The focus of medical insurance negotiations-the way to "negotiation reserve price"

In the past two days, a negotiation involving 1.
4 billion people has attracted the attention of many pharmaceutical people.
This is the medical insurance negotiation
.

Medical insurance negotiation is the key to whether a drug can be included in the medical insurance and at what price it can enter the medical insurance catalog.

Through medical insurance negotiations in the past two years, many world-renowned pharmaceutical companies' "noble drugs" finally offered "civilian" prices, and many imported drugs were given the lowest prices in the world.
How did the intense medical insurance negotiations proceed? What about? What are the stories behind the scenes? The author briefly introduces you here
.

The core of the negotiation is to negotiate the appropriate price for the purchase of the drug
.

To let it enter the medical insurance catalog, it can take into account the burden of patients and the affordability of medical insurance funds, but also consider the intention of pharmaceutical companies-companies can have a reasonable profit margin, and at the same time occupy the market to the greatest extent, to achieve the improvement of overall benefits

So the question is, how is the negotiated reasonable price determined?

For companies, innovative drugs have huge research and development costs, and companies have their own plans for the price of drugs
.

On the other hand, based on the affordability of the medical insurance fund and the cost-effectiveness of medicines, the medical insurance bureau must also make professional judgments

The reserve price of medicines for the medical insurance party cannot be determined by the administrative department
.

In order to ensure the reasonableness of the price setting, there must be some data or relevant evidence to support the price setting, and some professional methods will be used in the price calculation process

Our medical insurance fund is a big pot of soup.
How much can be used to buy or negotiate with companies to add new drug catalogs.
The main job of medical insurance experts is to make calculations within the scope of this big pot of soup, with a limited amount of money.
To buy the best medicines, through the joint calculations of these two groups of experts, the base price of each medicine negotiation is finally determined.
This base price determines whether the negotiation can be successful and is also the base price negotiated by the medical insurance department
.

There are many uncertainties in the negotiation process.
Pharmaceutical companies will make full estimates before the negotiation, but they certainly have no way to know the reserve price.
Therefore, from the company's perspective, it is necessary to prepare for various situations
.

The reserve price is the bottom line of the medical insurance bureau, and it is also the qualified line for enterprises to enter the medical insurance
.

Some companies try to take shortcuts, observe the composition of experts near the entrance of the medical insurance bureau, and even want to make small moves in private to contact them individually, etc.

On the other hand, the entire system and process of calculation also put a "safety lock" on the fairness and justice of the negotiation work
.

The calculations of the pharmaceutical economists are calculated independently by each expert, the expert group has a unified standard, and the confidentiality agreement is also signed
.

From the system point of view, the calculation team does not know which negotiation team member the drug you calculate will ultimately be evaluated.

Medicines and experts correspond one by one, and each is responsible for their own varieties.
Naturally, the responsibilities are more accurate.
Coupled with uniform standards, the result is more fair
.

On the other hand, the parallel calculations by the Pharmaceutical Economist Group and the Fund Measurement Expert Group do not interfere with each other.

The reserve price is derived from the two groups of experts finally giving us two sets of data, one is the price of a pharmaceutical economist, and the other is the price of the medical insurance fund calculation group.
These two groups are calculated in parallel, and each other does not know each other's reserve price, until the last two groups The parallel result is formed in a completely confidential state according to the fixed rules determined in advance to form the final bottom price of the medical insurance party, and it is strictly confidential, and will be handed over to the negotiation team at the negotiation site, so we can try to ensure that the bottom price is not leaked out during the entire process.

.

Before the final reserve price is determined, in order to dispel the concerns of enterprises, the leaders of each measurement team will communicate with the representatives of each pharmaceutical company on the method of calculating the drug price one by one.
After the feedback from both parties, the medical insurance bureau will integrate the contents of all parties.
, And finally get the negotiated price of each medicine
.

It is strictly confidential in the process of determining the drugs to be negotiated, calculating the negotiated price, and communicating with the company.
This reserve price has become the "card" in the hands of the negotiating team, so that the negotiating team can pass the "soul" time after time in the negotiation with the company.
"Bargaining" lowered the price.
After rounds of arduous negotiations, even business representatives shed tears when they were cut
.

After the first round of quotations are shortlisted, experts and companies have to negotiate further to make the company's quotation closer to the reserve price or even lower than the reserve price.
After the final round of quotations is successful, the company is considered to be the final negotiation success
.

According to the figures released by the Medical Insurance Bureau, calculated based on the actual reimbursement ratio of 50%, the patient's personal out-of-pocket payment will be reduced to less than 20% of the original.
Such a change will benefit nearly 1.
4 billion Chinese people
.

For pharmaceutical companies, the entry of innovative drugs into the medical insurance catalog is to seize market opportunities, while for medical insurance funds, it saves money and buys them.