may lead to the price relationship between Chinese medicine imbalance of the real risk.
, it is recommended that the purchase of traditional Chinese medicine belt and the promotion of the advantages of Chinese medicine diseases according to the disease collection and payment combination.
once there is reasonable support for the payment of medical insurance, the purchase of Chinese medicine belt is imperative.
this, the industry should take reasonable volume as the first goal, taking into account reasonable bidding, pricing.
the list of Chinese medicine by the hospital end of the impact of the national medical insurance drug catalog, the vast number of medical and health institutions on the recognition and acceptance of Chinese medicine, will certainly provide credibility support to the public trust, the use of Chinese medicine.
Based on the characteristics of Chinese medicine, it is understandable that the proportion of research and development expenses of Chinese medicine manufacturers is relatively low, but the high sales cost amount and proportion are the main factors that are criticized by the market.
data show that in 2020, 11 varieties of Chinese medicine products top20 in retail pharmacy terminals in China will have sales of more than 1 billion yuan, including flowering plague capsules, double yellow even oral liquid, plate blue root particles are listed.
cold medicine has 4 products on the list, blood supplements have 3 products on the list, intestinal medication, coughing sputum flat wheezing drugs have 2 products on the list.
in contrast, chinese traditional medicine in retail pharmacies bidding, pricing is not directly subject to health insurance negotiations, bargaining, with the impact of the procurement mechanism, there is still a profit plus, traditional marketing.
, brick-and-mortar pharmacies are subject to competition for products and prices from hospitals and pharmaceutical e-commerce companies.
healthy times, effective health insurance payments should enrich pharmacy cooperation.
In terms of graded diagnosis and treatment, from primary health care institutions to higher-grade hospitals, prescriptions for Chinese medicine or prescriptions containing traditional Chinese medicine should be approved all the way through, and secondly, when building Internet hospitals in physical medical and health institutions, attention should be paid to the optional route of prescription outflow, distribution through retail pharmacies and payment of medical insurance, in order to improve efficiency.
In general, the revitalization of traditional Chinese medicine, the promotion of traditional Chinese medicine, not only medical insurance policies, medical departments efforts, can innovatively play the direct cooperation between medical insurance and retail pharmacies, can attach importance to the development of various types of medical and health institutions at all levels to retail pharmacies of Chinese traditional medicine prescription outflow, but also with national technology, to play the unique advantages of Chinese medicine.
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