Medical network - on August 2, recently, people club department official release health care medicine directory access negotiations as a result, for it, by bead sheet resistance and rituxan for more than 10 kinds of tumor targeting drug. In addition, the accessibility of cancer targeted drugs has been greatly enhanced by the successful entry of the NHFPC into the 23 provinces of ecclinib and gefitinib.
In China, chairman of the society of clinical oncology Wu Yilong point of view, the health-care negotiation is a big step forward, "once we summed up the targeted drugs through negotiations to include them in the successful experience of health care, whether it's second and third generation after, even the tenth generation of drugs, can take this model, the government and enterprise of post-marketing drug to negotiate the price pressure to a reasonable range."
However, part of the national negotiation signing varieties, especially tumor targeted drugs earlier has passed the place where the negotiations in many provinces, cities and basic health care or a serious illness insurance to pay limits, around the provincial medical insurance directory adjustment, how to coordinate between countries negotiation with local standard, new talks at the state and has been listed in the directory at the provincial level the relationship between varieties of facing the game.
Tumor targeting drug "first"
A number of media outlets have reported that many cancer patients have chosen to buy medicines from countries such as India because they can't afford the high cost of tumor drugs. Wu Yilong tells a reporter, a preliminary investigation showed that its people's hospital of guangdong province bought 20% ~ 30%, the proportion of patients with foreign drugs but these drug quality is uneven, the side effects of the resulting consequence is very serious. "This phenomenon will also be contained as the price of tumor targeting drugs drops and is covered."
At present, the first generation of EGFR - TKI targeted therapy drugs have been around through different forms of reimbursement channels into the medical insurance to pay limits, roughly calculated according to the reporter, since to pay the costs of treating patients with an average dropped to 2300 yuan/month to 5500 yuan/month (only in terms of basic health care), has been in the range of ordinary people can afford the price.
"The survival of patients with lung cancer in the past period was only ten months, and targeted therapy of lung cancer patients with a median survival reached 39 ~ 40 months, also behind the huge change along with the improvement of patient survival and quality of life." Wu yilong said that targeted drug therapy is in line with the essence of current clinical medicine, which is to ensure that patients' lives are extended without compromising their quality of life.
It is worth noting that another advantage of targeted therapy is that its clear efficacy provides the basis for the evaluation of drug economics. Such as EGFR mutation of the first generation of lung cancer molecular targeted drug widely in drug resistance 10 ~ 12 months after the phenomenon, with the passage of time, the number of patients for drug use will become less and less, how many people will live long corresponding can afford medical, health care how many patients with new onset, can by summarizing the clinical estimates, market and so on various aspects of the data.
For the entry Wu Yilong points out, even in the face of harsh for Britain's national institute for health and clinical excellence (NICE), the vast majority of tumor targeted therapeutic drugs are approved by the rigorous cost-benefit calculation.
Therefore, in the domestic cancer drug burden under the background of the increasingly prominent contradiction, both from local and national level, to treat proves exactly, risk control tumor targeting drugs to negotiate the price linkage medicare payments, also to accumulate experience in management, paves the way for expanding the scope of the varieties in the future.
"Similar negotiation mechanism will be more and more normalized, mechanism, clinical doctors, companies, and other stakeholders all need to do a lot of preparation work, I think this kind of dynamic adjustment interval for at least two years." Fudan university school of public health professor Hu Shan advice, think in terms of quantity and price of the directory to establish exit mechanism, further consideration in the future for medicine curative effect is not obvious, to provide new drugs into the space; On the other hand, the total budget control should be made to the newly included negotiating drugs, which should be paid by the pharmaceutical factory or further reduced by more than a certain amount.
National negotiations VS local negotiations
Learned, jiangsu, zhejiang, jiangxi, Inner Mongolia, hunan and other 22 provinces and cities has launched a medicare drug negotiations, will be part of high tumor targeted drugs, even rare diseases medicine into the medical insurance to pay limits, but in different parts of the payment standard, the limit to pay limits, to send a gift terms, the agreement is not the same.
Since this year, will be in Shanghai, for example, Shanghai 18 after tumor targeting therapy drug centralized purchasing price cut into health insurance, medical insurance to pay limits and reduction, forming double the efficiency, and published in the form of personal quota pay standards. The country's negotiations are announced on the basis of the health care payment standard, which includes two parts of the cost of the basic health care fund and the insured. After comparing the payment criteria of five varieties of the negotiation between the countries and the Shanghai negotiation, the reporter found that the former had both higher and lower varieties than the latter, and the specifications were relatively abundant.
About how to join the relations between the two, future people club bureau of Shanghai health authorities in response to a reporter at the said: "high tumor before negotiations into health care medicine temporarily according to the existing standards, such as when the line will also consider the new directory."
Think in terms of the government at the provincial level, in order to maintain local consistency before and after medical insurance directory and the sustainability of medical insurance fund, the priority will be given local health departments have entered the provincial drug directory, but did not enter the catalog of national drug varieties (2017 edition). It was published in the supplement plan of the statement of guizhou, sichuan and other eight provinces, and the four provinces of qinghai, shanxi, hainan, hubei explicitly talks at the state level is beyond the scope of transfer into consideration.
On the other hand, there are still part of the province of new farmers and urban residents medical insurance system, the province health department also won new farming in transition period to fund can accommodate the talks at the state level to further balance. "Since the adjustment is included in the adjustment ratio, the true proportion of the adjustment of the national health insurance directory of the category of drugs in the provinces is likely to be less than 15%," he said. "Hu said.
Predictably, for these negotiations have practice place health care reimbursement mechanism of the province, the focus of the next provincial directory adjustment will be further comb coordination of up and down, the new and old standard conflict of interest. Expert advice, should be in accordance with the principle of benefit ginseng protect personnel, coordinate with the drug supplier. For other contracted drugs, local insurance agencies should also communicate with drug suppliers as soon as possible, and study local implementation plans on the basis of national agreement.
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