Interview with Liu Guoen, leader of the expert group of medical insurance pharmacoeconomics estimation: reducing personal payment burden is difficult to solve at one time

Reporter | Jin Miao

Edit|Xu Yue

Liu Guoen: There must be difficulties in terms of evidence
.
If a new drug has just been marketed, the population of clinical use is not many, the time is not long, and there is not enough data to show the cost-benefit gap between the new drug and similar drugs, the experts will start pharmacoeconomics research.
It is very limited in data
.

In this case, the first thing to look at is whether the innovative drugs have an advantage over existing drugs in terms of efficacy and whether they are more effective than existing drugs.
Another aspect that can be concerned is that innovative drugs may have side effects Whether it can be reduced a lot, if it can, it can be regarded as an innovation, because it improves the quality of life of patients, this innovation is also valuable
.

But no matter what, when comparing new drugs with existing drugs, these advantages must be presented through data
.
In this case, experts should also consider the cost gap between innovative drugs and existing drugs
.

Generally speaking, the unit price of innovative drugs is more expensive, but pharmacoeconomics should not only look at the unit price, but also the entire medical expenses of patients
.
Because many treatments need to assist other drugs and medical services, it depends on whether the overall cost is reduced due to the use of innovative drugs
.
If the part that is reduced and saved can hedge the price of innovative drugs itself, it is also a key consideration in pharmacoeconomics
.

Jiemian News: Are you worried that the innovative drugs currently entering medical insurance may not benefit patients and medical insurance as much as you look back in a few years?

Liu Guoen: This kind of uncertainty will always exist, and I am not worried
.
After a new drug is put on the market, it takes a certain amount of people and time to accumulate pharmacoeconomic data
.
It is normal that there is a gap between the theoretical cognitive judgment and the final objective result .

However, everyone is still as cautious as possible regarding the entry of new drugs into the market and the entry of new drugs into the medical insurance catalogue.
In recent years, we can see that the regulations of the drug review department have been improving year by year
.

Jiemian News: How to make room for the development of innovative drugs during the adjustment of the medical insurance catalog?

Liu Guoen: We need to discuss the extent of the price of new drugs provided by medical insurance, and we need to analyze specific issues in detail
.
Does the improvement of a quality-adjusted life year give 1 times GDP, or 1.
5 or 2 times?

Experts give a consensus on the pharmacoeconomics evaluation of new drugs, but the specific degree depends on the pharmacoeconomics experts' judgments based on specific products and specific experience.
It is difficult to give a one-size-fits-all principle
.

In the negotiation of the National Medical Insurance Catalogue last year, additional points were given to innovative drugs.
As for the increase of 5%, 8%, or 10%, it depends on each expert in charge of review and how they judge it.

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Going back to what was just now, are you worried that the benefits of innovative drugs to patients and medical insurance are not so great? I don't think this is something we are worried about.
This is an inevitable situation, but we hope to be as cautious as possible when the evaluation time is relatively short and the population size is relatively small
.

Jiemian News: There are high-level domestic innovative companies' appeals that medical insurance should be tilted towards domestic corporate products.
Is this reasonable?

Liu Guoen: From my personal opinion, this short-term method of adopting different evaluation criteria for the protection of a specific product provides protection on the surface, but in the long run, it will not be conducive to the growth of the protected product, because The competitiveness of products and enterprises has weakened
.

Jiemian News: When the medical insurance program was adjusted last year, everyone was concerned about the issue of PD-1 inhibitors.
For products with different indications for both domestic and foreign companies, how to operate the pharmacoeconomics of medical insurance?

Liu Guoen: There are both domestic and foreign drugs, but the ruler of pharmacoeconomics is the same.
It is the most fair and effective to maintain the same standard and the same ruler
.
(Question: There are so many PD-1 inhibitors, should we do an overall evaluation of the same kind, or should we evaluate each one separately?) Each drug is evaluated one by one, but when each product is evaluated, we will It is compared with its reference product, not a single product
.

Jiemian News: Are there any differences in the pharmacoeconomics materials submitted by domestic and foreign companies to the expert group?

Liu Guoen: Multinational pharmaceutical companies are indeed stronger in basic research, clinical technology, human capital, and management methods, including the importance and investment in pharmacoeconomics research.
They have obvious advantages.
Therefore, foreign companies are generally better in providing data.
The quality is better
.

Jiemian News: In the past two years, the inclusion of rare disease drugs during the adjustment of the medical insurance catalogue has received more attention.
Will there be a tilt towards rare disease drugs in the process of medical insurance pharmacoeconomic analysis?

Liu Guoen: The pharmacoeconomic evaluation criteria for rare disease drugs are the same, except that the results of our evaluation of rare disease drugs will be given a certain tilt when experts make price recommendations
.
Because of the rare disease drugs, the market itself is very small, and the investment and return that companies can obtain are much smaller than those of conventional products.
It is necessary to ensure that companies can recover their reports
.

For rare disease drugs, we also need to compare with existing drugs to calculate whether the health returns it brings can be controlled within a relative threshold range
.
If the threshold range of ordinary drug prices is set at 1, for rare disease drugs, it may be appropriately relaxed to 1.
5 or higher.
As the degree of economic development increases, this standard may of course be further increased
.

We think it is appropriate to give a certain tilt to the prices of rare disease drugs.
In fact, many other countries do the same
.

Otherwise, if the recommended price is obtained solely based on pharmacoeconomics, the main body of research and development of rare disease drugs will be in a very disadvantaged state
.
However, the scale given to rare disease drugs is a more complex issue, and the appropriate level of inclination is a matter of different opinions
.

Regardless of whether rare disease drugs are ultimately included in medical insurance, our prices have been given a certain tilt in pharmacoeconomics calculations, but there is no uniform division of the proportion of extra points, and the space is still left to our review experts as much as possible.
Their understanding of the disease and this product gives an appropriate ratio
.

Jiemian News: From the first batch of anti-cancer drug negotiations to the recent medical insurance negotiations, the prices of the negotiated drugs are indeed reduced, but there are many problems in the real landing, including whether patients can buy drugs in the hospital, and want to solve these fundamentally Question, is there some way?

Liu Guoen: Solving the problems related to medical insurance medication is not an overnight task, and it is unlikely to be solved overnight
.

We continuously improve the quality of medical insurance catalog review, continuously increase the proportion of national medical insurance payment, continuously reduce the burden of personal payment, and continuously improve the scientific degree of evaluation methods.
I think it is a process
.

For some more expensive drugs, such as PD-1 inhibitors that have entered the category B list, patients still pay a lot, which is still a burden for low-income people
.
Some people think that this is the failure of medical insurance adjustments
.
I think this statement is open to discussion, because how much medical insurance can pay is closely related to the country's financial capacity and economic development level.
It is not a problem that medical insurance can solve at one time
.

From another perspective, if these expensive drugs cannot be included in the medical insurance, it means that the individual has to bear 100%.
From this point of view, the individual's payment burden is still reduced
.

Although for many people, the burden after reduction is still heavy, this is a problem that needs to be solved step by step through development
.

We all hope that the economy can continue to grow, revenue can continue to increase, and national fiscal taxes continue to increase, so that our government's financial investment and medical insurance payments can be increased, thereby reducing personal burdens
.