Medical insurance negotiations are not a "life and death" for innovative drugs

The three-day national medical insurance negotiations have come to an end, and the results of the negotiations are still waiting
.

According to CCTV news, the results of the negotiations on the 2021 version of the National Medical Insurance Catalogue are expected to be announced at the end of November

In 2018, the National Medical Insurance Administration was formally established.
In the past three years, the dynamic adjustment mechanism of the medical insurance drug catalogue has been initially established.
The centralized procurement of drugs and high-value medical consumables has become normalized and institutionalized, and the "dual channel" management mechanism for drugs in the national medical insurance negotiations has entered On track
.

Huang Huabo, director of the Medical Service Management Department of the National Medical Insurance Administration, pointed out in a special report during the CIIE that in the previous drug catalogue adjustments, the National Medical Insurance Administration focused on including drugs with high clinical value, reasonable prices and better meeting basic medical needs into the catalog.
, Allowing patients to use new and good medicines faster!

Whether you can enter the medical insurance, you need to break through many barriers

Whether you can enter the medical insurance, you need to break through many barriers

For pharmaceutical companies, it is not easy for an innovative drug to go from listing to entering the medical insurance catalog
.

According to the "Work Plan for the Adjustment of the National Medical Insurance Drug Catalogue", a new drug must be included in the medical insurance after it has successfully passed the three passes of enterprise declaration, expert review, and on-site negotiation before it can be determined

Enterprise declaration, expert review, on-site negotiation

Hu Shanlian, a professor at the School of Public Health of Fudan University, is a member of the 2019 medical insurance access pharmacoeconomics evaluation expert group.
He introduced to the Health Times reporter that a variety of calculation methods were used in the negotiation process in 2019, including cost-effectiveness ratios, international reference prices, and competition Negotiations and budget impact analysis, etc.
, experts independently evaluate, form a suggested price, and finally submit an evaluation report
.

Hu Shanlian specifically mentioned that one of the highlights of pharmacoeconomics calculations is that in order to solve the balance between high-priced innovative negotiated drugs and future medical insurance funds, the budget impact analysis of new drugs that may be brought into the catalog is estimated
.

Especially for some renewed drugs, analyze the actual sales of the drugs after they are reimbursed on the market.

One of the highlights of pharmacoeconomics calculations is that in order to solve the balance between high-priced innovative negotiated drugs and future medical insurance funds, the possible budget impact analysis of new drugs after entering the catalog is estimated

"Only after the company makes its first offer, the negotiation team of the Medical Insurance Bureau can open the secret envelope price, know the "reserve price" of the Medical Insurance Bureau, and calculate the data on the spot; if the company's quote exceeds the envelope price by 15%, the negotiating staff will prompt, "You exceed 15%.
%", or just say "you have too much difference", and only those drugs whose quotations are within 15% in the second round can the company be eligible to continue the negotiation, otherwise it will be directly out
.

" A participant in this medical insurance calculation The medical insurance expert revealed in an interview with a reporter from the Health Times

Medical insurance negotiations are not a "life and death", and innovative payment mechanisms involving multiple parties are worth exploring

Medical insurance negotiations are not a "life and death", and innovative payment mechanisms involving multiple parties are worth exploring

"As the largest purchaser of medical services, the ultimate goal of medical insurance is to purchase valuable medical services and medicines for patients, and the value itself has "multiple dimensions
.

" It must be clear whether it is to encourage industry innovation or high-priced drugs Payment is not a matter of the medical insurance department, and medical insurance cannot be expected to pay for all value dimensions

In February 2019, Noxinassen Sodium Injection was approved in China, becoming China's first drug for the treatment of spinal muscular atrophy, with a single price of 699,700 yuan after it was launched in China
.

In the 2020 medical insurance catalogue adjustments, Nosinasodium has already participated in medical insurance negotiations, but in the end there was no follow-up

In addition, according to reliable sources, the CAR-T therapy Achilles injection, which has received much attention in this medical insurance negotiation, did not participate in the final medical insurance negotiation after passing the preliminary formal review of the national medical insurance drug catalog adjustment in 2021
.

After being officially approved for marketing on June 23, Akirensai injection was regarded by many cancer patients as the "last straw", but its sky-high price of 1.

"Considering that its production cost is difficult to significantly reduce in the short term, and the indications are limited, it may not pass the pharmacoeconomics calculation program in the end
.

" An industry expert who did not want to be named revealed to a reporter from the Health Times
.

Xuan Jianwei, director of the Pharmaceutical Research Institute of Sun Yat-sen University, told the Health Times reporter that the first major mission of medical insurance is to provide wide coverage and protect basic medications and medical needs.
The second is to support innovative products and As for the entry of equipment , as for how to use medical insurance funds rationally, "We should first consider the basic national conditions of China as a developing country.
How to make full use of the limited funds to solve the growing medical and health needs of patients is a test of medical insurance
.
"

The first major mission of medical insurance is to provide wide coverage to protect basic medications and medical needs, and the second is to support the entry of innovative products and equipment when the fund is sustainable.

Shi Lu Wen mentioned that in recent years, there have been many explorations of innovative medical technology or innovative payment mechanisms for pharmaceutical products.
For sky-high-priced drugs, the intervention of urban welfare insurance, commercial insurance, and various corporate drug donation policies, they are all trying to make supplementary payments.
It is recommended that under the guidance of the government, in the future, under the guidance of the government, we should cooperate with the Health Commission, the Administration of Traditional Chinese Medicine, the Medical Insurance, and the Drug Administration to establish special funds through the improvement of relevant administrative regulations, laws and policies, and service systems.
We will work with participants in the pharmaceutical industry to explore multi-level and multi-party innovative payment mechanisms
.
"

Explore multi-level and multi-party innovative payment mechanisms