The medical network "looked down on illness" on August 2, and even "poor health" was a heavy memory of some patients and their families. Recently, the results of the first national insurance negotiations on medical insurance have been settled, and 36 high-priced new medicines have been put into the category b category of medical insurance, bringing the benefits to patients.
As early as April this year, the ministry of human resources published 44 lists of the proposed drugs. After negotiations with related enterprises, 36 of them successfully negotiated, with a success rate of 81.8 percent, compared with the average retail price in 2016, the average reduction in the drug negotiations reached 44 percent, the highest decline of 70 percent.
People club department health department deputy director YanQingHui said the price just need medicine into the health care drugs directory, while significantly improve the level of health care medicine security, greatly reduce the burden on society, effective control of the fund expenditure, to improve ginseng protect personnel to get feeling, also conducive 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.
36 high prices just need medicine
The 36 high-priced new drugs are listed in the category b category, with the average drug payment standard falling by 40%.
The data shows that the health insurance catalog drugs are divided into class a and class b. The class a drug is reimbursed 100% by proportion, without the patient's self-payment. However, the specific reimbursement rate is different according to local policies and specific medicines.
The reporter found that the 36 drugs included in the category of medicine category b included 31 kinds of western medicine and 5 kinds of Chinese medicine, among which the anti-tumor drugs accounted for half of the total.
In western medicine, 15 is a cancer treatment drug, covered with lung cancer, gastric cancer, breast cancer, colorectal cancer and other common cancer types, including the earlier ginseng protect personnel to reflect more by bead sheet resistance, rituxan, b meters such as tumor targeted drugs for other respectively for the treatment of cardiovascular disease, kidney disease, eye disease, psychosis, anti-infection, diabetes medicines, etc. In Chinese medicine, three are antitumor drugs and two are cardiovascular and cerebrovascular drugs.
Jilin medical insurance bureau jinhua explained that enter the directory b class of medical insurance, and means that patients need to pay a small part of most expenses shall be borne by the medical insurance fund, at the same time negotiated payment standard, make the drug prices have fallen sharply, further reduce the patients' economic burden.
For the treatment of breast cancer, trastuzumab (herceptin), for example, the negotiations fell by 69%, with a determined payment standard of 7,600 yuan. After a 440 mg by bead sheet resistance, for every 22000 yuan, and a breast cancer patients need at least 14 the drug injection treatment cycle, due to not in medical insurance directory, all need to pay this part of the cost, in the future, patients in this spending "life-saving medicine" will fell sharply.
Buy the most cost-effective medicine with limited money
In fact, it is also the first time that China's drug insurance access has been negotiated.
The negotiations high-profile reason lies not only in health care for the incision expensive medicine to bring benefits to patients, more important is that the concept of the negotiations reflected the national drug access decision change - from the land of extensive experience to finely evidence-based decisions.
"The insurance agency, as a 'group buyer' representing the insured, will give full play to the advantages of professional management, and negotiate and negotiate with the 'provider' of drugs to properly determine the standard of medical insurance payment." Chen wen, a professor at fudan university, talks about the price negotiations between the health care agency and drug manufacturers, which sum up as "the most cost-effective medicine with limited money".
So how did the negotiating price for 44 drugs be finalized?
"One is patent medicine, innovative medicine or exclusive variety; The second is the drug quality, the effective effect, the clinical necessity; Three is drug price and treatment cost is high." Jinhua summarized the screening criteria for drug negotiations in three aspects.
According to her introduction, after completing the selection of the negotiating medicine, the negotiations set up "enterprise declaration" "expert evaluation" and "price negotiation" 3 links, declaring, evaluating and negotiating the three parties to be independent of each other.
There, according to the analysis on the one hand, provides for the enterprise to submit evidence of the channel, in order to prove the rationality of the solution or offer the negotiations, "allows businesses to actively participate, not seen before". On the other hand, the introduction of international health care important technical support for the talks, experts from different fields, respectively from the economy and health care drugs fund bear ability evaluation is calculated in two aspects, the final comprehensive evaluation results, the two groups expect payment sure health standards.
In Chen's view, the high success rate of this negotiation is inseparable from the innovation and breakthrough of programming and technical support. The next step is how to regularized negotiations through mechanisms and institutional support.
Medicare will be a reasonable choice for patients
It is well known that the method of access to health insurance in China is the mechanism of batch audit and expert voting. Every few years, health care will screen and vet new drugs that are listed after the last entry, and invite experts to vote on the list of medicines to be included in the catalog. Although some achievements have been made, the number of new drugs and the limited ability of medical insurance are limited.
"Under the original policy framework, the main value of drugs is reflected in filling clinical gaps. Now, health care is focused on more than just clinical value, but also economic factors -- in terms of socio-economic capacity and the affordability of patients. Chen pointed out that the new value orientation of the health care catalog drug negotiations will lead to a shift in the role of health care departments, drug producers and doctors.
"From the health department just paid, become to take the initiative to choose to pay and to determine the value of the product, price and rationality in the process of use, no doubt put forward higher requirements for management department."
For the drug providers, in the case of social and economic ability to withstand, drugs can be included in the coverage, so drug companies listed on r&d and product pricing ideas also need to adjust.
As a drug prescription of the doctor, consultant's pharmacist, and even the choice of patients mentality also switch will occur, need in drug clinical value and the balance of economic affordability to make a choice.
It is more important for the participants to actually enjoy the benefits of health care reform. Ding Jinxi China pharmaceutical university professor, said the future need to be considered as a whole the area policy compatibility with existing policy, for example, how to implement docking with the provincial medical insurance directory, and public hospital centralized purchasing system cohesion, straighten out social pharmacy procurement and distribution channels, and to solve outpatient starting line, the top line and the proportion of out-of-pocket problem, etc.
On July 19, at a news briefing, people club department deputy director of the social insurance business management center, Mr. Xu said the next step will be to guide local earnestly implement the negotiation result, ensure this huimin policy landing at an early date.
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