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Original title: The dynamic adjustment mechanism of the medical insurance drug catalog is basically established
Source: Daily economic information
Recently, the adjustment of the National Health Insurance Drug List in 2020 has officially ended. 119 drugs have been added to the list and 29 have been transferred. Among them, the cancer drug in question PD-1, entered the three national companies. According to reports, during this negotiation, PD-1 and PD-L1 monoclonal antibodies were finally preselected, including 3 drugs, including carrelizumab, involving diseases such as lung cancer, liver cancer, melanoma, lymphoma, etc. This type of malignant tumor, the average price drop reached 78%.
According to industry experts, from a patient burden perspective, by negotiating price cuts and health insurance reimbursement, the cumulative patient burden is expected to drop by about 28 billion yuan by 2021.
Results of Fifth Round of Health Insurance Negotiations Released
“The number of drugs negotiated is the highest and the field of treatment is the one that benefits the most.” This is what Xiong Xianjun, director of the Medical Services Management Department of the National Medical Security Administration, commented on this negotiation.
The health insurance negotiations received a total of 2,155 company statements, involving 1,267 medications. After review and publicity, 722 drugs finally passed the formal review, of which 704 were not included in the list. In the end, 23 (non-exclusive) drugs were transferred directly to the list and 138 exclusive drugs were included in the negotiation. In fact, the traded products are not only the 138 types above, but also the 24 types that are already in the catalog. The total number of drugs negotiated is 162. The results showed that 119 types of negotiations were successful, the total success rate of negotiations was 73.46%, and the average price of successfully negotiated drugs was reduced by 50, 64%.
In the end, through this catalog adjustment, a total of 119 drugs were incorporated into the catalog, involving 31 clinical treatment areas such as cancer, rare diseases, hepatitis, diabetes, rheumatism, cardiovascular and cerebrovascular, and digestion. The adjusted “National Basic Health Insurance, Industrial Accident Insurance and Maternity Insurance Drug Catalog (2020)” contains a total of 2,800 drugs, including 1,426 Western drugs and 1,374 Chinese patented drugs. There are still 892 kinds of Chinese medicinal herbs in the catalog with no adjustments.
“This time the success rate is not bad and the decline is not as good as last year.” Xiong Xianjun said that the catalog adjustment adheres to the “basic protection” functional positioning to ensure that the health insurance fund spending is controllable. In the catalog adjustment process, adhere to the basic principle of “every effort to ensure the basics and always adhere to sustainability”, through the transfer of drugs with low clinical value, negotiation and reduction of drugs with significantly higher costs in the catalog, and special negotiation on the prices of expired drugs, especially In recent years, is the concentrated purchase of quantity and “price by quantity” to further tighten the price of drugs, to achieve “freedom for birds” and to ensure the basic balance of funds.
“At present, we have initially explored a path with Chinese characteristics that guides the return of drug costs to a reasonable level.” Xiong Xianjun said that through strategic purchasing, the “price by volume” market mechanism for access to medicines will be fully utilized and based on scientific assessments and calculations. Companies have moved from passive buying to active trading during negotiations, which has produced better results. By calculations, tracking 114 drugs traded in the current catalog shows that the median price cut for health insurance negotiations from 2018 to 2020 is more than 50%. Along with the reimbursement of health insurance, a cumulative reduction of 55.872 million yuan in expenses for insured patients compared to before the negotiations.
Xiong Xianjun pointed out that in the next step, local governments will be instructed to do a good job in implementing the new version of the catalog, and the new version of the catalog will be officially released across the country from March 1. 2021. At the same time, the 17 cancer drugs traded in 2018 will be reimbursed under the original policy until February 28, 2021.
The varieties in the catalog will also open the way to negotiation
The economic orientation is also transmitted to the drugs in the original catalog. This is the first attempt to negotiate a reduction in the price of catalog drugs, which has significantly improved the economy. The review experts selected 14 unique drugs with high prices or costs and a large amount of funding. In the price reduction negotiations, the annual sales of these individual drugs exceeded 1 billion yuan. After negotiation, all 14 drugs were successfully negotiated and kept in the catalog, with an average price reduction of 43.46%.
The 14 unique products successfully negotiated are all Category B national health insurance products, including CSPC’s Injectable Sodium Chloride and Butylphthalide Softgels.HaiscoDolasetron Mesylate Injection, Boehringer Ingelheim Injectable Alteplase, Lanqin Oral Liquid from Yangtze River, Bailing Capsules from Hangzhou Zhongmei Huadong, etc.
On the 28th, CSPC issued an announcement that the company’s Butylphthalide Softgels and Butylphthalide Sodium Chloride Injection (Trade Name: Enbipu) from the company will be adjusted on March 1, 2021 with reference to the new catalog. , Which are reduced by 55.6% and 51.3% respectively from the current national minimum price.
According to data from Menet.com, total sales of 14 unique products in China’s public medical institutions in 2019 exceeded 35 billion yuan, including CSPC’s butylphthalide softgel, Shandong Danhong Pharmaceutical’s Danhong injection and that of Hangzhou Zhongmei East China. Bailing’s capsule sales exceeded 3 billion yuan, and salvia miltiorrhiza polyphenolate reached 4.1 billion yuan. In addition, Shenyang Sunshine’s sales of recombinant human thrombopoietin injection reached 2.9 billion yuan, Lanqin’s oral solution reached 2.8 billion yuan, and sales of Kanglaite injection, Kangai injection and releasing implants. sustained goserelin acetate sales also hit. 2.6 billion yuan.
Xiong Xianjun said that this attempt to negotiate the 14 drugs in the catalog is only the beginning. He said the above drugs entered the catalog of health insurance without negotiation, and the price is already inflated compared to the current market. In recent years, these drugs have little motivation and willingness to lower prices, so the monitoring will continue to negotiate on drugs with internal standards in the catalog.
Regarding the 29 drugs that were removed from the catalog, Xiong Xianjun said that these drugs are mainly of low clinical value and can be substituted, or have been revoked by the drug regulation department and become “zombie drugs.” The release of these drugs has been repeatedly verified by experts and determined in strict accordance with procedures, leaving room for more new and good drugs to be included in the catalog.
Decrease is not the determining factor Value is an important consideration
Xiong Xianjun said that the price reduction is not what the negotiations are after. The company’s retail price before was relatively reasonable, and naturally, the price reduction of health insurance negotiation will be small.For high-priced drugs, Xiong Xianjun said that we should considerCommon peopleAffordability of prices and affordability of health insurance after it is included in health insurance.
Zheng Jie, an expert in the Fund Measurement Group of the National Health Insurance Administration and deputy director of the Health Insurance Affairs Management Center of the Beijing Health Insurance Administration, presented that for drug pricing, It will completely excavate valuable information, including the retail price of this drug in the provinces and cities of various countries. And international retail prices, also considering the impact of import tax rates, etc., through these to determine the minimum price of drugs.
According to CCTV’s “Focus Interview” report, AstraZeneca’s PD-1 product “Duvalizumab” was priced at 2,159 yuan in the second round, and health insurance experts reminded that “you should trust word 1”. Although the company won the target in the second round of listing, in the fierce situation of price competition, the listing is still unable to reach the reserve price and the negotiation should be terminated.
This also means that BeiGene’s tislelizumab, Junshi’s terelizumab, and Hengrui’s karelizumab will have lower prices.
Shi Yuankai, deputy director of the National Cancer Center and deputy director of the Cancer Hospital of the Chinese Academy of Medical Sciences, said that in 2015, about 3,929 million malignant tumors occurred and about 2,338 million died. On average, more than 10,000 people are diagnosed with cancer every day, and 7.5 people are diagnosed with cancer every minute. Compared to historical data, the burden of cancer continues to increase. The latest statistics show that deaths from malignant tumors account for 23.91% of all deaths among residents, and the incidence and deaths from malignant tumors have been on the rise in the last ten years. Annual medical expenses caused by malignancies exceed 220 billion, and the situation is grim.
Shi Yuankai said the dual effects of negotiated price reductions and health insurance reimbursement have greatly improved the availability of drugs for patients. In recent years, cancer drugs traded in recent years are the main drugs for cancer treatment in the world and have clear indications for clinical treatment, which have basically been covered. Cancers in major organs.
Wang Rui, an analyst at Huajin Securities, said that the four PD-1 monoclonal antibody drugs produced in the country have entered the medical insurance catalog this time, and the results of the negotiation are better than market expectations. It is expected that after the negotiation, the market share of domestic products is expected to increase further. The health insurance catalog dynamically adjusts each year, the speed of incorporation of innovative drugs into health insurance has slowed considerably, and the normalization of health insurance negotiations will have some impact on the short-term price of the product, but effect of increasing volume after entering health insurance at a price by quantity.
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