Medicare negotiation confidentiality price suspected 97 drugs will be directly linked to the Internet, not accounting for the proportion of drugs

Wen Liang Jian On December 18, the National Health Insurance Bureau and the national health and Health Commission jointly issued the notice on the implementation of drugs in 2019 national health insurance negotiation According to the notice, 97 negotiated drugs should be directly linked to the provincial drug centralized purchase platform within the prescribed time limit; medical institutions and drug manufacturers should be organized to sign agreements in time, and medical institutions should purchase according to the agreements The official release of the document also confirmed the previous speculation In fact, before the release of the document, many medical insurance departments required to implement it as soon as possible For example, on December 13, Hunan Province issued a notice on the implementation of the national directory of basic medical insurance, industrial injury insurance and maternity insurance drugs, which clearly stated that the directory should be strictly implemented and policies should be linked 。 In addition, some places also facilitate the negotiation of drugs online as soon as possible On December 2, the Shanghai Pharmaceutical centralized bidding and purchasing management office issued a notice that it will open a new green channel for direct online access of negotiated drugs for medical insurance At present, the speed of implementation of the negotiation results of medical insurance has been gradually accelerated, and the local departments are even earlier than the release of the documents of the State Medical Insurance Bureau, which also means that the local medical insurance departments need to make the negotiation results of medical insurance drugs benefit the people as soon as possible within the specified time, so as to ensure that there is no discount on the implementation of the negotiation results Before, the national health insurance bureau did not form an effective monitoring mechanism for the drugs in the medical insurance catalogue of medical institutions or designated medical insurance institutions There were often problems that the drugs were still in short supply even if they were included in the medical insurance For example, in 2017, the successful negotiation of the breast cancer drug Herceptin, the selling price of a drug was reduced from 22000 yuan to 7600 yuan, but in the implementation of the policy, the drug supply was cut off, the hospital did not purchase, etc Problems are frequent In this document, the state health insurance bureau also proposed solutions to this problem According to the notice, the state health insurance bureau will select part of the overall planning areas in the country to monitor the use of drugs after the adjustment of the new version of the catalogue, negotiate the relationship between the landing of drugs and the vital interests of the insured patients, and ensure the smooth landing of the negotiated drugs by the local health insurance, health and other relevant departments Well done It can be said that since the establishment of the state health insurance bureau, the power in the hands of local medical insurance institutions has been greatly reduced In July this year, the state health insurance bureau issued a further notice, canceling the local power to supplement the medical insurance catalogue, and further unifying the local medical insurance negotiation rules It can be predicted that in the process of landing 97 varieties, the state health insurance bureau will carry out more strict supervision, as stated in the document, to ensure the smooth landing of negotiated drugs The circular also mentioned that the local medical insurance departments shall not affect the allocation and use of the drugs under negotiation on the basis of the total amount control of medical insurance, the quantity limit of the drug catalogue of medical institutions, and the proportion of drugs, etc In fact, for medical institutions, "drug share" is still hanging on their heads Although 97 varieties in this negotiation have entered the medical insurance reimbursement catalogue of all regions, under the control of the total drug cost, there is still no small resistance in the "entering the hospital" link From the past experience of drug price negotiation, "drug proportion" is almost the only factor limiting the volume of negotiated products This is not the first time for the state health insurance bureau to say so In November last year, the state health insurance bureau and the health care Commission issued the notice on doing a good job in the negotiation and implementation of 17 kinds of national health insurance anticancer drugs, requiring all regions to attach great importance to strengthening management, do a good job in online procurement and medical insurance payment, and explicitly requiring all regions not to use "total cost control", "drug proportion" and medical treatment The basic drug list of the organization influences the negotiation of the supply of anticancer drugs and the rational drug demand Once again, the notice proposes that the negotiated varieties do not account for the "proportion of drugs", which also shows the urgency of the official implementation of the negotiation catalogue With the gradual implementation of the notice, once the negotiated varieties are not affected by the medical insurance control fee in the future, the product will speed up its volume In addition, it is worth mentioning that these 97 varieties do not account for the proportion of drug use, which can really liberate the use quota of the product itself, and will be conducive to the priority use of negotiated drugs by medical institutions As far as enterprises are concerned, their products can be rapidly released, but after the release, the official monitoring of drug quality has not fallen According to the requirements of the notice, all localities shall establish a monitoring mechanism for the use of negotiated drugs, strengthen the statistical monitoring of the allocation, use and payment of negotiated drugs From January to June 2020, the provincial medical insurance departments shall summarize and report to the State Medical Insurance Bureau monthly, and the health and health departments at all levels shall strengthen the management and guidance of medical institutions The above regulations not only encourage medical institutions to use the products listed in the medical insurance catalog, but also put forward higher requirements for the quality of products, further screening the quality of the selected varieties, so as to achieve the survival of the fittest In the notice, the state health insurance bureau and the state health and Health Commission require that all provinces report the progress of relevant work in a timely manner as required, and the state will timely supervise and urge the provinces that are slow in progress and fail to implement policies within the prescribed time limit In fact, 97 medical insurance negotiation drugs have been directly purchased online in Henan, Guangxi, Guangdong and Guizhou Guangxi said in the notice that in view of the confidentiality of some pharmaceutical enterprises' application for payment standards determined through negotiation, the purchase price will not be displayed in the purchase process, and it can be expected that this measure will be welcomed by foreign pharmaceutical enterprises who are reluctant to disclose the price However, this phenomenon is not absolute According to the public information released by the drug centralized purchase platform of Yunnan Province, the price of acarbose chewable tablets applied by Hangzhou, Central America and East China decreased from 2.6877 yuan / tablet to 1.1 yuan / tablet, which means that the price of a box of acarbose chewable tablets decreased from 80.63 yuan to 33 yuan, a decrease of 59.11% Since then, the medical insurance payment price of the product has been declassified In fact, before the medical insurance negotiation, the price of acarbose chewable tablets has also been reduced in some winning provinces On June 21 this year, Hangzhou Zhongmei Huadong Pharmaceutical Co., Ltd applied for active price reduction in Heilongjiang Province, which was reduced from 80.5 yuan / box to 43.46 yuan / box, equivalent to 1.45 yuan / tablet, with a decrease of 46% According to the price of declassification, the price of this medical insurance negotiation was reduced by the state medical insurance bureau to 0.35 yuan / piece It can be predicted that as more and more provinces and cities begin to follow up the spirit of the National Health Insurance Bureau and the national health and Health Commission to directly link 97 items to the Internet in the future, the negotiation price of some varieties seeking price confidentiality in the negotiation will gradually open up, and for some foreign pharmaceutical enterprises that have opened the lowest price in China, if they want to continue to maintain global price stability, they will also face new challenges Challenges Appendix: 2019 medical insurance negotiation varieties