What are the latest developments in the 2020 Health Care Catalog negotiations?

Recently, the State Health Insurance Administration officially released the "2020 National Health Insurance Drug Catalog Adjustment Work Programme" and "2020 National Health Insurance Drug Catalog Adjustment Declaration Guide", China's national medical insurance drug catalog adjustment work officially opened this year.
with the normal adjustment of the medical insurance drug catalogue, the scope and accessability of patients' medication have been continuously enhanced, and the efficiency of the use of medical insurance funds has been continuously improved.
, through negotiations to increase efforts to promote drug prices, significantly reduce the burden on patients.
it's worth noting that this will be the fifth year in a row of negotiations since 2016 and the second year that the health-care catalog has been normalized.
health insurance catalog adjustment in the National Health Insurance Administration, the director of the Department of Medical Services Management Xiong Xianjun said that this year's medical insurance catalog adjustment will still take into account the basic medical insurance functional positioning, clinical needs of drugs, fund affordability.
Among them, the inclusion of new crown pneumonia-related respiratory diseases medication, for the new crown epidemic prevention and control normal support, and strive to achieve a more optimized drug catalog structure, management more scientific norms, payment more efficient and more equitable access.
Specifically, any of the conditions for the treatment of respiratory diseases related to neo-crown pneumonia, inclusion in the list of essential drugs, inclusion in the list of new drugs in urgent need of clinical treatment, encouragement of generic drug catalogues or encouragement of research and development to declare the list of children's medicines, and second batch of selected drugs in the national harvest may be declared for transfer.
to this, Xiong Xianjun said that the catalog adjustment is the first time the implementation of enterprise self-declaration, the scope of the review to be included in the evaluation of drugs to further focus, rather than all drugs already on the market into the scope of the review.
, innovation is encouraged, as long as the conditions are met, enterprises can declare, the State Health Insurance Administration will be in accordance with the relevant work procedures, work requirements in a timely manner to review these materials.
on health care payments, Mr. Xiong said he would strengthen the standard management of health-care payments.
he said the changes would allow all newly admitted drugs to be negotiated or auctioned simultaneously to determine payment criteria, helping to improve the efficiency of health-care funds and reduce the out-of-the-way burden on patients.
" adhere to the ups and outs, optimize the upgrade.
" Xiong Xianjun said, will be selected through a combination of factors to transfer the list of drugs.
institutions include medicines assessed by experts as risks outweighing benefits, "zombie drugs" in the catalogue, drugs that are widely withdrawn internationally, and exclusive products that can be replaced and are more expensive but fail to negotiate will be transferred out of the catalog, making room for more clinically valuable drugs to enter the catalog.
Xiong Xianjun revealed that although the 2020 health care catalog adjustment work started relatively late, but has developed a clear and detailed mission map, timetable.
in accordance with the schedule, the drug catalog adjustment is expected to be completed by the end of the year, with the aim of landing from 2021.
schedule determines that negotiations will be a top priority The programme of work shows that this year's catalog adjustment phase will be the preparation phase, the reporting phase, the expert review phase, the negotiation and bidding phase, and the announcement results stage.
, the bidding phase of the negotiations will take place from October to November.
chances of success this year are likely to be lower than in previous years.
" Xiong Xianjun said that based on the feedback requested, this year's work programme will further relax the deadline for innovative drugs, from 2015 to August 17, 2020, the new market or adaptation certificate / functional treatment of major changes in the scope of the drug are included in the review.
" is mainly the hope that those who have just been approved innovative drugs, especially those with independent intellectual property rights, to give faster access to the health insurance directory, but also to enable insured people to use better clinical value of innovative drugs as soon as possible, as soon as possible to benefit from the catalog adjustment.
," he said.
Xiong Xianjun also admitted that the time is further relaxed, the number of innovative drugs, especially the number of new drugs soon on the market will increase.
because these varieties have just been listed, enterprises in order to ensure certain benefits will inevitably be higher pricing, so whether to accept health insurance negotiations price is still unknown, it is expected that this year's success rate of negotiations may be lower than in previous years.
, the success rate of health-care catalog negotiations in 2019 was 64.7 percent, with 97 of the 150 drugs involved successfully negotiated.
, 70 of the 119 new drugs were successfully negotiated, including 52 Western medicines and 18 Chinese medicines.
27 of the 31 renewal drugs in the United States have been successfully negotiated.
overall data, the average price reduction for 70 new drugs was 60.7 percent, and the average price reduction for 27 renewal drugs was 26.4 percent.
it is worth mentioning that in the past, the health insurance catalog adjustment, access threshold is generally as of the end of the previous year, the year of new approval of drugs on the market can only wait until the next health insurance catalog adjustment.
this time, the time was extended directly to the date of publication of the programme (17 August), for the first time.
, the scope of the medical insurance catalog review is no longer selected by experts, but the implementation of the access system, by the enterprise self-declaration, eligible to enter the evaluation.
Xiong Xianjun mentioned that from the perspective of the health care sector, hope that more and better drugs can be in the morning market, early into the scope of health care payments, but China is still a developing country, basic health insurance financing is limited, in 2019 the per capita financing of residents' health insurance is only about 800 yuan, two-thirds of which is financial subsidies.
must emphasize and adhere to the basic medical insurance "guarantee the basic" positioning, can do their best, do their best, reasonable price.
" access to innovative drugs can not only through the basic medical insurance this way, can be through commercial insurance and so on to meet different levels of medical needs.
" Xiong Xianjun pointed out that under the new crown pneumonia epidemic, this year's health care fund spending increased at the same time, tax cuts reduced this year's health care fund income.
but the first half of the regular medical expenses decreased, the overall medical costs decreased, the second half of the year or rebounded.
, the overall balance of health-care funds this year is tight.
is also because of this, in the process of carrying out catalog adjustment work, will further strengthen the health care fund expenditure impact analysis, to ensure the smooth operation of the fund.
, we must also take into account the affordability of health-care funds in the current circumstances and need to balance encouraging innovation and ensuring their sustainability.
our fund measurement experts will also measure the impact of new drugs on the fund to determine the "floor price" that their health insurance can be included in.
indeed, it is understood that the "sky-high" life-long drug used to treat spinal muscular dystrophy, the Nosinasi sodium injection, has been on the health care agenda since it went on sale in China in 2019.
because the price has not come down after negotiations with enterprises, there has been no way to enter the health insurance directory.
" health-care directory applies to the nation, and it is important to ensure that medicines entering the health-care catalog are affordable everywhere.
Once such rare disease drugs are included in the health insurance list, for less developed regions, the fund used to pay for high-priced rare diseases, other basic diseases may not be guaranteed, and the subsequent may also cause local economic pressure, so the most fundamental solution is the state and pharmaceutical companies to negotiate prices down.
" industry insiders say.
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