Medical network - on July 20, the ministry of human resources and social security recently printed notice, will 36 kinds of drugs into the national basic medical insurance, inductrial injury insurance and maternity insurance drug catalogue (2017 edition) "b class scope, and synchronous identified these drugs to pay for health care standards.
Some patents, exclusive medicines, high clinical value, and accurate curative effect, will benefit the staff greatly if they can be included in the catalogue. But these drugs are expensive, and the health insurance fund is hard to bear, as existing market prices are included in the catalogue. In April, the ministry released a list of 44 drug companies that would be eligible for the inclusion of the appropriate medical insurance payment standards through health care agencies and drug companies. It is the first time that the access negotiation of medical drug catalog is common practice in China. The list of drugs officially included in the negotiations means that the health care directory negotiations have made a breakthrough.
The scope of drug reimbursement expanded
Xu yanjun, deputy director of social security at the ministry of social security, said: "in the 44 drugs involved in the negotiations, 36 of the 44 drugs negotiated successfully, with a success rate of 81.8 per cent."
The 36 drugs included in the drug catalog include 31 western medicines and five herbal medicines, xu said. Has 15 is in tumor therapy of western medicine, covered with lung cancer, gastric cancer, breast cancer, colorectal cancer, lymphoma, myeloma and other cancer types, by bead sheet resistance, for rituxan, boron with rice, and other tumor targeted drugs on the list. Other drugs include drugs for cardiovascular disease, kidney disease, eye disease, mental illness, anti-infection, diabetes and other major diseases or chronic diseases, as well as two drugs for treating rare diseases. Three of the drugs were cancer drugs, and two were cardio-cerebrovascular drugs.
"Through negotiations, will have strong social targeted medicine major diseases such as cancer treatment in medicine directory, to improve the security level of the basic medical insurance, but also take into account the affordability, fund is helpful to guide the reasonable medical behavior, promote the development of medicine industry innovation, health care, business has been basically achieved, ginseng protect people" win-win-win "goals." "Said xu.
Medical expenses are reduced
Compared with the average retail price in 2016, the average retail price of the negotiated drugs has dropped by 44 percent, the highest level to 70 percent, and most of the imported drug negotiations are below the international market price. For example, for injection in the treatment of metastatic breast cancer by bead sheet resistance, the reporter understands the market sales of the unit price is up to each of more than 25000 yuan, after negotiating a drop of 69%, the unit price is 7600 yuan only.
There is the deputy director of the institute of fudan university hospital management thought, the targeted drug negotiations chose curative effect, safe and reliable clinical required, but pricey patented drugs or drug innovation, through the adoption of negotiating with the monopoly provider of way, to reach the price of both sides to accept drug and medical insurance plan, this is a tentative new health positioning operation.
Medicare drug directory negotiations is orgnaization of agency of insurance as a representative of 'team', can take advantage of professional management, and drug 'providers' through consultations and negotiations, reasonable process of medicare payment standard, so as to realize with limited money, buy the most valuable medicine." There said.
Strict medical insurance administration
How should a negotiating drug in the health care drug catalog be managed? The department is clear that the 36 types of medical insurance payment criteria identified by the negotiating drug include the total cost of the basic medical insurance fund and the staff. The departments of social insurance everywhere must not bring these drugs out of the catalog or adjust the limits of these drugs.
What if the market price of future negotiation drugs will be adjusted to be lower than the current health insurance payment standard? Yan qinghui, deputy director general of the medical insurance department of the human society, explained that, in the effective period, if a generic drug is listed, it will adjust the medical payment criteria for the drug according to the price level of generic drugs. If the actual price of drug market is significantly lower than the current payment standard, the health insurance department can negotiate and re-establish the payment standard with the enterprise.
"Formed by the medicines directory to adjust, and pay the standard change, in the practice of operation, whether to match the expectations of original data evaluation; its drug usage changes, and the resulting impact on fund, it set constraints in clinical or in the adaptability problem in the process of drug management, also need to continuously monitor. In addition, also need to be periodically evaluated, such as whether the price need to be adjusted, periodic adjustments according to what kind of way, is to negotiate, or a reference variable to be revised, etc." There said.
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