The third batch of medical insurance products has been 3/4 times, 9 times, 10 times, and the highest is 24 times. Come and see if there is your home?

"In the future, there will be no more'blockbuster' drugs, but a'cluster bomb' type and a'categorized and directed' type.

This article attempts to answer three questions:

What changes will happen to the innovative drug market?

Is it necessary for innovative drugs to enter medical insurance through the National Talks?

How to solve the last mile of medical insurance?

01 What changes will happen to the innovative drug market?

Innovation is leading changes in the competitive landscape of the pharmaceutical industry.

On the one hand, the pattern of original research drugs and generic drugs is being reshaped.

On the other hand, the global drug structure has also undergone drastic changes.

It is worth noting that this change will lead to the birth of a new business model.

why? Xu Wei explained that chemical drugs are usually effective for many patients, but only 30% to 40% of these patients may be considered "effective treatment.

Therefore, he believes that based on this change, the sales model and competitive landscape of pharmaceutical companies will also change accordingly.

02 Is it necessary for innovative drugs to enter medical insurance through the National Talks?

"In fact, for clinical therapeutic drugs, we all think that entering medical insurance is always helpful for sales.

Multinational pharmaceutical companies are the first to receive the dividends of medical insurance.

Image data source: Mi Nei.

This effect makes all pharmaceutical companies salivate.

From the perspective of drugs that have never been covered by medical insurance, the first batch of drug negotiations organized by the Health and Family Planning Commission in 2015 included three drugs for the treatment of non-small cell lung cancer: erlotinib, gefitinib (Iressa), and icotinib After Iressa entered the medical insurance, there was a significant increase from 2016 to 2018, while erlotinib was gradually declining during the same period.

Xu Wei analysis believes that competitors in the same treatment field use medical insurance to expand their market share in a similar way to discounts.

"It is almost the only way for innovative drugs to enter the medical insurance catalog through medical insurance negotiations.

How to do it? Xu Wei believes that we can proceed from four directions: first consider the clinical value, that is, prepare to negotiate whether the drug has better safety than the existing treatment methods? Is it more effective and clinically valuable? Secondly, is it worthwhile to analyze from pharmacoeconomics? Analyze again from the budget impact whether medical insurance is affordable? Finally, from the perspective of price/expense, how can medical insurance pay more value?

The clinical value must first distinguish between which type of innovative drug is the negotiated drug, whether it is a breakthrough innovative drug or an improved new drug.

For improved new drugs, for example, risperidone has been invented by modifying the dosage form, then by modifying the structure, and then obtaining a longer life cycle, and in this cycle, it has significantly met the clinical needs of the clinical trial by modifying the dosage form and structure.

03How to solve the last mile of medical insurance?

In the 2020 medical insurance negotiations, many companies are facing landing problems.
This is what the industry calls "how to solve the last mile of medical insurance"?

"After the state talks, hospitals will not purchase at all", "There is a drug that we have been insured for 2 years, but in some places we have not been admitted to the hospital".
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Many pharmaceutical companies have encountered similar problems.
Hospitals will not purchase medical insurance drugs due to multiple obstacles such as the proportion of drugs and total control, making it difficult for pharmaceutical companies to enter medical insurance for innovative drugs.

According to Xu Wei, after years of hard work in the industry, a dual-channel approach has been created in the industry to supply patients with medicines.
Some of the national medicines will be placed in hospitals and the other part will be placed in DTP pharmacies.
In addition, the National Medical Insurance Administration also issued relevant policies to stipulate that the negotiated drugs are not included in the medical institution's drug proportion and total cost control assessment.

When there are more and more negotiated drugs and more and more types, many drugs are not necessarily used in hospitalization but in outpatient clinics, such as Chinese patent medicines, psychiatric drugs, anticancer drugs, and ophthalmological drugs.
These national outpatient drugs are facing the dilemma of high prices and shortage of medical insurance costs.
How to solve them? Xu Wei pointed out that in order to land, it is necessary to add local gates and gates, so as to allow these "expensive" drugs to break through the quotas of ordinary outpatient clinics and achieve the landing.

There is another way, that is, whether it is outpatient or hospitalization, after the completion of the national drug talks, a model similar to the previous special drug management will be carried out.
For example, the one-line payment in Sichuan Province does not distinguish between outpatient and hospitalization and no deductible line.
The medical insurance pool is directly based on Proportional payment, but the medical insurance pooling fund for a single natural year capped 150,000 yuan in drug costs for a single insured person.
There are also plans for Tianjin's DAA program, etc.
, and various places have different landing paths.

For products that have not entered the medical insurance catalogue, it is not without a way out.
Xu Wei believes that these products can be considered in three aspects: one is to enter local supplementary medical insurance; the other is to enter the combination of social insurance and commercial insurance, such as Hui Minbao, Suhuibao, etc.
; the third is pure commercial insurance.
The data shows that from 2012 to 2019, the proportion of pure commercial insurance in social health expenditure increased from 3% to 11%, which shows that the market share of commercial insurance is increasing year by year, and it will become a very important force in pharmaceutical insurance in the future.
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