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    Home > Medical News > Latest Medical News > Why can't I buy the medicine that is "soul bargaining" in the medical insurance in the hospital?

    Why can't I buy the medicine that is "soul bargaining" in the medical insurance in the hospital?

    • Last Update: 2021-04-18
    • Source: Internet
    • Author: User
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    Medical Network News on April 13 
     
    Many experts explained in detail: Why can't I buy medicines that are covered by medical insurance in the hospital?
     
    A few days ago, a set of data released by the Chinese Pharmaceutical Association showed that as of the third quarter of 2020, about 25% of the oncology innovative drugs included in the National Medical Insurance List in 2018-2019 were admitted to the 1,420 sample hospitals .
    Why can't the innovative drugs that have entered the medical insurance through "soul bargaining" be bought in the hospital? On April 9, the China Medical Insurance Research Association convened a number of industry experts to explain this in detail and put forward suggestions.
     
    Price reduction will not become the leading direction for drugs to enter the hospital's selection of drug catalogs
     
    Zhao Bin, deputy director of the Department of Pharmacy of Peking Union Medical College Hospital, said at the meeting that when drugs enter a hospital’s catalog, they must first meet clinical treatment needs.
    This is the first factor the hospital must consider, “especially the irreplaceability of disease treatment.
    Safety and comparison with existing drugs will be given key considerations, and the price reduction of drugs will not become the dominant direction in its selection.
    "
     
    Zhao Bin said frankly that it takes a long process for a drug to be marketed to be understood by doctors in detail.
    Because the number of cases included in the pre-market research of drugs is relatively small, the research time is relatively short, the age range of the experimental subjects is also narrow, and the conditions for drug use are very strict.
    Therefore, compared with the actual needs of hospitals to use drugs for a wide range of people, newly marketed drugs still have certain limitations, "for example, the limitations of drug effectiveness evaluation, the safety of medications for special populations, and the occurrence of rare adverse reactions .
    "Rate, etc.
    ", all need to be considered.
     
    Zhao Bin pointed out that the serious adverse reactions of many drugs were discovered only a few years after the market, with the increase in the number of users.
    Therefore, it will take a long time for clinicians to objectively grasp drug effectiveness and safety information and accumulate sufficient evidence.
     
      Shi Luwen, director of the Department of Pharmacy of Peking University, pointed out that with the normalization and standardization of my country's medical insurance access, even drugs that have just been approved can participate in medical insurance negotiations.
    For example, the negotiation time for national medical insurance drugs in 2020 is as of August of that year, and the negotiations are successful.
    Among the drugs, Zebutinib and Inituzumab were just approved for marketing in my country in June 2020.
    "Some drugs need to use sufficient evidence to determine their actual clinical value.
    "
     
      Drugs need to pass multiple tests to enter the hospital
     
      In addition to factors such as the effectiveness and safety of drugs, the cost of drugs has also become another important factor restricting its entry into the hospital catalog.
     
       "After the full implementation of the zero markup policy for drugs, drug equipment, storage, and wear have become the costs of public hospitals.
    " Cao Zhuang, an associate researcher at the National Institute of Medical Security, Capital Medical University, said that drugs have changed from a profit factor to a cost for medical institutions.
    Factors that affect the willingness of medical institutions to allocate medicines.
     
      In addition, according to the relevant drug management regulations, public hospitals with more than 800 beds are required to be equipped with no more than 1,500 types of drugs, including 1,200 types of Western medicines and 300 types of proprietary Chinese medicines.
    Cao Zhuang pointed out that for some hospitals that have been fully equipped, if they want to add new medicines, they need to call out a corresponding amount of medicines at the same time, which is relatively difficult and difficult.
     
      Zhao Bin added: "Different regions, different levels, different positioning of the hospital admitted patients with diseases of different spectrum, demand for treatment clinical drug is different, and therefore, the selection of hospital drugs mainly with functional orientation hospital, professional direction of clinical departments Very close relationship.
    Therefore, the drug catalogs of different hospitals are also very different.
    "
     
      At the same time, the entry of drugs into the hospital catalogue needs to be reviewed by the Pharmaceutical Affairs Management and Therapeutics Committee (hereinafter referred to as the "Committee").
    Cao Zhuang said that the setting of the committee's review procedures will also have an important impact on whether drugs can enter the hospital and the length of time it takes to enter the hospital.
     
      Zhao Bin said: “When the doctor confirms that it needs to submit a drug application for a new drug, the clinical department where the doctor is located will organize a preliminary selection of experts in the department, and then submit the selection results to the hospital’s committee.
    The committee will review the drug’s application.
    New additions, eliminations, and suspension of use will be reviewed.
    "
     
      However, the frequency of committee meetings is not fixed.
    Shi Luwen said that some hospitals are opened once a year, and some are opened once every two years.
    It is up to the hospital to decide.
     
       The "dual channel" medication guarantee mechanism eases the shortage of negotiated drug hospitals
     
      According to incomplete statistics, more than 20 provincial-level medical insurance departments have issued relevant policies, implementing a "dual-channel" guarantee policy for some negotiated drugs, that is, the use and reimbursement of some high-value or special drugs for the insured persons, and the implementation of designated medical care The method of joint guarantee between institutions and designated pharmacies .
    Cao Zhuang said: "This has largely solved the problem of insufficient supply of negotiated medicines in hospitals.
    We believe that this approach should be encouraged in areas where medical guarantees cannot be completely resolved through hospital channels.
    "
     
      Cao Zhuang pointed out that the "dual-channel" medication guarantee policy is a management innovation based on realistic conditions, and it is also a choice for listening to the voice of the masses and addressing reasonable needs.
    The implementation of a dual-channel guarantee policy puts forward a new requirement for medical insurance management.
    Many regions implementing the "dual channel" policy have established supporting management policies such as designated treatment institutions, designated responsible physicians, real-name system management, and designated drug supply institutions to strengthen drug management while meeting drug demand and supply.
     
      In addition, Caozhuang also believes that relevant policies and regulations should be improved to provide support for medical institutions to allocate negotiated drugs.
    There are also attempts in some areas.
    For example, in Yunnan Province, in order to do a good job in the landing of negotiated drugs, the medical insurance united health department has solved the problem of difficulty in hospital admission for negotiated drugs by canceling the proportion of drugs.
    Medical Network News on April 13 
     
      Many experts explained in detail: Why can't I buy medicines that are covered by medical insurance in the hospital?
     
      A few days ago, a set of data released by the Chinese Pharmaceutical Association showed that as of the third quarter of 2020, about 25% of the oncology innovative drugs included in the National Medical Insurance List in 2018-2019 were admitted to the 1,420 sample hospitals .
    Why can't the innovative drugs that have entered the medical insurance through "soul bargaining" be bought in the hospital? On April 9, the China Medical Insurance Research Association convened a number of industry experts to explain this in detail and put forward suggestions.
     
      Price reduction will not become the leading direction for drugs to enter the hospital's selection of drug catalogs
     
      Zhao Bin, deputy director of the Department of Pharmacy of Peking Union Medical College Hospital, said at the meeting that when drugs enter a hospital’s catalog, they must first meet clinical treatment needs.
    This is the first factor the hospital must consider, “especially the irreplaceability of disease treatment.
    Safety and comparison with existing drugs will be given key considerations, and the price reduction of drugs will not become the dominant direction in its selection.
    "
     
      Zhao Bin said frankly that it takes a long process for a drug to be marketed to be understood by doctors in detail.
    Because the number of cases included in the pre-market research of drugs is relatively small, the research time is relatively short, the age range of the experimental subjects is also narrow, and the conditions for drug use are very strict.
    Therefore, compared with the actual needs of hospitals to use drugs for a wide range of people, newly marketed drugs still have certain limitations, "for example, the limitations of drug effectiveness evaluation, the safety of medications for special populations, and the occurrence of rare adverse reactions .
    "Rate, etc.
    ", all need to be considered.
     
      Zhao Bin pointed out that the serious adverse reactions of many drugs were discovered only a few years after the market, with the increase in the number of users.
    Therefore, it will take a long time for clinicians to objectively grasp drug effectiveness and safety information and accumulate sufficient evidence.
     
      Shi Luwen, director of the Department of Pharmacy of Peking University, pointed out that with the normalization and standardization of my country's medical insurance access, even drugs that have just been approved can participate in medical insurance negotiations.
    For example, the negotiation time for national medical insurance drugs in 2020 is as of August of that year, and the negotiations are successful.
    Among the drugs, Zebutinib and Inituzumab were just approved for marketing in my country in June 2020.
    "Some drugs need to use sufficient evidence to determine their actual clinical value.
    "
     
      Drugs need to pass multiple tests to enter the hospital
     
      In addition to factors such as the effectiveness and safety of drugs, the cost of drugs has also become another important factor restricting its entry into the hospital catalog.
     
       "After the full implementation of the zero markup policy for drugs, drug equipment, storage, and wear have become the costs of public hospitals.
    " Cao Zhuang, an associate researcher at the National Institute of Medical Security, Capital Medical University, said that drugs have changed from a profit factor to a cost for medical institutions.
    Factors that affect the willingness of medical institutions to allocate medicines.
     
      In addition, according to the relevant drug management regulations, public hospitals with more than 800 beds are required to be equipped with no more than 1,500 types of drugs, including 1,200 types of Western medicines and 300 types of proprietary Chinese medicines.
    Cao Zhuang pointed out that for some hospitals that have been fully equipped, if they want to add new medicines, they need to call out a corresponding amount of medicines at the same time, which is relatively difficult and difficult.
     
      Zhao Bin added: "Different regions, different levels, different positioning of the hospital admitted patients with diseases of different spectrum, demand for treatment clinical drug is different, and therefore, the selection of hospital drugs mainly with functional orientation hospital, professional direction of clinical departments Very close relationship.
    Therefore, the drug catalogs of different hospitals are also very different.
    "
     
      At the same time, the entry of drugs into the hospital catalogue needs to be reviewed by the Pharmaceutical Affairs Management and Therapeutics Committee (hereinafter referred to as the "Committee").
    Cao Zhuang said that the setting of the committee's review procedures will also have an important impact on whether drugs can enter the hospital and the length of time it takes to enter the hospital.
     
      Zhao Bin said: “When the doctor confirms that it needs to submit a drug application for a new drug, the clinical department where the doctor is located will organize a preliminary selection of experts in the department, and then submit the selection results to the hospital’s committee.
    The committee will review the drug’s application.
    New additions, eliminations, and suspension of use will be reviewed.
    "
     
      However, the frequency of committee meetings is not fixed.
    Shi Luwen said that some hospitals are opened once a year, and some are opened once every two years.
    It is up to the hospital to decide.
     
       The "dual channel" medication guarantee mechanism eases the shortage of negotiated drug hospitals
     
      According to incomplete statistics, more than 20 provincial-level medical insurance departments have issued relevant policies, implementing a "dual-channel" guarantee policy for some negotiated drugs, that is, the use and reimbursement of some high-value or special drugs for the insured persons, and the implementation of designated medical care The method of joint guarantee between institutions and designated pharmacies .
    Cao Zhuang said: "This has largely solved the problem of insufficient supply of negotiated medicines in hospitals.
    We believe that this approach should be encouraged in areas where medical guarantees cannot be completely resolved through hospital channels.
    "
     
      Cao Zhuang pointed out that the "dual-channel" medication guarantee policy is a management innovation based on realistic conditions, and it is also a choice for listening to the voice of the masses and addressing reasonable needs.
    The implementation of a dual-channel guarantee policy puts forward a new requirement for medical insurance management.
    Many regions implementing the "dual channel" policy have established supporting management policies such as designated treatment institutions, designated responsible physicians, real-name system management, and designated drug supply institutions to strengthen drug management while meeting drug demand and supply.
     
      In addition, Caozhuang also believes that relevant policies and regulations should be improved to provide support for medical institutions to allocate negotiated drugs.
    There are also attempts in some areas.
    For example, in Yunnan Province, in order to do a good job in the landing of negotiated drugs, the medical insurance united health department has solved the problem of difficulty in hospital admission for negotiated drugs by canceling the proportion of drugs.
    Medical Network News on April 13 
     
      Many experts explained in detail: Why can't I buy medicines that are covered by medical insurance in the hospital?
      Many experts explained in detail: Why can't I buy medicines that are covered by medical insurance in the hospital?
     
      A few days ago, a set of data released by the Chinese Pharmaceutical Association showed that as of the third quarter of 2020, about 25% of the oncology innovative drugs included in the National Medical Insurance List in 2018-2019 were admitted to the 1,420 sample hospitals .
    Why can't the innovative drugs that have entered the medical insurance through "soul bargaining" be bought in the hospital? On April 9, the China Medical Insurance Research Association convened a number of industry experts to explain this in detail and put forward suggestions.
    Hospital hospital hospital
     
      Price reduction will not become the leading direction for drugs to enter the hospital's selection of drug catalogs
      Price reduction will not become the leading direction for drugs to enter the hospital's selection of drug catalogs
     
      Zhao Bin, deputy director of the Department of Pharmacy of Peking Union Medical College Hospital, said at the meeting that when drugs enter a hospital’s catalog, they must first meet clinical treatment needs.
    This is the first factor the hospital must consider, “especially the irreplaceability of disease treatment.
    Safety and comparison with existing drugs will be given key considerations, and the price reduction of drugs will not become the dominant direction in its selection.
    "
     
      Zhao Bin said frankly that it takes a long process for a drug to be marketed to be understood by doctors in detail.
    Because the number of cases included in the pre-market research of drugs is relatively small, the research time is relatively short, the age range of the experimental subjects is also narrow, and the conditions for drug use are very strict.
    Therefore, compared with the actual needs of hospitals to use drugs for a wide range of people, newly marketed drugs still have certain limitations, "for example, the limitations of drug effectiveness evaluation, the safety of medications for special populations, and the occurrence of rare adverse reactions .
    "Rate, etc.
    ", all need to be considered.
    Adverse reactions adverse reactions adverse reactions
     
      Zhao Bin pointed out that the serious adverse reactions of many drugs were discovered only a few years after the market, with the increase in the number of users.
    Therefore, it will take a long time for clinicians to objectively grasp drug effectiveness and safety information and accumulate sufficient evidence.
     
      Shi Luwen, director of the Department of Pharmacy of Peking University, pointed out that with the normalization and standardization of my country's medical insurance access, even drugs that have just been approved can participate in medical insurance negotiations.
    For example, the negotiation time for national medical insurance drugs in 2020 is as of August of that year, and the negotiations are successful.
    Among the drugs, Zebutinib and Inituzumab were just approved for marketing in my country in June 2020.
    "Some drugs need to use sufficient evidence to determine their actual clinical value.
    "
     
      Drugs need to pass multiple tests to enter the hospital
      Drugs need to pass multiple tests to enter the hospital
     
      In addition to factors such as the effectiveness and safety of drugs, the cost of drugs has also become another important factor restricting its entry into the hospital catalog.
     
       "After the full implementation of the zero markup policy for drugs, drug equipment, storage, and wear have become the costs of public hospitals.
    " Cao Zhuang, an associate researcher at the National Institute of Medical Security, Capital Medical University, said that drugs have changed from a profit factor to a cost for medical institutions.
    Factors that affect the willingness of medical institutions to allocate medicines.
     
      In addition, according to the relevant drug management regulations, public hospitals with more than 800 beds are required to be equipped with no more than 1,500 types of drugs, including 1,200 types of Western medicines and 300 types of proprietary Chinese medicines.
    Cao Zhuang pointed out that for some hospitals that have been fully equipped, if they want to add new medicines, they need to call out a corresponding amount of medicines at the same time, which is relatively difficult and difficult.
     
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