[Medicine heaven and earth] with all these efforts, the medical insurance fee control is coming! Hospital "first in command" responsibility system replacement; Huahai new collection 10 causes valsartan to cause the lawsuit case

The local government has made new policies and taken various measures, and the medical insurance fee control is coming! Recently, the development of auxiliary drug catalog, from the National Health Insurance Bureau, the National Health Care Commission has issued various policies, the era of medical insurance control fee! On December 12, the national health and Health Commission issued the notice on doing a good job in the clinical application management of auxiliary drugs (hereinafter referred to as the notice), which clearly requires to strengthen the management of auxiliary drugs and improve the level of rational drug use It is pointed out in the announcement that the whole process management of the selection, purchase, prescription, dispensing, clinical application, monitoring and evaluation of auxiliary drugs should be strengthened, that is, those auxiliary drugs with little clinical value are likely to be "out of the game" As we all know, the control effect of auxiliary drugs in the past is not good One of the reasons is that the definition of auxiliary drugs is not clear When national policies are implemented in various places, it is found that the work of strict control of auxiliary drugs is "self-contained", but this time it is different According to the notice, the adjustment of the catalogue of auxiliary drugs is based on the drug instructions and Drug Guidelines, etc This regulation points out the direction for provinces to develop the catalogue of auxiliary drugs It is reported that Xinjiang, Fujian and Inner Mongolia have made a clear definition of auxiliary drugs, in which Xinjiang and Fujian all mentioned to make a catalog according to the drug instructions and clinical guidelines, while Inner Mongolia is concerned about whether the drugs have auxiliary treatment effect or synergistic effect with the main treatment drugs In addition, at present, Guangxi, Shanghai, Hebei, Shandong, Heilongjiang, Jilin, Ningxia, Chongqing and Hainan have also issued relevant announcements requiring medical institutions to send auxiliary drug varieties through express reports From the number of reported varieties, Guangxi, Shanghai, Xinjiang, Hebei and other places require many and 20 varieties in principle, while Ningxia requires no less than 40; from the requirements of selection, the price and consumption amount of auxiliary drugs have become important reference values DRGs payment "DRGs payment" was put forward as early as the reform stage of medical insurance payment Recently (December 20), the official wechat of the National Medical Insurance Bureau issued a notice saying that in order to accelerate the pilot of DRGs, explore the establishment of DRGs payment system, and decide to organize the DRGs national pilot declaration work It can be seen that DRGs payment will be the top priority of medical cost control in the future, and it is also a means to regulate doctors' reasonable diagnosis and treatment It is worth mentioning that in DRGs covering all disease spectrum, doctors should strictly follow the clinical path for diagnosis and treatment, and prescribe prescriptions reasonably, especially for the use of auxiliary drugs The formulation of the catalogue of supplementary drugs for anti fraud insurance and DRGs payment, 4 + 7 volume purchase have an effective control over drug prices, medical expenses, etc., and the medical insurance fund is also free from wanton waste However, some hospitals can still carry out fraud insurance on the basis of complying with the above policies by finding several "false patients" and opening a "false diagnosis", resulting in a huge loss of medical insurance costs Now in January, medical staff and inspection departments of the Third Affiliated Hospital of Anhui University of traditional Chinese medicine collaborated with each other to defraud the national medical insurance fund for a long time During the tenure of the former president of a hospital in Anshan City, 73 doctors were involved in the investigation and treatment of the "nest case" of more than 64 million people, while part of retail pharmacies earned "pot man man man" by virtue of "daily necessities, health care products" and other non drug series 。 This shows that there are still many problems in the management and utilization of medical insurance funds in some areas Based on the phenomenon of deception, the state and provinces and cities have actively launched a series of crackdown activities this year On August 3, the State Office issued a document, proposing several key medical reform tasks such as fighting against fraud; on September 13, the state health insurance bureau, the State Health Commission, the Ministry of public security and the State Food and Drug Administration held a video conference on the national special action against fraud in medical security fund It is clear that designated medical institutions, designated retail pharmacies and insured personnel are the main inspection objects, with inpatient and outpatient services, pharmacy purchasing services as the main inspection contents At the same time, all provinces and cities actively carry out special inspections on designated medical insurance institutions, and try to conduct a variety of innovative supervision On December 18, xinjiang.com reported that 1246 designated pharmacies in Urumqi will withdraw rice, flour, oil and some miscellaneous commodities from the drugstore from now on In the future, citizens can no longer use social security card to swipe cards in drugstores to purchase non drugs beyond the scope approved by the medical insurance department In addition, the document also indicates that citizens, legal persons or other social organizations report the staff of medical security agencies, designated medical institutions, designated retail pharmacies and their staff, as well as insured personnel suspected of cheating and defrauding medical security funds, and provide relevant clues After verification, they shall be rewarded with a maximum amount of no more than 100000 yuan, while designated medical institutions and designated medical institutions shall be rewarded The reward standard can be appropriately raised if the internal personnel or the original internal personnel of the retail drugstore are selected In addition, this year, Henan Xinyang social medical insurance center, Dalian City, Guyuan City (Ningxia) Huizhou City (Guangdong) Social Insurance Fund Management Bureau issued a document stressing that the designated pharmacies of medical insurance are prohibited from placing and selling food, cosmetics, daily necessities and other commodities Henan Xinyang social medical insurance center requires to cancel the medical insurance service agreement for drugstores that do not comply with relevant regulations In August, the Tianjin Municipal Bureau of social affairs, the Municipal Planning Commission, the municipal market supervision committee and the Municipal Public Security Bureau jointly issued a document to promote the application of "Internet plus video surveillance" to achieve synchronous monitoring of medical data and services In July, Shanghai face recognition intelligent monitoring video system has been piloted in several designated pharmacies and some designated medical institutions In May, Wuhan realized the traceability of the whole process of drug information In April, the Department of human resources and social security of Guangdong Province issued a document, proposing to implement strict supervision over the whole coverage and process of medical insurance funds, establish a credit file tracking mechanism, and set up a monitoring period for the violators In addition, Hebei, Zhejiang, Fujian, Hubei, Xiamen and other provinces and cities have installed high-definition cameras in designated medical institutions, opened "Tianyan" 24 hours a day, real-time monitoring 24 hours a day, and realized the whole process control of medical purchase A large number of medical institutions or pharmacies have been punished while the "special action against fraud and defrauding of medical security fund" is still in progress For example, on December 20, Hunan Province issued a document to announce its remediation results, saying that 820 medical institutions had been rectified, 219 were criticized, 228 medical insurance services had been suspended, 44 service agreements had been terminated, 142 administrative penalties had been imposed, 142 individuals had been dealt with; Beijing Municipal Human Resources and Social Security Bureau issued an interest cancellation on December 21, and 22 designated medical institutions, including Beijing Dongyuan Hospital of traditional Chinese medicine, had been seriously dealt with, and 6 agreements had been terminated（ Including a branch of Beijing Tongrentang Jingbei Enterprise Management Co., Ltd 33 years of dean's first responsibility has been terminated! According to the official website of Hubei Provincial Health Committee, the general office of Hubei provincial Party committee recently printed and distributed the implementation opinions on strengthening the party's construction in public hospitals in the province The announcement clearly pointed out that the Secretary of the Party committee of the hospital presided over the overall work of the Party committee, took overall responsibility for the work of the hospital, and fulfilled the responsibility of the first responsible person It can be seen that the former "top leader" is bound to weaken the "discourse power" for the purchase of drugs, consumables and medical equipment in the future, and its role will also be transformed from "decision maker" to "executor" Presumably, this policy is of great significance for promoting the process of medical reform Huahai pharmaceutical recently announced that its subsidiaries have received 10 new lawsuits caused by valsartan incident Huahai pharmaceutical issued a notice on December 22 At present, its subsidiary Huahai (USA) International Co., Ltd (as of the date of this notice), the company has received 10 new lawsuits caused by valsartan events (9 of which are class lawsuits) According to the announcement, consumers in the U.S market filed a lawsuit with the District Court of New Jersey, the District Court of Fresno, eastern California, and other courts in the U.S due to the discovery of a very small amount of genotoxic impurities (NDMA) in the unknown impurities of valsartan API in Huahai, Zhejiang Province The 10 litigation claims involved are as follows: 1 The amount of the judgment granted to the plaintiff and the collective members is their economic loss, as well as the statutory and punitive damages for their actions 2 Medical supervision of the plaintiff and the collective members is allowed 3 Grant reasonable attorney's fees and expenses 4 Interest before and after award of judgment Recently, LVYE Pharmaceutical Group announced the acquisition of two biological antibody drugs under development of Shandong Boan Biotechnology Co., Ltd The acquired two biological antibody drugs ly01011 and ly09004 are monoclonal antibody drugs Among them, ly01011 is a recombinant anti RANKL all human monoclonal antibody injection, a biological analogue of xgeva, which is used to treat multiple myeloma and bone metastasis caused by solid tumor At present, the drug has obtained clinical approval and is about to enter phase I clinical; ly09004 is a recombinant human vascular endothelial growth factor receptor antibody fusion protein eye injection, which is a biological analogue of eyla Its indications include neovascular (wet) senile maculopathy, macular edema after retinal vein occlusion, diabetic macular edema, and diabetic macular edema Diabetic retinopathy of the patient The drug has been declared for clinical use Information source: yaozhi.com, yaozhi.com, saibailan, Health Bureau, enterprise announcement, pharmacy manager and other statements: this point of view only represents the author, not the position of yaozhi.com, welcome to exchange and supplement in the message area; if you need to reprint, please be sure to indicate the author and source of the article.