National health insurance catalog adjustment: which will enter and which will be kicked

Source: Cyprian 2016-08-29 recently, the Ministry of human resources and social security released a message that the adjustment of medical insurance catalog is the key work of this year This has revived the long dormant health care catalog The author thinks that the expansion of the new version of the medical insurance catalogue still needs to be started after the completion of the "two guarantees in one" Catalogue in each province and the determination of the bidding price of the corresponding products in each province There is also a key work that hasn't been completed The current drug catalog was formulated in 2009 It was originally called the drug catalog of basic medical insurance, and later expanded to the drug catalog of national basic medical insurance, work injury insurance and maternity insurance, with 2196 varieties Generally speaking, the current medical insurance drug catalog can basically meet the clinical needs, especially the basic needs of the majority of insured personnel The author believes that from the perspective of time schedule, the supplement of medical insurance catalog needs to be completed after the completion of the "two guarantees in one" catalog in each province In January 2016, the Ministry of human resources and social security issued a notice requiring all localities to strive to launch and implement the integrated basic medical insurance system for urban and rural residents in 2017 According to the report on August 8, 2016 on the official website of the Ministry of human resources and social security, the progress of "two guarantees in one" is only half completed Among the 32 provinces, districts and cities in China, 17 provinces are clearly managed by human resources and social sectors, 9 of which have achieved system integration in an all-round way; among the 333 prefecture level administrative regions (excluding 4 municipalities directly under the central government and the Corps), 174 of which have unified management systems are managed by human resources and social sectors, 108 of which have achieved system integration in an all-round way By the end of 2015, a total of 317 million people were involved in the system integration area, of which 91.5% were managed by the human resources and social sectors and 7.2% by the health sector The expansion of the new version of the medical insurance catalog still needs to be started after the completion of the "two guarantees in one" catalog in each province and the determination of the bidding price of the corresponding products in each province The Department in charge of the medical insurance catalogue can integrate according to the local "two guarantees in one" catalogue, and calculate the cost of the drug through the new round of bidding price and dosage, and even determine the guidance price of medical insurance payment in one step How can drugs enter the medical insurance catalogue? The selected drugs must meet the four basic conditions of basic guarantee, consideration of urban and rural areas, clear scope of use and controllable cost According to current rumors, it has entered 15 Products of more than provincial medical insurance supplement catalogue will automatically enter the selection catalogue; products that have been included in all kinds of evidence-based medicine guidelines and clinical treatment guidelines will be included in the selection catalogue; products with cost-effective advantages (including multi competitive product varieties, domestic products with independent intellectual property rights, and long-term clinical recognition on the market) will also be included in the selection catalogue In addition, there is a risk that "adjuvants" will be kicked out of the list In the past, the selection criteria of the Ministry of human resources and social security also included that the drugs listed in the medical insurance catalog must be included in the Pharmacopoeia of our country; all drugs included in the catalog must be therapeutic drugs, excluding some drug categories that mainly play the role of nutrition and tonic; new drugs with good curative effect, reasonable price and convenient use should be included as far as possible; and drugs that enter the medical insurance catalog of most provinces and regions The above conditions reflect that there is a certain demand for the drugs marked "auxiliary drugs" in the medical insurance catalog in clinical use, but it is expected to retain its position in the medical insurance catalog, which needs to be supplemented by clinical evidence In addition, how many provincial and district health insurance supplement directories to enter is not a clear statement in the past New drugs will be strictly controlled if the medical insurance goes through the bottom According to the official website of the Ministry of human resources and social security, February 26 this year In the context of the rapid growth of medical expenses, medical insurance funds are facing more and more pressure to pay, the growth of expenditure is higher than the growth of income, and even a considerable number of provinces have the situation that the current income can not offset the expenditure, and the risk of fund "underperforming" is increasingly prominent It is expected that the pressure of the increase and elimination of the medical insurance drug catalog will also be calculated by the human resources department In general, the Human Resources Department expects that the increased expenditure of the expansion of the medical insurance catalog will not account for a large proportion compared with the total plate of the medical insurance fund, and it is better not to bring too much pressure on the medical insurance fund From this point of view, the number of exclusive new drug products entering the medical insurance will be strictly controlled, unless such new drug products are used in the clinical first-line or essential clinical products currently on the market have no replaceable competitors Major innovative drugs, especially the treatment of major diseases, are expected to enter the new version of the medical insurance catalog, such as 1.1 class of new anti-tumor drugs New drugs or imported drugs that are negotiated to reduce prices nationwide are also expected to be officially included in the new medical insurance catalogue Most of the products that enter the supplementary catalogue of medical insurance of more than 15 provinces are auxiliary drugs? Among the drugs listed in the provincial supplementary medical insurance catalog, 80% of the products listed in more than 15 provincial medical insurance catalogs are injections, mainly for the treatment of cardiovascular and cerebrovascular diseases, antibiotics and nutritional supplements Many products added to the catalogue are still in the list of auxiliary drugs or key monitoring drugs published by some provinces, such as compound coenzyme, cerebrosine and carnosine, invert sugar electrolyte, mannan peptide, calf serum deproteinization, Shenxiong glucose, oxiracetam, ribonucleic acid, troxerutin, Xuebijing and other injections From the current trend, unless there is clinical data to confirm the clinical necessity of such products, it is difficult to enter the national health insurance Pay attention to the Chinese patent medicine for women and children entering the 2015 Pharmacopoeia There are 440 new varieties of Chinese medicine, 492 chemicals and 13 biological products in the 2015 Pharmacopoeia The above 945 products are expected to enter the selection catalogue   As the Chinese traditional medicine for women and children, xiaoerqixingcha oral liquid, xiaoerhuashi oral liquid, xiaoerfeike granules, xiaoertuihe mixture (xiaoertuihe oral liquid), xiaoerchaigui oral liquid, xiaoerchaigui antipyretic granules, xiaoerreshuiqing granules, xiaoerreshuiqing syrup, xiaoerxiaojizhike oral liquid, xiaoerxuanqiqiqingre granules and other products supported by the state are expected to be selected In addition, during the period of protection, women and children's medicines of traditional Chinese medicine with significant curative effect for specific diseases may also be included in the medical insurance catalogue, such as Xiaoer Shikou powder, Xiaoer baibei cough syrup, Xiaoer Shuangqing granules, Xiaoer Xiaoji cough oral liquid and Fu Ganlin oral liquid, etc.