There are still some worries about the new special medicine negotiation into the medical insurance: where does the money come from?

Source: medical economic report 2015-3-18 with the full implementation of the serious illness medical insurance system, the model of new special drugs included in the scope of medical insurance reimbursement through negotiation mechanism is gradually being promoted Recently, the Department of human resources and social security of Zhejiang Province has selected 15 kinds of high-value drugs for treating cancer and other serious diseases to be included in the payment scope of medical insurance for serious diseases, including Herceptin, Gleevec, Iressa, rituximab, qingweike, etc It is understood that the catalogue is recommended by human resources, social security, health and family planning departments and some authoritative medical institutions in Zhejiang Province After two rounds of clinical experts' selection, the average drug price is reduced by 19.27% Among them, the largest direct drop in drug prices was 54% Before that, Jiangsu included three kinds of drugs including Herceptin, Gleevec and Daxina in the payment scope of medical insurance fund, and Jiangxi included five kinds of special drugs including imatinib mesylate capsule (tablet), pemetrexed disodium for injection, recombinant human endostatin injection, trastuzumab for injection and letetrexed for injection into the payment scope of medical insurance Fund for serious diseases Through price negotiation, the drugs shortlisted in the payment scope of local serious illness medical insurance are mainly imported drugs, and there are also a few products of local enterprises, and the drug prices have declined to varying degrees Most of the imported drugs were shortlisted last year According to Article 15 of the key tasks of deepening the reform of medical and health system in 2014 issued by the general office of the State Council, we should improve the guarantee system for major and major diseases We have implemented serious illness insurance for urban and rural residents throughout the country, and standardized commercial insurance institutions to undertake it China's serious illness insurance system has entered the homes of ordinary patients Whether the effective drugs for serious illness treatment can be reimbursed is the key to the serious illness insurance system, "special drugs for serious illness insurance" is put on the agenda It is reported that in order to ensure "fairness, openness and fairness" in the selection and negotiation of drugs for serious diseases, Zhejiang Province Many experts selected from the medical insurance expert pool are responsible for the recommendation, selection and negotiation of specific drugs The formulation of rules does not involve specific implementation, and the selection of drugs does not involve specific negotiation Each group checks and balances with each other Those who participate in the negotiation cannot determine the rules and select drugs, so as to put an end to the corruption soil from the rules Speaking of the 15 varieties, the relevant people in Zhejiang province introduced that, first, according to the standard of serious illness treatment, the effect is clear, the voice of the crowd is strong, combined with the incidence rate, clinical curative effect and other factors, 62 drugs were recommended, forming the base for the selection of the special drug base for serious illness insurance in the whole province Secondly, the experts from the selection expert group screened 62 drugs and selected 31 As an alternative drug for negotiation, seed drugs ensure that the selected drugs have better pharmacoeconomic value Finally, another group of medical insurance and clinical experts conduct competitive negotiation with drug companies It is worth noting that the 15 drugs selected in Zhejiang are mainly imported drugs, while the local enterprises only have Zhengda Tianqing, Fudan Zhangjiang and Baitai pharmaceutical, while the 5 drugs in Jiangxi According to the response of Jiangxi authorities, five kinds of special drugs are imported as well as made in China The insured shall apply to the local medical insurance agency according to the relevant procedures, and can enjoy the corresponding treatment only after passing the examination According to the data of the national health and Family Planning Commission, as of the end of November 2014, the NCMS serious illness insurance has covered 219 cities and 1563 counties (cities and districts), 22 diseases including lung cancer, gastric cancer, end-stage renal disease, leukemia, congenital heart disease, hemodialysis, etc have all been included in the scope of serious illness insurance, and the proportion of reimbursement for hospitalization expenses within the policy of participating farmers has reached 90% 。
On January 29, the national health and Family Planning Commission, the Ministry of Finance and other six ministries and commissions issued the notice on doing a good job in the work of new rural cooperative medical care in 2015, which pointed out that the serious illness insurance system should be fully implemented By the end of 2015, the province (District, city) as a unit to achieve the unified policy of serious illness insurance for urban and rural residents, and organize the implementation of the policy However, the report on the development of China's medical and health undertakings (2014) released in February this year predicted that in 2017, the basic medical insurance fund for urban employees would not be able to offset the expenditure in the current period By 2024, there will be a serious deficit of 735.3 billion yuan in the accumulated balance of the fund Therefore, the source of funds has become an unavoidable problem for the serious illness medical insurance which depends on the basic medical insurance funds To maintain the stable operation of the national serious illness insurance policy, one of the ways is to increase the financial investment in the serious illness insurance Not long ago, the "Qingdao model" was highly praised The reimbursement funds for serious illness relief in Qingdao did not come from medical insurance, but from the special funds of the municipal government The social security department was only responsible for negotiation and handling However, whether the national and local governments have the money to invest and are willing to invest has become an important issue, which will directly affect the comprehensive implementation of the serious illness medical insurance in the future In the long run, the pressure of reimbursing funds may bring more opportunities to domestic new specialty drug enterprises with better pharmacoeconomic value in R & D and production, a business person told reporters.