The national centralized procurement has saved a total of 300 billion!

On July 22, the National Health and Health Commission held a press conferen.

Li Shuchun, deputy director of the Pharmaceutical Management Department of the National Medical Insurance Administration, introduced that since 2018, the National Medical Insurance Administration, together with relevant departments, has promoted the reform of centralized procurement of drugs and high-value medical consumables to expand in depth and bread.

"Intensively promoted the centralized procurement of 7 batches of state-organized drugs, covering a total of 294 drugs, and the amount involved accounted for 35% of the annual purchase amount of chemical and biological drugs in public medical institutions; focusing on cardiology and orthopedics to carry out state-organized high-value medical consumabl.

In addition, what deserves more attention is the DRG/DIP medical insurance payment reform work that is being fully and deeply pilot.

"Expanding coverage, building mechanisms, laying foundations, and promoting synergy" solidly promote the reform of payment methods to achieve full coverage at the end of the 14th Five-Year Plan period, which is an important goal of the current DRG/DIP medical insurance payment refo.

Not long ago, the Beijing Medical Insurance Bureau issued the document "Notice on Printing and Distributing the Management Measures for the Exclusion of CHS-DRG Paid New Drugs and New Technologies (Trial)" (hereinafter referred to as the "Notice"), and decided to try out the CHS-DRG Paid New Drugs and New Technology Exclusion Payment Management This payment method clarifies that innovative drugs, innovative medical devices, and innovative medical service projects may not be paid in the form of DRG, but paid separate.

However, in the face of the time point of the "Three-Year Action Plan" for the reform of DRG/DIP payment methods, the end of the "14th Five-Year Plan" means that DRG/DIP will be fully implement.

The industry view is that DRG/DIP guides the clinical transformation to low-cost, high-efficiency, high-quality "value medical car.

Deepen the reform of the review and approval system, speed up the launch of new and good drugs, promote the consistency evaluation of drugs, and reduce the burden of drug use by the mass.

In order to further solve the problem of "difficult and expensive medical treatment" and adhere to the positioning of "basic insurance", the National Medical Insurance Administration fully plays the role of "big buyer", and squeezes out the "moisture" of the market price of pharmaceutical equipment through two important measures of volume purchase and medical insurance negotiati.

The reform of the DRG/DIP medical insurance payment system is undoubtedly the starting point for strengthening clinical rational drug u.

In November last year, the National Medical Insurance Administration issued the "Notice on Printing and Distributing the Three-Year Action Plan for the Reform of DRG/DIP Payment Methods" (Medical Insurance Fa [2021] .

The policy proposes that in 2022, 2023 and 2024, with the provinces (autonomous regions and municipalities) as the unit, no less than 40%, 30%, and 30% of the overall planning areas will be launched to carry out the reform of DRG/DIP payment methods and make actual payments; After the DRG/DIP payment reform work is launched, the comprehensive coverage of DRG/DIP payment medical institutions will be achieved according to a three-year arrangement, and the annual progress should not be lower than 70%, 80%, and 90% respective.

The purpose of DRG/DIP payment reform is to rationalize drug use and ensure people's heal.

Experts said that in the context of medical insurance control fees, once a certain medical device product or treatment plan is included in DRG/DIP payment, it is bound to change from the past profit item to the cost item for medical institutions; with the continuous improvement of medical insurance informatization supervision , product price, clinical use, medical record diagnosis and other key information are fully exposed to the big data of the medical insurance system, the safety and effectiveness are doubtful, the clinical needs are unclear, and the varieties without clinical advantages have been piled up by pharmaceutical rebates and expense marketing in the pa.

For innovative pharmaceutical products, the DRG/DIP payment model will also have a certain impa.

Through disease diagnosis and treatment grouping, innovative products and innovative solutions will have to be compared with other products and solutio.

This comparison includes not only clinical efficacy, but also multiple dimensions such as safety and economy, that is, to determine whether innovative products and innovative solutions can meet the The key factor in the clinical path of rational drug use is the level of comprehensive clinical val.

Industry analysts pointed out that in the context of DRG/DIP, it does not mean that innovative drugs are necessarily good, and low-priced drugs are necessarily go.

Treatment interventions may be new or old, not all treatment interventions meet the standards of diagnosis and treatment, and not all treatment interventions that meet the standards of diagnosis and treatment are the most cost-effective optio.

Comparing different innovative drugs or other drugs to see which one is better and which one is worse, and giving a unified assessment through a comprehensive clinical evaluation, can truly optimize the drug structu.

"Taking non-small cell lung cancer as an example, different intervention methods such as conservative treatment, surgical treatment, radiotherapy, cryoablation, e.

, are comprehensively evaluated to select the intervention method with the highest value for patients for propensity to pay; while in conservative treatment, choose the For the generation of targeted drugs, which one to choose from the same generation of targeted drugs can also be evaluated by comprehensive value, and the higher comprehensive value can be pa.

Innovative drugs, especially many Me-too drugs, if they cannot achieve Me-better, Best- In-class, the competition in subdivisions will be more intense, and whether the comprehensive clinical value can ultimately reflect the competitive advantage of the true value of innovative drugs, there are variabl.

"

According to information from the National Medical Insurance Bureau, as of now, more than 200 regions across the country are promoting the reform of DRG/DIP payment methods for hospitalization expens.

Judging from the progress of the reform, the pilot regions have indeed experienced a decline in the burden of personal medical expenses of the insured people, and internal medical institutio.

The effect of strengthening management and improving medical insurance management and service capabiliti.

For the pharmaceutical industry, which affects the whole body, the "bull nose" effect of medical insurance payment is being manifest.

It is generally expected in the industry that, due to the terminal market test brought about by the DRG/DIP payment reform, innovative drugs will most likely experience greater pressure on the payment si.

The original intention of "vacating the cage for the bird" and "encouraging innovation" is to let the people "use the medicine and use the medicine wel.

Since the establishment of the National Medical Insurance Administration, more than 300 innovative drugs have been included in medical insurance payment through medical insurance negotiati.

With the reform of DRG/DIP payment methods, the pharmaceutical industry also hopes to create a more relaxed atmosphere for innovative dru.

On July 13, the Beijing Medical Insurance Bureau issued the document "Notice on Printing and Distributing the Management Measures for the Exclusion of CHS-DRG Paid New Drugs and New Technologies (Trial)" (hereinafter referred to as the "Notice"), and decided to try out the CHS-DRG Paid New Drugs and New Technology Exclusion Payment Management w.

This payment method clarifies that innovative drugs, innovative medical devices, and innovative medical service projects may not be paid in the form of DRG, but paid separately and according to the fac.

The above-mentioned policies have opened up opportunities for innovative drugs and innovative medical devices, and have also attracted public attention in the field of pharmaceutical innovati.

However, some analysts pointed out that the actual number of varieties that meet the "exclusion payment" of the DRG payment reform will not be too ma.

If you look closely at the "Notice", innovative drugs/innovative medical devices that meet the requirements must meet the following requirements at the same time:

New generic drugs/medical devices that have been approved for marketing by the drug regulatory department within three years (including the year of application and the two preceding calendar years, the same below); drugs that have undergone major changes due to increased functions or indications within three years; Drugs newly included in the National Medical Insurance Drug List within three years; new medical devices that can be charged separately due to price adjustments within three yea.

Obtain the classification and code of medical insurance drugs from the National Medical Security Administration / classification and code of medical consumables for medical insuran.

Comply with the relevant price polici.

The clinical effect is greatly improved compared with traditional drugs/medical devic.

It has a great influence on the payment standard of the DRG gro.

The cumulative number of cases of people covered by basic medical insurance in the city has reached more than 50, and the number of rare diseases is not limit.

At first glance, it seems that the policy side has released a signal of loose payme.

However, it is not difficult to see from the specific requirements that "within three years", "the clinical effect has been greatly improved", "the number of insured cases" "has a greater impact on DRG payme.

" ” and other factors are satisfied at the same time, it is possible to be independent of DRG payment within a certain period of time when the product is launch.

Experts believe that DRG/DIP payment itself needs to be comprehensively calculated and analyzed based on the data of the product in real clinical drug use scenari.

For products with very high innovation value, the real clinical application time is relatively short, and the clinical drug experience and data are insufficie.

Using the "excluded payment" policy to transition can not only meet the urgent clinical needs, but also accumulate experience and data in drug use to support the subsequent entry of products into DRG/DIP payment manageme.

This is a reasonable choice to balance payment and demand, and should not be excessi.

The interpretation is considered to be "open to paymen.

Obviously, the DRG/DIP policy for some innovative pharmaceutical products provides a certain degree of buffer, which does not mean that these products can be separated from the management of medical insurance funds and the supervision of rational drug use, but also related to the rectification of clinical drug use, crackdown on fraud and insurance fraud and other regulatory polici.

There is no confli.

For the medical insurance supervision department, once a violation is found, it is bound to be severely punished by supervisi.

So, is it possible for the differentiated "except payment" policy measures to be piloted nationwide? Whether it is purchasing with volume or negotiating medical insurance, exploring "not included in the proportion of drugs" and "not included in the scope of comprehensive cost control", or standardizing the overall payment behavior of outpatient clinics, all localities are making certain differentiated policies based on local actual conditio.

In September 2021, the National Medical Insurance Administration and the National Health Commission jointly issued the "Notice on Adapting to the Normalization of National Medical Insurance Negotiations and Continuing to Do a Good Job in the Landing of Negotiated Drugs":.


For negotiated drugs that are paid separately, they will not be included in designated medical institutio.

The scope of the total amoun.


lists the negotiated drugs that are reasonably used separately, and does not include the proportion of drugs in medical institutions, the average cost per time, and other assessment indicators that affect their landi.

" This generally opens a hole for innovative pharmaceutical products on the DRG Iron Curta.

With the DRG pilot being rolled out across the country, transferring from hospital to outpatient clinic is a way of exploiting loopholes for innovative medical device products to avoid D.

Henan, Shaanxi, Guangdong, Jiangsu and other places have successively delineated the scope of outpatient special dru.

For innovative drugs that have been marketed in recent years, they will be given loose and preferential policies such as no threshold, no maximum limit, and no inclusion in DRG and drug ratio assessme.

However, in April 2022, the Zhejiang Provincial Medical Insurance Bureau issued the "Three-Year Action Plan for Comprehensively Promoting the Reform of Medical Insurance Payment Methods in Zhejiang Provinc.

, to form a closed loop that runs through the entire medical insurance payment cycle and management proce.

As soon as the article came out, it undoubtedly tightened the caliber of innovative products "inpatient transfer to outpatient clini.

According to the "Notice" issued by Beijing this time, if the financing situation of Beijing's medical insurance fund is comprehensively considered, the medical resources are relatively abundant, and the policy trend is worthy of attention; in contrast, whether most urban medical insurance funds in China have the confidence to follow up and follow suit is still open to questi.

The market point of view is that today's pharmaceutical companies must fully adjust their mentality to meet clinical needs and focus on clinical value as the co.

For medical insurance big data information will pay for supervision, companies must abandon and supervise the "guerrilla" logic: avoid competition and fight for "exclusiv.

”, the transfer of fees from inside the hospital to the outside of the hospital, the restriction of western medicine to replace traditional Chinese medicine, the transformation of traditional Chinese medicine monitoring into general health, and the search for loopholes in marketing with go.


A complete marketing orientation will eventually lead to nowhe.

Today, a unified national medical insurance information platform has been established, and the intelligent supervision subsystem can accurately combat large prescriptions, drug abuse, illegal insurance fraud and other behavio.

For all medical insurance agencies, designated medical institutions, designated retail pharmacies, and insured persons The main body, as well as the upstream and downstream enterprises of the pharmaceutical industry chain, must adhere to the "bottom line" of legal complian.

On July 8, the National Medical Insurance Administration held a special meeting of the leading group on network security and informatizati.

Hu Jinglin, director of the National Medical Insurance Administration, emphasized that deepening the construction and application of the medical insurance information platform is an important strategic task at present and in the futu.

The application work in the whole field of medical insurance management and the whole process of medical insurance service gives full play to the advanced efficiency of the platfo.

In the next three years, the DRG/DIP payment reform will have a more comprehensive, thorough and profound impact on the industry cha.

Regardless of in-hospital or out-of-hospital, online and offline, innovative drug generic drugs, medical insurance payment is a "big buyer", making full use of big data, DRG/DIP comprehensive information management, and clinical drug use "putting life-saving money on the edge", the entire pharmaceutical industry The chain will eventually face the industrial revolution brought about by "value medical car.