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Original title: Average price reduction exceeds 50%. 119 drugs are successfully included in health insurance. The new version of the national basic health insurance, work accident insurance and maternity insurance drug catalog will be implemented in March 2021
Every time reporter Zhou Chengcheng Every time editor Wang Keran
On December 28, the National Administration of Medical Security and the Ministry of Human Resources and Social Security announced the “Catalog of Medicines of the National Basic Medical Insurance, Work Accident Insurance and Maternity Insurance (2020)”, which will be formally implemented on March 1, 2021.
After this catalog adjustment, a total of 119 drugs were transferred to the catalog and 29 drugs were removed from the catalog. The final catalog included a total of 2,800 drugs, including 1,426 Western drugs and 1,374 Chinese patent drugs. There are still 892 kinds of Chinese medicinal herbs in the catalog with no adjustments.
Judging by the negotiation situation, the National Medical Insurance Directorate negotiated a total of 162 drugs, and the negotiation was successful in 119 (including 96 from the catalog and 23 from the catalog), with a success rate of 73.46% and an average price reduction of 50.64%.
Regarding the negotiation of PD-1 drugs that has attracted a lot of attention, 7 drugs participated in the negotiation and finally 3 national PD-1s were successfully selected. In addition, this adjustment attaches great importance to the protection of drugs related to the treatment of new coronary pneumonia, including ribavirin injection, Abidol granules and other drugs in the catalog. The latest version of the new national plan for the diagnosis and treatment of coronary pneumonia includes all the drugs included in the list of the national health insurance. .
Xiong Xianjun, director of the Medical Services Management Department of the National Health Insurance Administration, said the adjustment adheres to the functional positioning of “basic protection”, by transferring drugs with low clinical value, negotiations to reduce drugs with cost significantly higher in the catalog and special negotiations on the prices of expired drugs. , Buying with quantity, squeezing the price and the humidity of the medicine, realizing the free cage and the bird. The medicine savings fund transferred in 2020 is approximately the same as the estimated cost of the fund spent on the negotiated medicines.
14 “ancient breeds” must be traded
Compared with previous years, an important characteristic of this adjustment is that the number of drugs negotiated for price cuts is the highest and the treatment fields the most benefited. The 96 exclusive products transferred in the final negotiation, plus 23 non-exclusive drugs transferred directly, involved 31 clinical groups, representing 86% of all clinical groups, and patients benefited most widely.
At the same time, it also tried for the first time to negotiate a reduction in the price of medicines in the catalog, and included 14 “old varieties” in the catalog in the negotiations. After the negotiation, all 14 drugs were successfully negotiated and remained in the catalog, with an average drop of 43.46%.
What are the considerations for price reduction negotiations for catalog drugs? Xiong Xianjun said that this is because some drugs were originally listed in the catalog without negotiations, and in recent years, the price has not been reduced much, the price is relatively expensive, and the occupancy of the medical insurance fund is also large. . 14 exclusive drugs with sales of more than 1 billion yuan have negotiated price cuts.
What is the motivation of these companies to negotiate? Xiong Xianjun said that the company will be notified in advance that if the negotiation fails, the company’s drugs may be removed from the catalog. Also, some drugs already have drugs with similar curative effects on the list. If they are excluded from the list, it will not affectCommon peopleMedicine.
Will annual sales exceeding 1 billion yuan become the “threshold” for future price reduction negotiations for catalog drugs? Xiong Xianjun candidly said that 2020 is an exploration of the existing varieties in the catalog. In the future, the different varieties in the catalog will be determined according to the different conditions of each year.
Success rate of health insurance negotiations exceeds 73%
Compared to previous years, the success rate for this round of health insurance negotiations is higher, but the decline is slightly less. 162 types of drugs were negotiated and 119 were successfully negotiated, with a success rate of 73.46% and an average price reduction of 50.64%.
“We are not looking for a reduction, nor are we looking for the success rate of the negotiations,” Xiong Xianjun said in an interview with the media, including “Daily Business News” reporters after the meeting.
Due to the high success rate of this negotiation, Xiong Xianjun believes that one of the most important factors is that good communication with the company in the initial stage allows you to understand the basic requirements and principles of the insurance company price calculation. doctors, so the company quote and the psychology of the medical insurance company The price is also closer.
Xiong Xianjun pointed out that in this round of negotiations, the company’s original price is relatively low, so the reduction in negotiation will not be very large.
Xiong Xianjun said that some drugs that are very expensive have not been included in this round of negotiations on health insurance. This also wants to send a very clear signal to the company. Even if corporate drugs are not included in the medical insurance catalog, the market price of drugs should be based on the actual situation of China as a developing country.
Many drugs for rare diseases are often expensive, and some drugs have also been included in health insurance through successful negotiations. For example, the disease modifying treatment (DMT) drug for the treatment of multiple sclerosis, fingolimod hydrochloride capsules and sinimod tablets have also passed this round. The negotiations are included in the medical insurance.
But Xiong Xianjun also pointed out that health insurance can’t really pay for some “sky-high” price drugs. Therefore, in the field of rare diseases, in addition to considering the benefits to patients with clinical efficacy, the affordability of the fund must also be considered.
Tweak 17 New Cancer Drugs
Cancer drugs have always been the center of attention.
Shi Yuankai, vice president of the Cancer Hospital of the Chinese Academy of Medical Sciences, noted that the health insurance department considers the health insurance department to have the greatest strength to include cancer drugs in health insurance. By negotiating price cuts and reimbursing health insurance, the proportion of the personal burden on patients is reduced, the financial burden on patients is reduced, and the availability of medicines to patients is improved.
Shi Yuankai said that many of the new drugs for treating tumors in the medical insurance catalog were launched recently in the last one or two years. Some drugs originally on the list will also see a relatively large drop in negotiations in 2020.
Data shows that 14 unique cancer drugs have been renewed or traded according to the rules, with an average drop of 14.95%, of which individual first-line cancer drugs have been reduced by more than 60 %. The price of 14 anticancer drugs is estimated to be reduced, which is expected to save more than 3 billion yuan for cancer patients in 2021.
Additionally, 17 new cancer drugs have been added to this setting, including PD-1, lenvatinib, etc. According to the CCTV news, several newly listed cancer drugs will be “on the shelves” at the lowest price in the world.
Huang Bin, vice president of AstraZeneca China, said that based on China’s population and economic development, no foreign company or company can ignore the value of the Chinese market. Through the health insurance policy and a series of supporting policies, the accessibility of health insurance trading products has been significantly improved, allowing companies to see space and volume opportunities by price. Therefore, while ensuring reasonable commercial returns and sustainable pharmaceutical innovation, companies can and are willing to supply the best medicines at the lowest prices.
3 national PD-1 drugs were selected
Regarding the monoclonal antibody of the broad spectrum anti-cancer drug PD-1, in addition to Xinda Bio’s Sintilimab, which was successfully negotiated in 2019, the other 7 PD-1 drugs have participated in this health insurance negotiation.
In this round of health insurance negotiations, 3 domestically produced PD-1 drugs were successfully selected, includingJunshi BioFrom triprolizumab,Hengrui MedicineCarrelizumab, Tilelizumab from BeiGene. Negotiations between Merck’s pembrolizumab and Bristol-Myers Squibb’s nivolizumab failed.
In terms of price, Xiong Xianjun revealed that the price of the newly included health insurance drug PD-1 is lower than that of Cinda Bio’s Sintilimab.
Public data shows that Sintilimab has dropped by 64% after health insurance negotiations in 2019, costing 2,843 yuan per tube.
The number of indications affects your sales volume. Xiong Xianjun noted that there are no restricted indications for PD-1 drugs included in health insurance and approved indications will prevail.
Specifically, Hengrui Medicine’s Karelizumab is the domestically produced PD-1 with the most approved indications. All four indications are included in the insurance list, namely Hodgkin lymphoma, liver cancer, non-small cell lung cancer, and esophagus. Squamous cell carcinoma. BeiGene’s tislelizumab has two indications, while Junshi Bio’s treplizumab has only one melanoma.
On the failure of the PD-1 negotiations between multinational pharmaceutical companies, Xiong Xianjun said that importing companies should consider international prices, so their price expectations are different from those of the health insurance department. Many national companies still have their main markets in the country, so they have a better chance of reaching an agreement with the health insurance department on the price.
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