The medical website on August 7 saw the list of "trastuzumab", Chen jun (pseudonym) a stone in the heart of the land.
Chen's mother was suffering from breast cancer and needed an injection of trastuzumab, known as herceptin. Previously in China, the drug, which is produced by the multinational pharmaceutical company roche, has a retail price of more than 20,000 yuan. In a treatment cycle, at least 14 injections are administered. For patients, even partial reimbursement can be a huge expense.
Recently, the ministry of human resources and social security announced 36 kinds of drugs in medical insurance directory of price negotiation as a result, to pay for health care and synchronized to determine the drug standard, among which herceptin. After negotiations, each drug payment standard dropped to 7,600 yuan, a drop of nearly 70%.
Be incorporated into the national basic medical insurance, inductrial injury insurance and maternity insurance drug catalogue (2017 edition) "b range of drugs, most are keen in patients with tumor targeting drugs, and drug in the treatment of cardiovascular disease, a major diseases such as hemophilia. Compared with the average retail price in 2016, the average price of a negotiated drug fell by 44 per cent, the highest drop of 70 per cent.
This is the first time China's national drug insurance market has been negotiated. For the patient, the price of a new drug is a "green light". And for medicare and drug companies, it can also be a win-win.
Patients with high drug prices benefit
Visa application, air ticket purchase, currency exchange, bargaining, cold chain transportation... A year ago, a netizen Shared his experience of buying herceptin in new Delhi, India. In order to buy a few medicine, all the way, the mind is exhausted. Even so, the cost of buying medicine is lower than domestic buying. Several netizens replied that they were planning to buy medicine in India after seeing the "strategy" of buying medicine.
Mr. Chen said he had the same idea, but was afraid to buy a fake or expired drug, fearing that he would not be given an injection after he returned to China.
After this time into the medical insurance directory, herceptin single price down to $7600, according to ginseng protect patients from the lowest pay twenty percent computation, each drug in patients with the lowest costs only 1500 yuan, equivalent to a one-way ticket to new Delhi.
Drugs like herceptin are a "targeted drug" for tumors. Targeted drugs are drugs that can "target" specific lesions and accumulate or release active ingredients in the target area. Because of its high potency and low toxicity, targeted drug is the ideal medicine for cancer treatment.
For a long time, some cancer patients have to rely on imported targeted drugs and some innovative drugs to sustain life. However, these drugs are limited by patent restrictions and are often extremely expensive and cannot be reimbursed through health insurance. Faced with the burden of "money for life", many chose to give up, and some were forced to join the "army of medicine" to purchase imported drugs or "generic drugs" from neighboring countries such as India.
Why is the price of Chinese patent medicine high? Experts believe that on the one hand, it is related to China's drug patent system, and on the other hand, some super national treatment of foreign drugs. Some foreign drugs, even after the patent protection period, enjoy the highest price level treatment in the centralized procurement process of public hospitals.
Of the 36 drugs that have been successful in the price negotiations, most are still in patent protection, with 31 western medicines and five Chinese medicines, with anti-tumor drugs occupying half of the total. The statistics show that these drugs involve more than 10 foreign pharmaceutical companies, and many of them have been sold in China in 2015 alone, which can be as high as hundreds of millions or even billions of yuan.
Herceptin, for example, had sales of 1.92 billion yuan in 2015; Roche's other treatment for the lung cancer drug, erlotini, negotiated a 58% reduction in sales of 624 million yuan in 2015. In addition, some drugs, such as astrazeneca, glaxosmithkline and bayer, have also fallen in price.
In the category of medicine that enters the health insurance directory, the patient can only pay partial self-payment, and the specific reimbursement rate varies according to local policies and specific medicines. Jilin jinhua, director of the health bureau, said the patient pays a small part of medical insurance fund for most of the costs, negotiated payment standards allow drug prices have fallen sharply, further reduce the patients' economic burden.
Institutional innovation and fair negotiation
Told the financial times reported that pharmaceutical companies through "long" and "very difficult" the price after negotiations, highlighted the world's big drug companies is working with the Chinese government to reduce drug prices, while making some revenue growth of the product.
In April, the ministry released a list of 44 drugs to be negotiated. In the end, the success rate of the negotiations reached 81.8%. There were reports that the talks were quiet, serious, bargaining hard and beyond the company's expectations, and some business people were sweating it out.
How can we deliver results in just four months from the preparation to implementation? Depth involved in the negotiations of China pharmaceutical university professor Ding Jinxi pointed out that as the first national negotiations, medicine health care access is not many work, need to learn from international experience and combining with China's national conditions make groundbreaking system design.
According to the relevant person in charge of people club department and participate in negotiations expert introduction, before the talks, takes care of two group of experts, respectively from the economy and health care of drug funds bear ability from two aspects of evaluation is calculated. On the one hand, it analyzes the clinical value of drugs, the price of peripheral market and the reference ratio of similar drugs. On the other hand, using the health insurance to run "big data", to measure the impact of the drug on the health insurance fund after the inclusion of the drug in the catalogue, make recommendations on this basis, as the main basis for the negotiation.
In the case of pharmaceutical enterprises, the pharmaceutical information, drug price and other materials should be submitted according to the declaration list. At the same time, the health insurance party will give the experts the conclusion of the assessment and the payment scope and policy conditions of the drug to the enterprise, allowing the enterprise to make changes.
Enter the negotiation stage, the health insurance agency separately organizes the negotiation expert and the enterprise representative to carry on the price negotiation. The drug companies had two chances to make an offer, and if the minimum bid was more than 15 percent higher than the expected price, the negotiations were suspended. On the contrary, the two sides can further negotiate. The final payment standard cannot exceed the expected payment standard.
Ding jinxi said that the declaration, review and negotiation are mutually independent and mutually restricted, guaranteeing the fair, scientific and reasonable negotiations.
To be sure, this drug access negotiations are just the beginning. The people expect that more new drugs and life-saving drugs will be included in the health care system, and the drug negotiation mechanism and system will be regularized.
Sun yat-sen university researcher at the institute of medicine economic TaoLiBo believe that in this access negotiations, China's health began to adopt the categorized management idea: the ordinary drugs, still adopts the traditional way of batch approval; For new drugs that are expensive, innovative and less competitive, evidence-based negotiations are used. This lays the foundation for the development of medical insurance access to "non-innovative drug reference payment standards, innovative drugs for negotiating access".
Yan qinghui, deputy director of the health insurance division of the ministry of health, said: "like patent medicines and exclusive varieties, the clinical value is relatively high, and the effectiveness is relatively accurate, and the people do need it. We want to give full play to the group buying advantage of health insurance, and negotiate the appropriate payment criteria on the basis of equal consultation with enterprises."
Win-win cooperation needs to be implemented
Experts believe that high price just need medicine into the health care medicine catalogue, it's health care, enterprise, ginseng protect people "three win", will lead to health departments, drug producers, the doctor role as positive change.
China has become the world's second largest pharmaceutical consumer market, wu zhenzhen, deputy director of the state food and drug administration, said yesterday. In 2016, the pharmaceutical market in China was over 1495 billion yuan, with an estimated growth of more than 13 percent, of which the prescription drug market was over 800 billion yuan.
The personage inside course of study says, for health care, as the growth of the payments for prescription drugs, have to "with limited money, buy the most valuable medicine", in the protection of patients with medication at the same time, ensure smooth running of medical insurance fund, effective control of medical insurance fund and social medical expenses burden.
For pharmaceutical companies, sales are expected to rise further as the drug is negotiated into the healthcare directory. Especially for foreign drug firms, as indications with increasingly fierce market competition, and the future may also face generic competition in China, so attend the negotiations and incorporated into the medical insurance directory is the best choice. At the same time, the move could encourage more domestic companies to invest in new drugs.
It is a good idea to cut the price of medicine in the first place, but the reform dividend will benefit the insured patients and the implementation of the health insurance department. Tao libo believes that the problem of cooperation between national health insurance and local health insurance is the difficulty of further reform of the admittance mechanism.
The department had previously requested that the proportion of the basic medical insurance fund for 36 drugs and the share of the participating personnel should be determined by the pooling areas. According to previous regulations, the local health insurance department has a 15 percent control over the national category of the category b medical drugs, which can be adjusted and adjusted, and the proportion of payments will be determined according to local conditions. However, the ministry of social security has made it clear that the competent department of social insurance of the provinces (autonomous regions and municipalities) shall not transfer the relevant drugs to the catalogue or adjust the scope of payment.
Mr Yan said the current payment standard was valid until December 31, 2019. Within the validity period, if there is a generic drug listing, the department will adjust the medical insurance payment standard according to the price level of the generic drug. Local retail pharmacies should be encouraged to provide medicine to the insured and play a positive role in ensuring the supply of medical insurance.
Ding Jinxi thinks, the next step to consider as a whole the area policy compatibility with existing policies, including 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., make a bargain social benefit maximization. |
