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Medical Network News on June 2 In the context of stricter medical insurance control fees and increasingly tight medical insurance funds, medical insurance payment standards will eventually be introduced.
Recently, a "Letter on Soliciting Opinions on Determining Basic Medical Insurance Drug Payment Standards (Consultation Draft)" has been circulated in the industry.
The document shows that the classification will be determined in conjunction with catalog entry negotiations and mass procurement.
Payment standards, clarify the responsibilities and powers of the national and provincial medical insurance departments, do a good job of linking up, and make steady progress.
The document shows that the classification will be determined in conjunction with catalog entry negotiations and mass procurement.
Payment standards, clarify the responsibilities and powers of the national and provincial medical insurance departments, do a good job of linking up, and make steady progress.
And implement dynamic adjustments to payment standards.
The adjustment cycle should be linked to the national medical insurance negotiations and the drug collection cycle.
In principle, it should be adjusted every two years.
The adjustment cycle should be linked to the national medical insurance negotiations and the drug collection cycle.
In principle, it should be adjusted every two years.
He also pointed out that from 2021, the provincial medical insurance bureaus should develop payment standards in a gradual and hierarchical manner.
In principle, all western medicines and proprietary Chinese medicines in the national medical insurance catalogue should be covered by the end of 2024.
In principle, all western medicines and proprietary Chinese medicines in the national medical insurance catalogue should be covered by the end of 2024.
National talks on drugs: the payment standard is determined by the common name according to the negotiation rules
According to the negotiation rules, the national unified payment standard shall be determined according to the common name.
If the negotiated drug has the expiration of the agreement, the drug with the same generic name is listed, and the drug is included in the centralized procurement of drugs, the provincial medical insurance department can adjust the drug’s price based on market competition, the price of the drug with the same generic name, or the results of the centralized procurement of drugs, etc.
Payment standards.
If the negotiated drug has the expiration of the agreement, the drug with the same generic name is listed, and the drug is included in the centralized procurement of drugs, the provincial medical insurance department can adjust the drug’s price based on market competition, the price of the drug with the same generic name, or the results of the centralized procurement of drugs, etc.
Payment standards.
Centralized procurement of drugs: the payment standard is determined based on the selected price
The country selects selected drugs and determines the medical insurance payment standard based on the selected price.
The same medical insurance payment standard shall be implemented for the original research drugs, reference preparations, and generic drugs that have passed the consistency evaluation under the same generic name.
The same medical insurance payment standard shall be implemented for the original research drugs, reference preparations, and generic drugs that have passed the consistency evaluation under the same generic name.
For the selected drugs in provincial centralized procurement, the provincial medical insurance department shall determine the medical insurance payment standard according to the selected price:
For varieties that have passed the consistency evaluation (including deemed over-evaluation and biosimilar drugs, the same below), a unified payment standard shall be determined according to the common name according to the collection results;
For drugs that have not been covered by the consistency evaluation, a unified payment standard shall be determined in principle according to the results of centralized procurement and the same generic name and the same quality group.
Establish a gradual adjustment mechanism for varieties with a large gap between actual prices and payment standards.
If the actual price is more than twice the payment standard, the payment standard should be adjusted gradually, and the adjustment will be in place within 2-3 years.
The provincial medical insurance department can determine the price red line, and limit the drugs that exceed the red line in links such as linking to the Internet.
Encourage the centralized procurement of non-selected pharmaceutical companies to take the initiative to reduce prices, converge towards payment standards, and reduce the burden on patients.
If the actual price is more than twice the payment standard, the payment standard should be adjusted gradually, and the adjustment will be in place within 2-3 years.
The provincial medical insurance department can determine the price red line, and limit the drugs that exceed the red line in links such as linking to the Internet.
Encourage the centralized procurement of non-selected pharmaceutical companies to take the initiative to reduce prices, converge towards payment standards, and reduce the burden on patients.
For generic drugs that have not been evaluated, the medical insurance payment standard shall not be higher than that of drugs that have passed evaluation under the same generic name.
Narcotics and first-class psychoactive drugs: payment standards are determined according to government pricing
Government-priced narcotic drugs and first-class psychoactive drugs shall be paid according to the common name of the government to determine the unified national payment standard.
For exclusive products that have not yet implemented government pricing, those who have negotiated access to the National Medical Insurance Catalogue will be subject to payment standard management with reference to negotiated drugs.
For exclusive products that have not yet implemented government pricing, those who have negotiated access to the National Medical Insurance Catalogue will be subject to payment standard management with reference to negotiated drugs.
Other drugs: In principle, the payment standard is determined based on the provincial purchase price
For drugs that implement centralized procurement other than the aforementioned three cases, a coordination mechanism between the payment standard and the procurement price of the provincial procurement platform (including the record price, the same below) shall be established.
In principle, the payment will be determined based on the procurement price of the provincial procurement platform standard.
For drugs with the same generic name and specifications produced by the same enterprise, the payment standards within the province should be consistent.
In principle, the payment will be determined based on the procurement price of the provincial procurement platform standard.
For drugs with the same generic name and specifications produced by the same enterprise, the payment standards within the province should be consistent.
It is encouraged to determine the payment standards for drugs with different acid radicals, bases, the same main chemical composition and the same route of administration according to the common name or by selecting representative specifications and dosage forms.
The document also pointed out that the payment standard is an important benchmark for the settlement of drug costs included in the scope of medical insurance payment.
Patients use drugs whose prices are not higher than the payment standard, and patients and medical insurance will be shared proportionally based on the actual sales price.
Patients use drugs whose prices are higher than the payment standard, and the part that exceeds the payment standard is paid by the patient, and the part within the payment standard is shared by the patient and the medical insurance in proportion.
Patients use drugs whose prices are not higher than the payment standard, and patients and medical insurance will be shared proportionally based on the actual sales price.
Patients use drugs whose prices are higher than the payment standard, and the part that exceeds the payment standard is paid by the patient, and the part within the payment standard is shared by the patient and the medical insurance in proportion.
Medical institutions and medical staff use drugs whose prices are higher than the payment standard, and must comply with the principle of clinical necessity, and at the same time, the patient's right of informed consent must be guaranteed.
Review of policies related to medical insurance payment standards
In fact, medical insurance payment standards already have mature experience in the international arena.
In China, although the standards have not yet been unified, the country has been trying to unify medical insurance payment standards over the years.
In China, although the standards have not yet been unified, the country has been trying to unify medical insurance payment standards over the years.
First of all, from a theoretical point of view, the formulation of medical insurance payment standards is a reform of the formation mechanism of drug prices.
The medical insurance payment standard refers to the uniform payment price of medical insurance according to the common name.
It is the floor price.
Drugs that exceed the medical insurance payment standard may be shared by the patient and the hospital.
The medical insurance payment standard refers to the uniform payment price of medical insurance according to the common name.
It is the floor price.
Drugs that exceed the medical insurance payment standard may be shared by the patient and the hospital.
We know that the original drug price was the highest retail price set by the Development and Reform Commission, and then the actual transaction price was formed through bidding in various provinces and cities.
Since June 2015, the National Development and Reform Commission has liberalized drug price management and cancelled most of the government pricing of drugs.
The actual transaction prices of drugs are mainly formed by market competition.
At the same time, the mechanism for guiding the formation of reasonable drug prices is explored through the formulation of medical insurance payment standards.
Since then, the "dual pricing mechanism" of hospital drug sales prices has changed from the previous "Development and Reform Commission pricing %20 winning bid price" to "winning bid price %20 medical insurance payment standard".
The actual transaction prices of drugs are mainly formed by market competition.
At the same time, the mechanism for guiding the formation of reasonable drug prices is explored through the formulation of medical insurance payment standards.
Since then, the "dual pricing mechanism" of hospital drug sales prices has changed from the previous "Development and Reform Commission pricing %20 winning bid price" to "winning bid price %20 medical insurance payment standard".
In May 2015, the Office of the State Council issued the 2014 Work Summary of Deepening the Reform of the Medical and Health System and the Key Tasks in 2015, requiring the Ministry of Human Resources and Social Security and the National Health and Family Planning Commission to be responsible for completing the formulation of medical insurance payment standards by September 31 of that year .
Regrettably, the standard could not be introduced that year.
Regrettably, the standard could not be introduced that year.
In April 2016, the General Office of the State Council's "Key Tasks for Deepening the Reform of the Medical and Health System in 2016" required: "Develop basic medical insurance drug payment standards in accordance with relevant national policies.
"
"
On November 24, 2016, the Ministry of Human Resources and Social Security issued the " Guiding Opinions on the Establishment of Standards for the Payment of Basic Medical Insurance Drugs (Draft for Comment)", but so far, the official draft has not been issued.
The "Draft for Solicitation of Opinions" clearly establishes the medical insurance payment standard in accordance with the (drug) generic name in principle.
The "Draft for Solicitation of Opinions" clearly establishes the medical insurance payment standard in accordance with the (drug) generic name in principle.
1) For drugs that have passed the consistency evaluation or have a small difference in quality, the payment standard shall be established based on the generic name in principle.
For drugs with the same generic name (same dosage form and specification), the unified payment standard for drugs with the generic name shall be established according to the smallest dosage unit.
For drugs with the same generic name (same dosage form and specification), the unified payment standard for drugs with the generic name shall be established according to the smallest dosage unit.
2) Gradually determine the payment standards for drugs of different dosage forms and specifications under the same generic name by selecting representative products and calculating the price difference.
Relevant rules can be implemented with reference to the rules for drug price difference comparison.
Medicines limited to children's use should be listed separately as representative products.
Relevant rules can be implemented with reference to the rules for drug price difference comparison.
Medicines limited to children's use should be listed separately as representative products.
In recent years, relevant departments have also begun to try to unify relevant medical insurance payment standards on national centralized procurement and medical insurance negotiation drugs.
On February 2, 2018, the Ministry of Human Resources and Social Security issued a notice on negotiating the payment of generic drugs.
The notice clarified that the negotiated generic drugs belong to the scope of the basic medical insurance, work-related injury insurance and maternity insurance drugs.
The payment standards for the negotiated generic drugs are temporarily based on generic drugs.
The actual market sales price of pharmaceuticals shall be implemented, but shall not exceed the payment standard of the corresponding negotiated drugs in Document 54.
If the specifications of the generic drugs are inconsistent with the negotiated drugs, please refer to the "Notice of the National Development and Reform Commission on Printing and Distributing the "Drug Price Difference Rules" (Fagai Price [2452]) for calculation.
The notice clarified that the negotiated generic drugs belong to the scope of the basic medical insurance, work-related injury insurance and maternity insurance drugs.
The payment standards for the negotiated generic drugs are temporarily based on generic drugs.
The actual market sales price of pharmaceuticals shall be implemented, but shall not exceed the payment standard of the corresponding negotiated drugs in Document 54.
If the specifications of the generic drugs are inconsistent with the negotiated drugs, please refer to the "Notice of the National Development and Reform Commission on Printing and Distributing the "Drug Price Difference Rules" (Fagai Price [2452]) for calculation.
On November 28, 2019, the National Medical Insurance Administration held a press conference to introduce the status of the 2019 National Medical Insurance Negotiation Access Drug List.
This negotiation has determined the national uniform payment standard for 97 drugs, of which 47 drugs have applied for confidentiality, and the payment standard agreement will not be publicly announced.
The validity period ends on December 31, 2021.
After the validity period expires, the payment standard shall be adjusted in accordance with the relevant provisions of the medical insurance.
This negotiation has determined the national uniform payment standard for 97 drugs, of which 47 drugs have applied for confidentiality, and the payment standard agreement will not be publicly announced.
The validity period ends on December 31, 2021.
After the validity period expires, the payment standard shall be adjusted in accordance with the relevant provisions of the medical insurance.
During the validity period, if there is a drug with the same generic name (generic drug) on the market, the medical insurance department will adjust the payment standard for the drug according to the price level of the generic drug, and the generic name can also be included in the scope of centralized procurement.
If there is a major national policy adjustment or the actual price of the drug market is significantly lower than the current payment standard, the National Medical Insurance Bureau will negotiate with the enterprise to re-set the payment standard and notify separately.
As for the national centralized procurement of drugs, the coordination of payment standards and purchase prices for centralized procurement of drugs and medical insurance should be explored.
On January 1, 2019, the State Council issued the "National Organization for the Centralized Procurement and Use of Drugs Pilot Program", clarifying that for centralized procurement of drugs within the scope of the medical insurance catalog, the centralized procurement price shall be used as the medical insurance payment standard.
In principle, the same generic name shall be used.
For the original research drugs, reference preparations, and generic drugs that have passed the consistency evaluation, the medical insurance fund shall be settled according to the same payment standard.
In principle, the same generic name shall be used.
For the original research drugs, reference preparations, and generic drugs that have passed the consistency evaluation, the medical insurance fund shall be settled according to the same payment standard.
Patients use drugs whose price is higher than the payment standard, and the part that exceeds the payment standard is paid by the patient.
If the price of the drug used by the patient is quite different from the centralized purchase price of the selected drug, the payment standard can be adjusted gradually, and the adjustment will be in place within 2-3 years.
And formulate supporting policies and measures; patients who use drugs whose prices are lower than the payment standard will be paid at the actual price.
If the price of the drug used by the patient is quite different from the centralized purchase price of the selected drug, the payment standard can be adjusted gradually, and the adjustment will be in place within 2-3 years.
And formulate supporting policies and measures; patients who use drugs whose prices are lower than the payment standard will be paid at the actual price.
In the related documents of centralized procurement and expansion, it is specified that medical insurance designated retail pharmacies participating in this purchase can be allowed to increase the price appropriately based on the selected price, and the part exceeding the payment standard shall be paid by the patient, and the part below the payment standard shall be reimbursed by the medical insurance according to the regulations.
.
.
In September 2019, the National Medical Insurance Administration posted its response letter to the National People's Congress representatives on the proposal for settlement of medical insurance in different places on the official website of the National Medical Insurance Administration, which also revealed the concept and implementation of a unified medical insurance payment standard and a unified national medical insurance catalog.
At present, there is no lack of exploration experience in various places that is worthy of high-level reference.
Zhejiang, Fujian, Anhui, Tianjin and other places are exploring and practicing.
In the future, not only will the unified payment standard under the common name be used, but the hospital and the retail market will also achieve price synergy.
Zhejiang, Fujian, Anhui, Tianjin and other places are exploring and practicing.
In the future, not only will the unified payment standard under the common name be used, but the hospital and the retail market will also achieve price synergy.
Once the medical insurance payment standards are unified, there will be more opportunities to stay in the market, competition will be more fair and effective, and the role of product brand and quality will also be prominent.
After the same product, the same quality, and the same price, the fight is the brand.
The same payment standard is higher than the payment standard.
Patients pay by themselves.
Patients who are price-sensitive will choose cheaper drugs.
Patients who value the brand more may bear part of the cost by themselves.
Choose the original research drug.
Both choices make sense and are left to the market (patients) to decide.
After the same product, the same quality, and the same price, the fight is the brand.
The same payment standard is higher than the payment standard.
Patients pay by themselves.
Patients who are price-sensitive will choose cheaper drugs.
Patients who value the brand more may bear part of the cost by themselves.
Choose the original research drug.
Both choices make sense and are left to the market (patients) to decide.
Medical Network News on June 2 In the context of stricter medical insurance control fees and increasingly tight medical insurance funds, medical insurance payment standards will eventually be introduced.
Recently, a "Letter on Soliciting Opinions on Determining Basic Medical Insurance Drug Payment Standards (Consultation Draft)" has been circulated in the industry.
The document shows that the classification will be determined in conjunction with catalog entry negotiations and mass procurement.
Payment standards, clarify the responsibilities and powers of the national and provincial medical insurance departments, do a good job of linking up, and make steady progress.
The document shows that the classification will be determined in conjunction with catalog entry negotiations and mass procurement.
Payment standards, clarify the responsibilities and powers of the national and provincial medical insurance departments, do a good job of linking up, and make steady progress.
And implement dynamic adjustments to payment standards.
The adjustment cycle should be linked to the national medical insurance negotiations and the drug collection cycle.
In principle, it should be adjusted every two years.
The adjustment cycle should be linked to the national medical insurance negotiations and the drug collection cycle.
In principle, it should be adjusted every two years.
He also pointed out that from 2021, the provincial medical insurance bureaus should develop payment standards in a gradual and hierarchical manner.
In principle, all western medicines and proprietary Chinese medicines in the national medical insurance catalogue should be covered by the end of 2024.
In principle, all western medicines and proprietary Chinese medicines in the national medical insurance catalogue should be covered by the end of 2024.
National talks on drugs: the payment standard is determined by the common name according to the negotiation rules
According to the negotiation rules, the national unified payment standard shall be determined according to the common name.
If the negotiated drug has the expiration of the agreement, the drug with the same generic name is listed, and the drug is included in the centralized procurement of drugs, the provincial medical insurance department can adjust the drug’s price based on market competition, the price of the drug with the same generic name, or the results of the centralized procurement of drugs, etc.
Payment standards.
If the negotiated drug has the expiration of the agreement, the drug with the same generic name is listed, and the drug is included in the centralized procurement of drugs, the provincial medical insurance department can adjust the drug’s price based on market competition, the price of the drug with the same generic name, or the results of the centralized procurement of drugs, etc.
Payment standards.
Centralized procurement of drugs: the payment standard is determined based on the selected price
The country selects selected drugs and determines the medical insurance payment standard based on the selected price.
The same medical insurance payment standard shall be implemented for the original research drugs, reference preparations, and generic drugs that have passed the consistency evaluation under the same generic name.
The same medical insurance payment standard shall be implemented for the original research drugs, reference preparations, and generic drugs that have passed the consistency evaluation under the same generic name.
For the selected drugs in provincial centralized procurement, the provincial medical insurance department shall determine the medical insurance payment standard according to the selected price:
For varieties that have passed the consistency evaluation (including deemed over-evaluation and biosimilar drugs, the same below), a unified payment standard shall be determined according to the common name according to the collection results;
For drugs that have not been covered by the consistency evaluation, a unified payment standard shall be determined in principle according to the results of centralized procurement and the same generic name and the same quality group.
Establish a gradual adjustment mechanism for varieties with a large gap between actual prices and payment standards.
If the actual price is more than twice the payment standard, the payment standard should be adjusted gradually, and the adjustment will be in place within 2-3 years.
The provincial medical insurance department can determine the price red line, and limit the drugs that exceed the red line in links such as linking to the Internet.
Encourage the centralized procurement of non-selected pharmaceutical companies to take the initiative to reduce prices, converge towards payment standards, and reduce the burden on patients.
If the actual price is more than twice the payment standard, the payment standard should be adjusted gradually, and the adjustment will be in place within 2-3 years.
The provincial medical insurance department can determine the price red line, and limit the drugs that exceed the red line in links such as linking to the Internet.
Encourage the centralized procurement of non-selected pharmaceutical companies to take the initiative to reduce prices, converge towards payment standards, and reduce the burden on patients.
For generic drugs that have not been evaluated, the medical insurance payment standard shall not be higher than that of drugs that have passed evaluation under the same generic name.
Narcotics and first-class psychoactive drugs: payment standards are determined according to government pricing
Government-priced narcotic drugs and first-class psychoactive drugs shall be paid according to the common name of the government to determine the unified national payment standard.
For exclusive products that have not yet implemented government pricing, those who have negotiated access to the National Medical Insurance Catalogue will be subject to payment standard management with reference to negotiated drugs.
For exclusive products that have not yet implemented government pricing, those who have negotiated access to the National Medical Insurance Catalogue will be subject to payment standard management with reference to negotiated drugs.
Other drugs: In principle, the payment standard is determined based on the provincial purchase price
For drugs that implement centralized procurement other than the aforementioned three cases, a coordination mechanism between the payment standard and the procurement price of the provincial procurement platform (including the record price, the same below) shall be established.
In principle, the payment will be determined based on the procurement price of the provincial procurement platform standard.
For drugs with the same generic name and specifications produced by the same enterprise, the payment standards within the province should be consistent.
In principle, the payment will be determined based on the procurement price of the provincial procurement platform standard.
For drugs with the same generic name and specifications produced by the same enterprise, the payment standards within the province should be consistent.
It is encouraged to determine the payment standards for drugs with different acid radicals, bases, the same main chemical composition and the same route of administration according to the common name or by selecting representative specifications and dosage forms.
The document also pointed out that the payment standard is an important benchmark for the settlement of drug costs included in the scope of medical insurance payment.
Patients use drugs whose prices are not higher than the payment standard, and patients and medical insurance will be shared proportionally based on the actual sales price.
Patients use drugs whose prices are higher than the payment standard, and the part that exceeds the payment standard is paid by the patient, and the part within the payment standard is shared by the patient and the medical insurance in proportion.
Patients use drugs whose prices are not higher than the payment standard, and patients and medical insurance will be shared proportionally based on the actual sales price.
Patients use drugs whose prices are higher than the payment standard, and the part that exceeds the payment standard is paid by the patient, and the part within the payment standard is shared by the patient and the medical insurance in proportion.
Medical institutions and medical staff use drugs whose prices are higher than the payment standard, and must comply with the principle of clinical necessity, and at the same time, the patient's right of informed consent must be guaranteed.
Review of policies related to medical insurance payment standards
In fact, medical insurance payment standards already have mature experience in the international arena.
In China, although the standards have not yet been unified, the country has been trying to unify medical insurance payment standards over the years.
In China, although the standards have not yet been unified, the country has been trying to unify medical insurance payment standards over the years.
First of all, from a theoretical point of view, the formulation of medical insurance payment standards is a reform of the formation mechanism of drug prices.
The medical insurance payment standard refers to the uniform payment price of medical insurance according to the common name.
It is the floor price.
Drugs that exceed the medical insurance payment standard may be shared by the patient and the hospital.
The medical insurance payment standard refers to the uniform payment price of medical insurance according to the common name.
It is the floor price.
Drugs that exceed the medical insurance payment standard may be shared by the patient and the hospital.
We know that the original drug price was the highest retail price set by the Development and Reform Commission, and then the actual transaction price was formed through bidding in various provinces and cities.
Since June 2015, the National Development and Reform Commission has liberalized drug price management and cancelled most of the government pricing of drugs.
The actual transaction prices of drugs are mainly formed by market competition.
At the same time, the mechanism for guiding the formation of reasonable drug prices is explored through the formulation of medical insurance payment standards.
Since then, the "dual pricing mechanism" of hospital drug sales prices has changed from the previous "Development and Reform Commission pricing %20 winning bid price" to "winning bid price %20 medical insurance payment standard".
The actual transaction prices of drugs are mainly formed by market competition.
At the same time, the mechanism for guiding the formation of reasonable drug prices is explored through the formulation of medical insurance payment standards.
Since then, the "dual pricing mechanism" of hospital drug sales prices has changed from the previous "Development and Reform Commission pricing %20 winning bid price" to "winning bid price %20 medical insurance payment standard".
In May 2015, the Office of the State Council issued the 2014 Work Summary of Deepening the Reform of the Medical and Health System and the Key Tasks in 2015, requiring the Ministry of Human Resources and Social Security and the National Health and Family Planning Commission to be responsible for completing the formulation of medical insurance payment standards by September 31 of that year .
Regrettably, the standard could not be introduced that year.
Regrettably, the standard could not be introduced that year.
In April 2016, the General Office of the State Council's "Key Tasks for Deepening the Reform of the Medical and Health System in 2016" required: "Develop basic medical insurance drug payment standards in accordance with relevant national policies.
"
"
On November 24, 2016, the Ministry of Human Resources and Social Security issued the " Guiding Opinions on the Establishment of Standards for the Payment of Basic Medical Insurance Drugs (Draft for Comment)", but so far, the official draft has not been issued.
The "Draft for Solicitation of Opinions" clearly establishes the medical insurance payment standard in accordance with the (drug) generic name in principle.
The "Draft for Solicitation of Opinions" clearly establishes the medical insurance payment standard in accordance with the (drug) generic name in principle.
1) For drugs that have passed the consistency evaluation or have a small difference in quality, the payment standard shall be established based on the generic name in principle.
For drugs with the same generic name (same dosage form and specification), the unified payment standard for drugs with the generic name shall be established according to the smallest dosage unit.
For drugs with the same generic name (same dosage form and specification), the unified payment standard for drugs with the generic name shall be established according to the smallest dosage unit.
2) Gradually determine the payment standards for drugs of different dosage forms and specifications under the same generic name by selecting representative products and calculating the price difference.
Relevant rules can be implemented with reference to the rules for drug price difference comparison.
Medicines limited to children's use should be listed separately as representative products.
Relevant rules can be implemented with reference to the rules for drug price difference comparison.
Medicines limited to children's use should be listed separately as representative products.
In recent years, relevant departments have also begun to try to unify relevant medical insurance payment standards on national centralized procurement and medical insurance negotiation drugs.
On February 2, 2018, the Ministry of Human Resources and Social Security issued a notice on negotiating the payment of generic drugs.
The notice clarified that the negotiated generic drugs belong to the scope of the basic medical insurance, work-related injury insurance and maternity insurance drugs.
The payment standards for the negotiated generic drugs are temporarily based on generic drugs.
The actual market sales price of pharmaceuticals shall be implemented, but shall not exceed the payment standard of the corresponding negotiated drugs in Document 54.
If the specifications of the generic drugs are inconsistent with the negotiated drugs, please refer to the "Notice of the National Development and Reform Commission on Printing and Distributing the "Drug Price Difference Rules" (Fagai Price [2452]) for calculation.
The notice clarified that the negotiated generic drugs belong to the scope of the basic medical insurance, work-related injury insurance and maternity insurance drugs.
The payment standards for the negotiated generic drugs are temporarily based on generic drugs.
The actual market sales price of pharmaceuticals shall be implemented, but shall not exceed the payment standard of the corresponding negotiated drugs in Document 54.
If the specifications of the generic drugs are inconsistent with the negotiated drugs, please refer to the "Notice of the National Development and Reform Commission on Printing and Distributing the "Drug Price Difference Rules" (Fagai Price [2452]) for calculation.
On November 28, 2019, the National Medical Insurance Administration held a press conference to introduce the status of the 2019 National Medical Insurance Negotiation Access Drug List.
This negotiation has determined the national uniform payment standard for 97 drugs, of which 47 drugs have applied for confidentiality, and the payment standard agreement will not be publicly announced.
The validity period ends on December 31, 2021.
After the validity period expires, the payment standard shall be adjusted in accordance with the relevant provisions of the medical insurance.
This negotiation has determined the national uniform payment standard for 97 drugs, of which 47 drugs have applied for confidentiality, and the payment standard agreement will not be publicly announced.
The validity period ends on December 31, 2021.
After the validity period expires, the payment standard shall be adjusted in accordance with the relevant provisions of the medical insurance.
During the validity period, if there is a drug with the same generic name (generic drug) on the market, the medical insurance department will adjust the payment standard for the drug according to the price level of the generic drug, and the generic name can also be included in the scope of centralized procurement.
If there is a major national policy adjustment or the actual price of the drug market is significantly lower than the current payment standard, the National Medical Insurance Bureau will negotiate with the enterprise to re-set the payment standard and notify separately.
As for the national centralized procurement of drugs, the coordination of payment standards and purchase prices for centralized procurement of drugs and medical insurance should be explored.
On January 1, 2019, the State Council issued the "National Organization for the Centralized Procurement and Use of Drugs Pilot Program", clarifying that for centralized procurement of drugs within the scope of the medical insurance catalog, the centralized procurement price shall be used as the medical insurance payment standard.
In principle, the same generic name shall be used.
For the original research drugs, reference preparations, and generic drugs that have passed the consistency evaluation, the medical insurance fund shall be settled according to the same payment standard.
In principle, the same generic name shall be used.
For the original research drugs, reference preparations, and generic drugs that have passed the consistency evaluation, the medical insurance fund shall be settled according to the same payment standard.
Patients use drugs whose price is higher than the payment standard, and the part that exceeds the payment standard is paid by the patient.
If the price of the drug used by the patient is quite different from the centralized purchase price of the selected drug, the payment standard can be adjusted gradually, and the adjustment will be in place within 2-3 years.
And formulate supporting policies and measures; patients who use drugs whose prices are lower than the payment standard will be paid at the actual price.
If the price of the drug used by the patient is quite different from the centralized purchase price of the selected drug, the payment standard can be adjusted gradually, and the adjustment will be in place within 2-3 years.
And formulate supporting policies and measures; patients who use drugs whose prices are lower than the payment standard will be paid at the actual price.
In the related documents of centralized procurement and expansion, it is specified that medical insurance designated retail pharmacies participating in this purchase can be allowed to increase the price appropriately based on the selected price, and the part exceeding the payment standard shall be paid by the patient, and the part below the payment standard shall be reimbursed by the medical insurance according to the regulations.
.
.
In September 2019, the National Medical Insurance Administration posted its response letter to the National People's Congress representatives on the proposal for settlement of medical insurance in different places on the official website of the National Medical Insurance Administration, which also revealed the concept and implementation of a unified medical insurance payment standard and a unified national medical insurance catalog.
At present, there is no lack of exploration experience in various places that is worthy of high-level reference.
Zhejiang, Fujian, Anhui, Tianjin and other places are exploring and practicing.
In the future, not only will the unified payment standard under the common name be used, but the hospital and the retail market will also achieve price synergy.
Zhejiang, Fujian, Anhui, Tianjin and other places are exploring and practicing.
In the future, not only will the unified payment standard under the common name be used, but the hospital and the retail market will also achieve price synergy.
Once the medical insurance payment standards are unified, there will be more opportunities to stay in the market, competition will be more fair and effective, and the role of product brand and quality will also be prominent.
After the same product, the same quality, and the same price, the fight is the brand.
The same payment standard is higher than the payment standard.
Patients pay by themselves.
Patients who are price-sensitive will choose cheaper drugs.
Patients who value the brand more may bear part of the cost by themselves.
Choose the original research drug.
Both choices make sense and are left to the market (patients) to decide.
After the same product, the same quality, and the same price, the fight is the brand.
The same payment standard is higher than the payment standard.
Patients pay by themselves.
Patients who are price-sensitive will choose cheaper drugs.
Patients who value the brand more may bear part of the cost by themselves.
Choose the original research drug.
Both choices make sense and are left to the market (patients) to decide.
Medical Network News on June 2 In the context of stricter medical insurance control fees and increasingly tight medical insurance funds, medical insurance payment standards will eventually be introduced.
Recently, a "Letter on Soliciting Opinions on Determining Basic Medical Insurance Drug Payment Standards (Consultation Draft)" has been circulated in the industry.
The document shows that the classification will be determined in conjunction with catalog entry negotiations and mass procurement.
Payment standards, clarify the responsibilities and powers of the national and provincial medical insurance departments, do a good job of linking up, and make steady progress.
The document shows that the classification will be determined in conjunction with catalog entry negotiations and mass procurement.
Payment standards, clarify the responsibilities and powers of the national and provincial medical insurance departments, do a good job of linking up, and make steady progress.
And implement dynamic adjustments to payment standards.
The adjustment cycle should be linked to the national medical insurance negotiations and the drug collection cycle.
In principle, it should be adjusted every two years.
The adjustment cycle should be linked to the national medical insurance negotiations and the drug collection cycle.
In principle, it should be adjusted every two years.
He also pointed out that from 2021, the provincial medical insurance bureaus should develop payment standards in a gradual and hierarchical manner.
In principle, all western medicines and proprietary Chinese medicines in the national medical insurance catalogue should be covered by the end of 2024.
In principle, all western medicines and proprietary Chinese medicines in the national medical insurance catalogue should be covered by the end of 2024.
National talks on drugs: the payment standard is determined by the common name according to the negotiation rules
National talks on drugs: the payment standard is determined by the common name according to the negotiation rules According to the negotiation rules, the national unified payment standard shall be determined according to the common name.
If the negotiated drug has the expiration of the agreement, the drug with the same generic name is listed, and the drug is included in the centralized procurement of drugs, the provincial medical insurance department can adjust the drug’s price based on market competition, the price of the drug with the same generic name, or the results of the centralized procurement of drugs, etc.
Payment standards.
If the negotiated drug has the expiration of the agreement, the drug with the same generic name is listed, and the drug is included in the centralized procurement of drugs, the provincial medical insurance department can adjust the drug’s price based on market competition, the price of the drug with the same generic name, or the results of the centralized procurement of drugs, etc.
Payment standards.
Centralized procurement of drugs: the payment standard is determined based on the selected price
Centralized procurement of drugs: the payment standard is determined based on the selected price The country selects selected drugs and determines the medical insurance payment standard based on the selected price.
The same medical insurance payment standard shall be implemented for the original research drugs, reference preparations, and generic drugs that have passed the consistency evaluation under the same generic name.
The same medical insurance payment standard shall be implemented for the original research drugs, reference preparations, and generic drugs that have passed the consistency evaluation under the same generic name.
For the selected drugs in provincial centralized procurement, the provincial medical insurance department shall determine the medical insurance payment standard according to the selected price:
For varieties that have passed the consistency evaluation (including deemed over-evaluation and biosimilar drugs, the same below), a unified payment standard shall be determined according to the common name according to the collection results;
For drugs that have not been covered by the consistency evaluation, a unified payment standard shall be determined in principle according to the results of centralized procurement and the same generic name and the same quality group.
Establish a gradual adjustment mechanism for varieties with a large gap between actual prices and payment standards.
If the actual price is more than twice the payment standard, the payment standard should be adjusted gradually, and the adjustment will be in place within 2-3 years.
The provincial medical insurance department can determine the price red line, and limit the drugs that exceed the red line in links such as linking to the Internet.
Encourage the centralized procurement of non-selected pharmaceutical companies to take the initiative to reduce prices, converge towards payment standards, and reduce the burden on patients.
If the actual price is more than twice the payment standard, the payment standard should be adjusted gradually, and the adjustment will be in place within 2-3 years.
The provincial medical insurance department can determine the price red line, and limit the drugs that exceed the red line in links such as linking to the Internet.
Encourage the centralized procurement of non-selected pharmaceutical companies to take the initiative to reduce prices, converge towards payment standards, and reduce the burden on patients.
For generic drugs that have not been evaluated, the medical insurance payment standard shall not be higher than that of drugs that have passed evaluation under the same generic name.
Narcotics and first-class psychoactive drugs: payment standards are determined according to government pricing
Narcotics and first-class psychoactive drugs: payment standards are determined according to government pricing Government-priced narcotic drugs and first-class psychoactive drugs shall be paid according to the common name of the government to determine the unified national payment standard.
For exclusive products that have not yet implemented government pricing, those who have negotiated access to the National Medical Insurance Catalogue will be subject to payment standard management with reference to negotiated drugs.
For exclusive products that have not yet implemented government pricing, those who have negotiated access to the National Medical Insurance Catalogue will be subject to payment standard management with reference to negotiated drugs.
Other drugs: In principle, the payment standard is determined based on the provincial purchase price
Other drugs: In principle, the payment standard is determined based on the provincial purchase price For drugs that implement centralized procurement other than the aforementioned three cases, a coordination mechanism between the payment standard and the procurement price of the provincial procurement platform (including the record price, the same below) shall be established.
In principle, the payment will be determined based on the procurement price of the provincial procurement platform standard.
For drugs with the same generic name and specifications produced by the same enterprise, the payment standards within the province should be consistent.
In principle, the payment will be determined based on the procurement price of the provincial procurement platform standard.
For drugs with the same generic name and specifications produced by the same enterprise, the payment standards within the province should be consistent.
It is encouraged to determine the payment standards for drugs with different acid radicals, bases, the same main chemical composition and the same route of administration according to the common name or by selecting representative specifications and dosage forms.
The document also pointed out that the payment standard is an important benchmark for the settlement of drug costs included in the scope of medical insurance payment.
Patients use drugs whose prices are not higher than the payment standard, and patients and medical insurance will be shared proportionally based on the actual sales price.
Patients use drugs whose prices are higher than the payment standard, and the part that exceeds the payment standard is paid by the patient, and the part within the payment standard is shared by the patient and the medical insurance in proportion.
Patients use drugs whose prices are not higher than the payment standard, and patients and medical insurance will be shared proportionally based on the actual sales price.
Patients use drugs whose prices are higher than the payment standard, and the part that exceeds the payment standard is paid by the patient, and the part within the payment standard is shared by the patient and the medical insurance in proportion.
Medical institutions and medical staff use drugs whose prices are higher than the payment standard, and must comply with the principle of clinical necessity, and at the same time, the patient's right of informed consent must be guaranteed.
Review of policies related to medical insurance payment standards
Review of policies related to medical insurance payment standards In fact, medical insurance payment standards already have mature experience in the international arena.
In China, although the standards have not yet been unified, the country has been trying to unify medical insurance payment standards over the years.
In China, although the standards have not yet been unified, the country has been trying to unify medical insurance payment standards over the years.
First of all, from a theoretical point of view, the formulation of medical insurance payment standards is a reform of the formation mechanism of drug prices.
The medical insurance payment standard refers to the uniform payment price of medical insurance according to the common name.
It is the floor price.
Drugs that exceed the medical insurance payment standard may be shared by the patient and the hospital.
The medical insurance payment standard refers to the uniform payment price of medical insurance according to the common name.
It is the floor price.
Drugs that exceed the medical insurance payment standard may be shared by the patient and the hospital.
We know that the original drug price was the highest retail price set by the Development and Reform Commission, and then the actual transaction price was formed through bidding in various provinces and cities.
Since June 2015, the National Development and Reform Commission has liberalized drug price management and cancelled most of the government pricing of drugs.
The actual transaction prices of drugs are mainly formed by market competition.
At the same time, the mechanism for guiding the formation of reasonable drug prices is explored through the formulation of medical insurance payment standards.
Since then, the "dual pricing mechanism" of hospital drug sales prices has changed from the previous "Development and Reform Commission pricing %20 winning bid price" to "winning bid price %20 medical insurance payment standard".
The actual transaction prices of drugs are mainly formed by market competition.
At the same time, the mechanism for guiding the formation of reasonable drug prices is explored through the formulation of medical insurance payment standards.
Since then, the "dual pricing mechanism" of hospital drug sales prices has changed from the previous "Development and Reform Commission pricing %20 winning bid price" to "winning bid price %20 medical insurance payment standard".
In May 2015, the Office of the State Council issued the 2014 Work Summary of Deepening the Reform of the Medical and Health System and the Key Tasks in 2015, requiring the Ministry of Human Resources and Social Security and the National Health and Family Planning Commission to be responsible for completing the formulation of medical insurance payment standards by September 31 of that year .
Regrettably, the standard could not be introduced that year.
Medicine Medicine MedicineRegrettably, the standard could not be introduced that year.
In April 2016, the General Office of the State Council's "Key Tasks for Deepening the Reform of the Medical and Health System in 2016" required: "Develop basic medical insurance drug payment standards in accordance with relevant national policies.
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On November 24, 2016, the Ministry of Human Resources and Social Security issued the " Guiding Opinions on the Establishment of Standards for the Payment of Basic Medical Insurance Drugs (Draft for Comment)", but so far, the official draft has not been issued.
The "Draft for Solicitation of Opinions" clearly establishes the medical insurance payment standard in accordance with the (drug) generic name in principle.
Medicine, medicine, medicineThe "Draft for Solicitation of Opinions" clearly establishes the medical insurance payment standard in accordance with the (drug) generic name in principle.
1) For drugs that have passed the consistency evaluation or have a small difference in quality, the payment standard shall be established based on the generic name in principle.
For drugs with the same generic name (same dosage form and specification), the unified payment standard for drugs with the generic name shall be established according to the smallest dosage unit.
For drugs with the same generic name (same dosage form and specification), the unified payment standard for drugs with the generic name shall be established according to the smallest dosage unit.
2) Gradually determine the payment standards for drugs of different dosage forms and specifications under the same generic name by selecting representative products and calculating the price difference.
Relevant rules can be implemented with reference to the rules for drug price difference comparison.
Medicines limited to children's use should be listed separately as representative products.
Relevant rules can be implemented with reference to the rules for drug price difference comparison.
Medicines limited to children's use should be listed separately as representative products.
In recent years, relevant departments have also begun to try to unify relevant medical insurance payment standards on national centralized procurement and medical insurance negotiation drugs.
On February 2, 2018, the Ministry of Human Resources and Social Security issued a notice on negotiating the payment of generic drugs.
The notice clarified that the negotiated generic drugs belong to the scope of the basic medical insurance, work-related injury insurance and maternity insurance drugs.
The payment standards for the negotiated generic drugs are temporarily based on generic drugs.
The actual market sales price of pharmaceuticals shall be implemented, but shall not exceed the payment standard of the corresponding negotiated drugs in Document 54.
If the specifications of the generic drugs are inconsistent with the negotiated drugs, please refer to the "Notice of the National Development and Reform Commission on Printing and Distributing the "Drug Price Difference Rules" (Fagai Price [2452]) for calculation.
The notice clarified that the negotiated generic drugs belong to the scope of the basic medical insurance, work-related injury insurance and maternity insurance drugs.
The payment standards for the negotiated generic drugs are temporarily based on generic drugs.
The actual market sales price of pharmaceuticals shall be implemented, but shall not exceed the payment standard of the corresponding negotiated drugs in Document 54.
If the specifications of the generic drugs are inconsistent with the negotiated drugs, please refer to the "Notice of the National Development and Reform Commission on Printing and Distributing the "Drug Price Difference Rules" (Fagai Price [2452]) for calculation.
On November 28, 2019, the National Medical Insurance Administration held a press conference to introduce the status of the 2019 National Medical Insurance Negotiation Access Drug List.
This negotiation has determined the national uniform payment standard for 97 drugs, of which 47 drugs have applied for confidentiality, and the payment standard agreement will not be publicly announced.
The validity period ends on December 31, 2021.
After the validity period expires, the payment standard shall be adjusted in accordance with the relevant provisions of the medical insurance.
This negotiation has determined the national uniform payment standard for 97 drugs, of which 47 drugs have applied for confidentiality, and the payment standard agreement will not be publicly announced.
The validity period ends on December 31, 2021.
After the validity period expires, the payment standard shall be adjusted in accordance with the relevant provisions of the medical insurance.
During the validity period, if there is a drug with the same generic name (generic drug) on the market, the medical insurance department will adjust the payment standard for the drug according to the price level of the generic drug, and the generic name can also be included in the scope of centralized procurement.
If there is a major national policy adjustment or the actual price of the drug market is significantly lower than the current payment standard, the National Medical Insurance Bureau will negotiate with the enterprise to re-set the payment standard and notify separately.
Enterprise business enterprise As for the national centralized procurement of drugs, the coordination of payment standards and purchase prices for centralized procurement of drugs and medical insurance should be explored.
On January 1, 2019, the State Council issued the "National Organization for the Centralized Procurement and Use of Drugs Pilot Program", clarifying that for centralized procurement of drugs within the scope of the medical insurance catalog, the centralized procurement price shall be used as the medical insurance payment standard.
In principle, the same generic name shall be used.
For the original research drugs, reference preparations, and generic drugs that have passed the consistency evaluation, the medical insurance fund shall be settled according to the same payment standard.
In principle, the same generic name shall be used.
For the original research drugs, reference preparations, and generic drugs that have passed the consistency evaluation, the medical insurance fund shall be settled according to the same payment standard.
Patients use drugs whose price is higher than the payment standard, and the part that exceeds the payment standard is paid by the patient.
If the price of the drug used by the patient is quite different from the centralized purchase price of the selected drug, the payment standard can be adjusted gradually, and the adjustment will be in place within 2-3 years.
And formulate supporting policies and measures; patients who use drugs whose prices are lower than the payment standard will be paid at the actual price.
If the price of the drug used by the patient is quite different from the centralized purchase price of the selected drug, the payment standard can be adjusted gradually, and the adjustment will be in place within 2-3 years.
And formulate supporting policies and measures; patients who use drugs whose prices are lower than the payment standard will be paid at the actual price.
In the related documents of centralized procurement and expansion, it is specified that medical insurance designated retail pharmacies participating in this purchase can be allowed to increase the price appropriately based on the selected price, and the part exceeding the payment standard shall be paid by the patient, and the part below the payment standard shall be reimbursed by the medical insurance according to the regulations.
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Pharmacy pharmacy pharmacy.
In September 2019, the National Medical Insurance Administration posted its response letter to the National People's Congress representatives on the proposal for settlement of medical insurance in different places on the official website of the National Medical Insurance Administration, which also revealed the concept and implementation of a unified medical insurance payment standard and a unified national medical insurance catalog.
At present, there is no lack of exploration experience in various places that is worthy of high-level reference.
Zhejiang, Fujian, Anhui, Tianjin and other places are exploring and practicing.
In the future, not only will the unified payment standard under the common name be used, but the hospital and the retail market will also achieve price synergy.
Hospital hospital hospitalZhejiang, Fujian, Anhui, Tianjin and other places are exploring and practicing.
In the future, not only will the unified payment standard under the common name be used, but the hospital and the retail market will also achieve price synergy.
Once the medical insurance payment standards are unified, there will be more opportunities to stay in the market, competition will be more fair and effective, and the role of product brand and quality will also be prominent.
After the same product, the same quality, and the same price, the fight is the brand.
The same payment standard is higher than the payment standard.
Patients pay by themselves.
Patients who are price-sensitive will choose cheaper drugs.
Patients who value the brand more may bear part of the cost by themselves.
Choose the original research drug.
Both choices make sense and are left to the market (patients) to decide.
After the same product, the same quality, and the same price, the fight is the brand.
The same payment standard is higher than the payment standard.
Patients pay by themselves.
Patients who are price-sensitive will choose cheaper drugs.
Patients who value the brand more may bear part of the cost by themselves.
Choose the original research drug.
Both choices make sense and are left to the market (patients) to decide.
