It’s done! Price reduction! Save More Than 100,000 Yuan for Patients Demystifying the “Famous Scene” Behind Health Insurance Negotiations |

Original title: The talk is over! Price reduction! Save more than 100,000 yuan for patients! Secret behind the “famous scene” of health insurance negotiations …

From December 14 to 16, the National Medical Insurance Office organized the negotiation of the adjustment of the 2020 medical insurance drug catalog. The drugs in this negotiation include both drugs for tumors for the treatment of malignant diseases and drugs for common diseases of concern. to the people. Many innovative medicines are included Negotiations The catalog of medical insurance is closely related to the vital interests of all and alsosocietyThis has caused widespread concern.

　　“Price for Quantity” Pharmaceutical Companies Strive to Enter Health Insurance

On December 28, the National Health Insurance Administration held a negotiation on the adjustment of the 2020 health insurance drug catalogPress conference. Negotiations were conducted on 162 exclusive drugs and a total of 119 drugs were successfully negotiated.

National Health Insurance AdministrationadministrationXiong Xianjun

Since 2017, the state has held health insurance drug negotiations for three consecutive years and has successfully listed more than 40 cancer drugs on the health insurance category B list through the “amount-to-trade access method.” by price “. Not only that, this year’s health insurance catalog adjusted 17 new anticancer drugs and three national cancer PD-1 / L1 inhibitors were included in health insurance.

This health insurance negotiation is of extraordinary importance to Aunt Gao, a melanoma patient. Aunt Gao is 67 years old and has been suffering from malignant melanoma for 14. Melanoma is a type of skin cancer, but 95% of skin cancer patients died of melanoma.

Despite the amputation of her finger, Aunt Gao’s cancer cells spread from her fingers to her lymph nodes in just a few months. Shortly after the second operation, the cancer cells spread to the lungs. The amputation did not help. During the next 14 years of treatment, Aunt Gao’s condition wasHersheyBad.

In 2018, a new foreign antitumor drug for melanoma entered Chinamarket, Let the family see the light, and this drug is a PD-1 / L1 antibody inhibitor drug, Although the side effects and drug resistance of the drug are less and the curative effect is more durable, the drug is expensive and an injection a month costs 18,000 yuan. Although national drugs do not take long to be available, they require two injections per month. It costs more than 7,000 yuan per injection, 14,000 yuan a month, and more than 200,000 yuan a year for medicines alone. Aunt Gao and her husband are retired employees. The combined monthly pension for the two is less than 7,000 yuan. They are overwhelmed by the price of the drugs and have already carried more than half a millionexternal debt。

After the PD-1 monoclonal antibody drugs were included in health insurance, the annual fee for treatment was reduced by approximately 25% based on the original buy one get one charity assistance program.RefundFor her part, Gao Auntie only needs to pay less than 2,000 yuan for medicines on her own every month, and she will reduce her payment for medicines by more than 100,000 yuan each year.

China Cancer CenterreportStatistics show that, on average, more than 10,000 people are diagnosed with cancer every day in China and 7.5 people are diagnosed with cancer every minute. Medical expenses caused by malignant tumors exceed 220 billion annually. The high cost of drugs has crushed countless families like Aunt Gao, so what happened to the negotiating parties at that time?GameWhat?

The scenario of the negotiation on access to national health insurance drugs is a game without gunpowder. One side represents the interests of the country and patients and a huge market, while the other side is responsible forcompanyWin future survival and developmentDealImportant task. For businesses, health insurance negotiations are both a place of examination and a place of competition.

This year, the field of cancer drugs continues to be the focus of health insurance negotiations, and PD-1 / PD-L1 antibody inhibitors are the focus of everyone’s attention. In 2019, Sintilimab was the first and only PD-1 to enter the National Health Insurance List.priceThe drop reached 64%, but after entering health insurance, sales revenue in the first half of 2020 has been equal to the full year of 2019. Public data shows that accumulated sales of the drug in the first three quarters of 2020 exceedRMB1.5 billion yuan, and shows an upward trend quarter by quarter.

From a negotiation perspective, according to the “price per quantity” principle in health insurance negotiations, the level of the quote directly determines whether the company can be shortlisted. Low price is the main competitiveness. The negotiation itself has undergone reasonable and detailed calculations, taking into account the tolerance of the patient andbackgroundAffordability, but also consider reasonablenessprofit。

Xiong Xianjun, Director of the Department of Medical Management of the National Health Insurance Administration

　　Price cuts without going into health insurance and imported drug prices began to make concessions

According to the catalog published by the Office of Health Insurance, the 7 PD-1 models involved in health insurance negotiations this timeproductAmong them, the four PD-1 products brought in by four multinational pharmaceutical companies are not covered by health insurance, and the other three products brought in by three local pharmaceutical companies areborrowThe price advantage became the ultimate winner.

As of December 2020, more than 100 national companies have invested in PD-1 antibody research and development. This shows that the PD-1 antibody racetrack is very competitive.

　　Junshi Biovice presidentChen wei

In this health insurance negotiation, even though the imported drugs from the four multinational pharmaceutical companies were not included in the health insurance, they responded immediately under pressure.Through the patient assistance policy developed by the China Cancer Foundation, the company allows medicationcostFrom 480,000 yuan a year to 110,000 yuan.

If national medicines are included in the medical insurance or imported medicinesDisguised discounted priceThe price-lowering effect of these health insurance negotiations has really benefited cancer patients. Following the announcement of the health insurance catalog, when can patients use these new drugs included in health insurance?

Xiong Xianjun said that in this health insurance negotiation, the National Health Insurance Bureau first tried to negotiate a price reduction for medicines in the catalog. These varieties are all one billion products, and 14 products are down 43.46%. In January 2019, the column “Half Hour Economy” once paid attention to the dilemma of not being able to buy medicine at the hospital after the price of medicines was lowered and health insurance was entered.

　　[Observación de media hora]Drug price cuts: the market is the “trump card” and innovation is “trust”

In recent years, we have found that there are more and more “high-priced” drugs, whose prices have become more affordable, and they have also entered the health insurance catalog. This aspect benefited from the negotiation of the prices of the health insurance medications, by negotiating “fair bargain, balanced benefit, and price by quantity.”mechanismTo achieve a “three win” situation where the health insurance fund is affordable, patients can benefit, and pharmaceutical companies are willing to profit. On the other hand, the reduction of drug prices benefited from the independent innovation of domestic medicine.In recent years, since the implementation of the reform of the national drug review, the state has encouraged and guided R&D and innovation of pharmaceutical companies, and the number and technical level of national innovative drugs and original investigational drugs have increased significantly.ChangheProgress, which makes the countryInternal companyHave confidence and ability to compete with multinational pharmaceutical companies. We believe that in the future, more good drugs that are “affordable and available” will be included in health insurance to benefit people.

(Source: CCTV Finance)

(Responsible editor: DF512)