Medical network on August 9 - national health insurance directory negotiation result has come out more than half, discuss the heat in the cooling, small make up for the future implementation rules are increasingly interested in, however, countries are also no further instructions, so do some analysis, combing information hope sprang out effect, listening to the sound of Montana from the industry.
National drug negotiations as early as the 2009 national health insurance directory adjustment, the response to "the central committee of the communist party of China, the state council on deepening the opinions of the medical and health system reform, the call to be raised, interpret adjustment scheme of that year, with the following description:
The implementation of this mechanism, first class is 8 years. While waiting for so long, but the negotiations result is successful, 36 drug talks into the directory, success rate of 81.8%, compared with the average retail price of 2016, negotiations and drug average decline reached 44%, the highest reached 70%, the high bargaining power, visible state health department to do their homework.
Here, the exploration of access negotiations has to be carried out by the local health care department, which provides the most immediate experience to the national health service. Review places in on what happened in recent years, can be found mostly talk about the products targeted drugs and drugs rare diseases, and slow disease drug is relatively small, this is mostly due to the slow disease drugs in medical insurance directory have similar products, for local health departments, to carry out the negotiations need to solve urgently is the urgently needed for treating patients, rather than the icing on the cake, targeted drugs and drugs rare diseases relative irreplaceability is urgently be included in the scope of reimbursement. However, some of the slow-disease products in the negotiation of the state, which are more exclusive products, are more expensive than similar ones, and are not suitable for direct inclusion in the catalog, thus reducing prices to the level of similar products through negotiation.
A glimpse of local negotiating access drugs
Incomplete statistics according to local government departments to open files (in addition to imatinib and by bead sheet resistance, other varieties of statistical provinces/cities only for zhejiang, hunan, shandong, Shanghai, chengdu, Qingdao, shenzhen, foshan, jiangxi)
Category 1: products directly included in the 2017 national health care catalog
The characteristic of such products is that the long time of listing and the imitations have caused the price competition. Typically, it's imatinib.
Imatinib's latest knockout price in jiangxi has been priced at 14.05 yuan, which is not the lowest price in the country. (small procedure: the latest bid price in imatinib)
Imatinib before entering the 17 version of the directory, has been in 19 provinces can submit an expense account, there is no doubt that novartis tumor on gleevec showed strong ability of market access and Liu Yong case caused the general attention, in a certain sense also health care access to our product has a certain positive effect. Many slow-moving patients sought an Indian version of imatinib for reimbursement and prices, while gleevec has a range of charitable activities, but still more expensive. Imitations of listing could further reduce the costs of treating patients, the latest data show that imatinib imitations in jiangxi recently winning bids only 14.05 yuan/piece, directly to the targeted and traditional chemotherapy drug price was close to the price, direct access to the directory is well-deserved.
Before, on the other hand, if the overall costs and products close to on the list, even if is the exclusive products, may also have direct access to the directory, such as Barry of resistance, rabbit anti thymocyte immunoglobulin, anti human T cells rabbit immunoglobulin the three transplant anti-rejection products.
Category 2: products of national negotiation access
The characteristic of such products is that the price is more expensive than the similar ones, while there are no imitations. Typical of trastuzumab. By bead sheet resistance from the point of sales data, is the nation's highest sales target products, as well as imatinib, many provinces and cities separately for out of the file, the two varieties in many parts of the country to realize the insurance reimbursement. And this by bead sheet resistance is not directly into the health care, on the one hand, there is no doubt that is because the sole identity and expensive, on the other hand, although HER2 targets at present domestic products in development, but is actually listed herceptin and sand (EGFR + HER2 targets).
If it is listed products more targets, then there is no doubt is a bayonet see red when access, popular targets such as EGFR, the two who planning commission negotiation products to go into the directory, and it for the talks.
Each of the three indications of the same indication had been negotiated by the NHFPC and the department of human resources
The three companies have been fiercely competitive, and the number of local claims has gone hand in hand with seven to eight districts. It for sample of 2015 hospital sales were 13.8% lower, on the other, both through the national talks after the price in the market, so this time are all must be the national health talks. In terms of the daily treatment fee, both gefitinib and erlotini were once a day, and the cost of the day was 198.6 yuan, which was not very large. It can be seen that the updated version of erlotini talks later than the other two, but is the biggest in terms of the decline, and is the cheapest in terms of daily treatment costs.
Third category: failed national negotiations
The characteristic of such products is that the competition is fierce and the price reduction is insufficient. Typically, the number of local access to the two products, such as situximab and infixidone, is not small, and it is not easy to include the scope of the national health insurance negotiations. The ability to enter negotiations means that products have a certain amount of market share and expert support rather than products that are not negotiated. However, two products of the same kind have direct access to the catalog products. The treatment before EGFR and ek for direct access to the directory, and have it for, and this bead sheet resistance in negotiations, in this case, cetuximab is undoubtedly enormous price pressure. TNF alpha before the restructuring of people Ⅱ type of tumor necrosis factor receptor antibody fusion protein - direct access to the directory, while the British, xidan resistance in the case of considering the charity, treatment costs and the former is relatively close, however the limit of crohn's disease of this kind of disease to limit, can say directly to negotiate with the symbol of failure.
On the other hand, some products make mistakes in the long-term strategy. Rare diseases medication wave was born, in a local access number should be more, and in pulmonary hypertension treatment, PDE5 class didn't indication, the domestic josefa front element is a quasi delisted status again, born wave is relatively stable. However, when the product expired at the beginning of 2016, the price of the product was cut by 80% in the first place, which was considered to be inconsistent with the product price cycle and the industry price rule before the unprecedented negotiation of price reduction. At the end of the negotiations, the negotiations failed, and the bitter end was in the domestic pulmonary hypertension.
Category 4: varieties not included in the negotiation scope
On the one hand, these products are relatively expensive, and similar products are already in the catalog. Is also the TNF alpha, for example, the world's Ada wood sheet resistance, sales of drugs as well as in the heap, although in some cities have examples of successful negotiation before, but the overall market share is not big, no expert support to in the negotiations.
On the other hand is the time to market late, some products from the product classification, belongs to the relatively new generation, of course the price also is very expensive, due to the small market share, and experts awareness is not enough, so there is no enter negotiations.
From the above situation, the relationship between the local negotiation access and the inclusion of the state negotiation is not fully positive, but the reimbursement area in the form is still in decline. The difference is that each region do not need both the developed and less developed areas of fund pressure difference, in addition to the weak bargaining power itself of objective factors, the rigid demand for the price is not particularly strong, into a more rich products.
In this country before negotiations, the negotiations for health care access on policy of local government is vague or general, although in the above-mentioned cure of twelfth five-year plan "of the central committee of the communist party of the opinions of the state council on deepening the reform of medical health system", the medical insurance directory in 09 notification, the implementation of urban and rural residents of a serious illness insurance work guidance "and other documents on the ideals of approximation, the countries themselves, however, did not carry out negotiations, also does not have the guiding opinions, meet the demand for treating patients is not keeping pace with The Times, where negotiation is arises at the historic moment.
So, under the background of this fuzzy policy, specific to each region, the background of the drug negotiations, potential promoters, capital source and mechanism is also different, so the name also have the difference, such as zhejiang province, hunan province, foshan bring drugs into a serious illness insurance reimbursement system, paid for by a serious illness insurance fund, covering all ginseng protect people, named as a serious illness insurance special drug reimbursement directory; And shenzhen and chengdu can be called a big disease special medicine supplementary medical insurance, ginseng protect personnel to voluntary participation, the extra pay a small fee (20 yuan in shenzhen and chengdu difference of identity in proportion to pay), most of the rest of the subsidies by the government (financial or medical insurance fund).
So will the form of local negotiations continue in the future?
In terms of the rigor of this negotiation, it is unfair to continue the reimbursement of local negotiating medicines, and to the 36 medicines that have been reduced to catalogue. Take by bead sheet resistance, before the negotiations, according to incomplete statistics, has 12 provinces and cities in the country can submit an expense account, you can submit an expense account of provinces and cities in large possibility on is the main source of sales, to accept a 64.8% cut in price point lost in quantity? Therefore, the failure of the products to exclude the local health care directory, from a certain Angle means procedural justice.
It is reported that people club department in a recent national health insurance directory work communication conference, clearly put forward various provinces and cities can not again will not talk with 8 varieties in health insurance directory, and is likely to be a requirement to provinces about execution ground. In addition to the provincial plan, the provinces have already decided not to include in the provinces where they have been introduced before the negotiations.
This way, for the above mentioned three varieties of negotiations fail, have bigger hit, because before the three products achieved a number of areas of reimbursement, which means that the currently reimburses region became unable to submit an expense account, the next few years and there is no chance. If early knowledge is such a result, is it a better strategy to refuse to negotiate directly or to bite your teeth?
But in fact, the call of the provincial supplementary quota limit for 291, at present because the last time adjust the number of excess, miho union catalog merge varieties increased, and so on, some provinces have super, not some little remaining places, combined with the local negotiations most expensive product, number of patients with widowhood, branch in the local directory review without fine doesn't account for what advantage, difficulty is big on the list.
So, is there no chance of local negotiations?
On the policy side, the state has not ruled out continuing local negotiations, but it has not been banned. From fund management point of view, even if is the same province, different economy as a whole the area will also have certain differences, economy is relatively developed areas by means of negotiations will be relatively expensive drugs into the scope of reimbursement, from the perspective of patients, reduce the burden; From a social point of view, it alleviates the situation of poverty reduction due to illness. Some rare diseases drugs, in particular, on the population quantity of it, will not produce too much burden to fund, as already mentioned the wave and the raw of m glycosides enzyme products, such as to medication continuity of life-saving medicines, once cannot submit an expense account, patients can't afford, will produce certain negative influence of society.
Before, countries are also solicit opinions about health insurance directory dynamic adjustment, actually the future or first pilot license in some economically developed regions, on the basis of pharmacoeconomics evidence, conduct dynamic adjustment of more expensive drugs. If there is a better, more economical product, existing products can be adjusted in time to achieve better management of the health care fund. On the way, as mentioned by individual extra pay a certain amount of combining government investment mechanism innovation, guide the business risks leading to undertake, extra expansion of major disease drug reimbursement may also be a good direction. Most important, in order to ensure the fairness, the state may set forth principles for negotiation, give guidance and supervision, make the local professional strict level consistent with national negotiations negotiations, the price level is consistent, avoid unnecessary game. |
