Price reduction of patent drugs: it's hard to get dividends if medical insurance doesn't "take over"

Source: Science and technology daily September 14, 2016 patent medicine is very expensive and cannot be used, which has been a pain in the heart of many patients Drug price reduction for more than two months, how about the national implementation? Does the patient enjoy the dividend after price reduction? For this reason, the reporter visited several hospitals recently On May 20, this year, the national health and Family Planning Commission issued the notice on centralized procurement of drugs under national negotiation, and published the results of national drug price negotiation: tenofovir dipivoxil for chronic hepatitis B and exetane and gefitinib for non-small cell lung cancer, with price reductions of 67%, 54% and 55% respectively In order to better implement the policy, the health and Family Planning Commission also requires all regions to do a good job in linking up with the medical insurance payment policy According to the data reported by the national health and Family Planning Commission last year, the drug cost of hepatitis B patients can be saved by 12 thousand a year There are about 90 million hepatitis B virus carriers in China, of which about 28 million are chronic hepatitis B patients Chronic hepatitis B is the main cause of liver cirrhosis and liver cancer Therefore, it is in line with the clinical practice of Chinese medicine to choose viral hepatitis in the first national drug price negotiation pilot As the first-line oral drug for chronic hepatitis B recommended by the World Health Organization and the latest guideline for the prevention and treatment of chronic hepatitis B (updated in 2015), tenofovir dipivoxil belongs to the patent drug The monthly average drug cost before the negotiation is about 1500 yuan, and the monthly average drug cost after the negotiation is reduced to 490 yuan This means that a hepatitis B patient can save 1010 yuan a month and about 12000 yuan a year In addition, another first-line hepatitis B drug, entecavir, recommended by the guide, costs about 820 yuan per month Currently, 10 generic companies are selling entecavir on the market, according to insight For patients with hepatitis B, tenofovir dipivoxil is not the only drug available, but this price reduction is equivalent to a more affordable choice, to a certain extent, reducing the drug expenditure of patients At the same time, it will promote the process of antiviral treatment of chronic hepatitis B in China, and also significantly reduce the incidence of cirrhosis and liver cancer The effect of targeted drugs is better than that of chemotherapy Two of the three drugs included in the national drug price negotiation are targeted drugs for the treatment of non-small cell lung cancer For a long time, this kind of medicine has a high price and many lung cancer patients can not afford it The World Health Organization predicts that by 2025, the number of new lung cancer cases in China will exceed 1 million every year, becoming the world's largest lung cancer country "Clinically, lung cancer can be divided into non-small cell lung cancer and small cell lung cancer Among them, non-small cell lung cancer is the most common, accounting for 80% to 85% of the total number of lung cancer Most patients have entered the advanced stage when they are diagnosed For these patients, in the past, when there was only chemotherapy, the average survival time was only 8-10 months " In recent years, with the arrival of precision medicine and standardized diagnosis and treatment mode, targeted drug therapy has become an important means of clinical treatment of non-small cell lung cancer, Professor Fang Jian, director of the second Department of thoracic oncology, Peking University Cancer Hospital, told Science and technology daily Professor Fang Jian further explained that the imported target drug yiruisha (gefitinib), which was included in the new rural cooperative medical system, as the first-line drug for the treatment of advanced lung cancer with EGFR gene mutation, has become the first-line standard treatment recommended by various clinical guidelines at home and abroad "Clinical studies have confirmed that the average survival time of patients taking targeted drugs is extended to 2.5-3 years, and some patients can obtain longer survival time." Previously, due to the high price, some patients can only choose chemotherapy to maintain Before linking up the national drug price negotiation results, take Iressa (gefitinib) as an example, lung cancer patients have to bear 500 yuan of drug cost per day After the implementation of the national drug price negotiation results, the daily expenditure is only 200 yuan On the basis of the national drug price negotiation and price reduction, the lung cancer patients in Beijing who participate in the new rural cooperative medical system can at least reimburse 50% of the average drug cost through the new rural cooperative medical system That is to say, the target drug can be used for treatment at a maximum cost of more than 100 yuan per day In addition, the patients with EGFR positive lung cancer can be reimbursed through NCMS It can be seen that the national drug price negotiation system, as well as the convergence of medical insurance policies such as the new rural cooperative medical system and serious illness insurance, not only reduce the drug price reasonably, but also greatly reduce the economic burden of patients with serious illness, and solve the practical problem of "poverty due to cancer" return to poverty Patients in Beijing have been able to enjoy the dividend of price reduction Previously, Beijing Municipal Commission of health and family planning officially issued a document saying that in the procurement cycle from 2016 to 2017, all public medical institutions directly purchase three kinds of negotiated drugs on the Beijing centralized drug procurement platform according to the negotiated price results The reporter learned that Beijing's agricultural related areas will include negotiated drugs in the compensation scope of the new rural cooperative medical system In terms of reimbursement management, it can be used in the qualified district level and above designated medical institutions of NCMS Among them, ektinib and gefitinib are used in Beijing Cancer Hospital and Cancer Hospital of Chinese Academy of Medical Sciences, tenofovir ester is used in Beijing You'an Hospital Affiliated to Capital Medical University and Beijing Ditan Hospital Affiliated to Capital Medical University, and each medical institution shall be provided with a prescription or medical order by a physician above the Deputy director As a result, Beijing has become the first municipality directly under the central government to implement the results of drug price negotiation nationwide This means that patients can buy these three drugs at a price lower than half of the previous price At the same time, thanks to the follow-up of Beijing's new rural cooperative medical policy, patients will have a lower burden of treatment drugs, benefiting 2238000 new rural cooperative insurance participants in 13 agricultural areas in Beijing The implementation and further promotion of the policy can make these drugs with reduced prices cover a wider range of medical insurance population, and enable more patients to enjoy the "dividend" of national drug price negotiation and medical insurance policy convergence, using this advanced treatment means Medical insurance landing is the real welfare Despite the notice requirements, all regions should purchase online before the end of June, and connect with medical insurance to benefit patients as soon as possible But up to now, nearly a third of the provinces in the country have not connected the drugs with medical insurance Under the condition of uneven "docking" in the whole country, there is a great price contrast between the drugs for the same disease A staff member of the drug administration department of a provincial health and Family Planning Commission once revealed that a patient in Hubei even flew to Yunnan, the earliest place where the price of drugs began to be reduced, because "even if the plane ticket is included, it is still cheap" Experts, who declined to be named, said the policy was a boon for patients, but in reality, the implementation of drug price negotiations in many provinces has been hindered How to implement the substantial price reduction of patent drugs is the key Experts believe that the key to the implementation of the policy lies in the connection with the medical insurance For the common people, the real benefit is to implement the policy and get the cheap drugs that can be reimbursed within the scope of medical insurance Health insurance has not been implemented, and many work related to the new deal are facing bottlenecks After the announcement of the national negotiation results, the medical insurance should follow up quickly, include the drugs with reduced price into the purchase catalogue of the hospital, and strengthen the publicity and supervision of the reimbursement drugs for medical insurance used by the hospital and doctors The drug prices of enterprises have been reduced, and the reduced drugs have been included in the medical insurance smoothly, but the key is that doctors need to issue medical insurance reimbursement according to patients' conditions Strengthen the supervision of the hospital to prevent doctors from prescribing drugs in disorder, so that patients can afford to see and use drugs.