The national medical insurance catalog is in the industry: more than 80% of the drug prices are down

Source: Economic Reference News 2015-03-13 drug price reform linked to the adjustment of medical insurance payment method, the reporter of economic reference news recently learned from the authority that the adjustment of national medical insurance catalog has entered a window period, and relevant departments are considering the reform of drug price mechanism and studying the new formulation method of medical insurance catalog "There is a strong call for the adjustment of the medical insurance catalogue New drug development and medical technology are constantly improving, so there is a need for catalog adjustment But now we have a new situation, that is, the price determination mechanism of drugs needs to be reformed, which raises new problems " In this context, the revision of the medical insurance drug payment catalogue and standards is no longer a simple expansion, because it is connected with the medical price, the above authority told the economic reference“ Drug prices are no longer subject to administrative pricing, and the issue of medical insurance catalog needs to be considered as a whole We are in-depth study with relevant departments, and there may be great changes and new approaches in the future " The reporter learned that according to the Convention, the medical insurance catalog is adjusted once every five years, and this year it will enter the time window of re revision China established the medical insurance system for urban employees in 1999, formulated the first version of the medical insurance catalogue the following year, and revised it in 2004 In December 2009, the Ministry of human resources and social security issued the 2009 version of the national directory of drugs for basic medical insurance, work injury insurance and maternity insurance, which included all therapeutic drugs in the national directory of basic drugs into the category a part of the drug directory It is worth noting that the revision of the current medical insurance catalog has become a hot topic in the two sessions Several representatives said that the current directory has been in effect for five years, and the version has not been able to meet the requirements of increased coverage of medical insurance and increased demand for medical consumption Ding liming, deputy to the National People's Congress and chairman of Beida Pharmaceutical Co., Ltd., said that the update and adjustment cycle of the medical insurance drug catalog should be standardized, and the scientific evaluation mechanism for the selection of medical insurance drug catalog should be improved "Because the adjustment interval is too long, the new drug can only wait for the next catalog adjustment to have access This obviously does not adapt to the current speed of new drug research and development and the public's pursuit of better treatment effect In the United States and France, it only takes six months for new drugs to enter the reimbursement catalog, while in Germany and the United Kingdom, it only takes one month " He said Zhao Ping, member of the CPPCC National Committee and former president of the Cancer Hospital of the Chinese Academy of Medical Sciences, believes that the product structure of the current medical insurance catalog is unreasonable, in which most of the drugs are ordinary drugs, and less drugs are used for serious and difficult diseases In order to enter the medical insurance catalog, many pharmaceutical enterprises make every effort in the rent-seeking process, coupled with the long process of medical insurance drug audit, the cost of independent research and development is too high, and innovation There are few medicines Ren Wuxian, deputy to the National People's Congress and chairman of Yabao Pharmaceutical Co., Ltd., also believes that the next version of the national health insurance catalog should be updated as soon as possible, and the evaluation mechanism for updating the national health insurance catalog should be improved It is suggested that we should follow the 1999 policy, adjust the national medical insurance catalogue every two years, and gradually improve it to the level of developed countries At the same time, expand the coverage of the catalogue, ensure the reimbursement qualification of clinically necessary drugs, and improve the access of patients to clinically necessary innovative drugs In fact, the basic idea of drug price reform has been determined, including the elimination of drug government pricing, through medical insurance control and bidding procurement, the actual transaction price of drugs is formed by market competition, and the maximum retail price limit or ex factory price set by the original government has been basically eliminated According to the government work report, we should seize the opportunity to speed up price reform The direction of reform is to give play to the decisive role of the market in the allocation of resources, significantly reduce the types and projects of government pricing, and liberalize the prices of goods and services with competitive conditions in principle We will abolish the pricing of most drugs by the government and delegate pricing power to a number of basic public services A person in the industry told the economic reference newspaper that at present, all drugs listed in the medical insurance catalog have government pricing and ceiling prices When medical insurance is reimbursed, it is reimbursed in proportion to the price determined by the national development and Reform Commission But in the future, when drug pricing is cancelled, in theory, drug companies will price as much as they want "For example, if a drug was sold for 10 yuan, it would be reimbursed for 7 yuan After the reform, when the price reaches 100 yuan, does the medical insurance have to pay 70 yuan as a percentage? It is clearly impossible " He said that the adjustment mechanism of the medical insurance catalog needs to be changed and taken into account "Now there is a research direction As long as the medicine is listed in the medical insurance catalog, we will reimburse it according to a certain price multiplied by the corresponding proportion, no matter how much the medicine is sold Therefore, there is a linkage problem in the adjustment of the medical insurance catalog Only when the document of canceling the drug government's pricing is issued can we discuss how to determine the payment standard The specific payment method also needs the consensus of all departments, which is still under discussion " The industry said For this idea, Ren Wuxian believes that after the reform of drug price determination mechanism, more than 80% of drug prices will automatically decline "The regulators are worried that the price of drugs will soar after the price limit is lifted I don't think so, because more than 80% of drugs are competitive As long as there is a bidding, the price will be reduced Only 10% of the drugs are expensive and need a bargaining process with the government " Ren said he hoped that when the new payment method for medical insurance was determined, the 10% reimbursement standard for drugs would not be too low "80% of the low-cost drug profits ensure the survival of the enterprise, and the remaining 10% are R & D innovation, which is related to the future development and growth of the enterprise." He believes that at present, China still lacks independent and authoritative pharmacoeconomic evaluation institutions and evaluation index system, and does not improve the specific methods, standards and processes of health technology evaluation for evidence-based medicine and pharmacoeconomic research evidence In order to make the new version of medical insurance catalog more reasonable, efforts should be made to improve this problem.