Enable patients to use good drugs more quickly. This year, the work plan for adjusting the national medical insurance drug catalog has been officially announced. Medical insurance | catalog | drugs
Today, the National Medical Insurance Administration announced the "2023 National Basic Medical Insurance, Work Injury Insurance, and Maternity Insurance Drug Catalog Adjustment Work Plan". This is the sixth consecutive year since the establishment of the Medical Insurance Administration that it has carried out the adjustment of the medical insurance drug catalog. Why adjust the national medical insurance drug catalog? What tangible benefits can it bring to the people? How fast does innovative drugs go from being approved to being included in medical insurance?
The work plan for directory adjustment this year has been officially announced
The adjustment scope of the drug catalog in 2023 is from January 1, 2018 to June 30, 2023, for new generic drugs approved for market by the national drug regulatory department, drugs with significant changes in indications or functional indications, and drugs that have obtained drug approval documents for this change, as well as drugs included in the National Essential Drug Catalog. Among them, for drugs included in the "encouraged generic drug catalog", drugs included in the "encouraged research and development application for children's drug list", and rare disease treatment drugs, there are no restrictions on the approval time.
Ding Jinxi, Executive Vice Dean and Professor of the Graduate School of China Pharmaceutical University: When conducting clinical trials, there are very few rare disease patients, and the same goes for children, so the cost of development is very high. So after it goes public, its cost recovery will also be slow, one is difficult to develop and the other is difficult to sell, so we have some preferential policies in terms of medical insurance access.
In addition, this year's work plan for catalog adjustment no longer takes COVID-19 medicine as a separate drug declaration condition, but applies according to the general type of innovative drugs. According to the "Work Plan", the enterprise will officially start the application process from July. For drugs that have passed formal review, the National Medical Insurance Administration will organize joint evaluations by experts in pharmacy, clinical practice, pharmacoeconomics, medical insurance management, and work-related injury insurance management. After evaluation, four types of results have been formed: proposed direct transfer in, proposed negotiation or bidding transfer in, proposed direct transfer out, and proposed to be processed according to the renewal rules. It is expected that the final catalog adjustment results of the relevant drugs will be announced in November this year after on-site negotiations or bidding.
Rapid inclusion of new drugs in medical insurance to meet clinical medication needs
In the adjustment of the national medical insurance drug catalog in 2022, 108 new negotiated and competitive drugs were added, of which 105 were new drugs launched in the past five years. A considerable number of drugs were approved and included in the medical insurance catalog that year. Over the past 5 years, out of 70 major new drug development special drugs that participated in negotiations, 66 negotiations have been successful, with a success rate of 94%, achieving rapid clinical application.
Medical insurance significantly increases expenditure on new drugs, guiding enterprises to focus on research and development
By establishing a medical insurance admission and negotiation renewal mechanism with new drugs as the main body, the waiting time for new drugs to be included in the medical insurance catalog has been reduced from an average of nearly 5 years in the past to less than 2 years. The expenditure of medical insurance on new drugs increased from 5.949 billion yuan in 2019 to 48.189 billion yuan in 2022, an increase of 7.1 times. The initial R&D investment of the enterprise has received reasonable returns, and the innovation enthusiasm has greatly increased.
Ding Jinxi, Executive Vice Dean and Professor of the Graduate School of China Pharmaceutical University: Usually, a tertiary hospital only has about 1500 such standards. Therefore, when a newly launched product enters the hospital, the hospital will convene a pharmaceutical management committee to study whether the drug is suitable for admission to the hospital. So when it comes to judging whether a drug can be admitted to a hospital, one very important criterion is to see if it has been covered by medical insurance. The efficacy, quality, and cost-effectiveness of medical insurance have been demonstrated and guaranteed. After the second negotiation on medical insurance, firstly, the price has dropped significantly, and a large part of the price has been reimbursed by the government. This means that the patient's self payment is very small. Of course, if they are willing to buy, the sales will open up, and the company is still very willing to participate in the negotiation to enter medical insurance.
The hospital pharmacy is equipped with negotiation drugs through a "dual channel" system
"Dual channel" refers to the mechanism of meeting the reasonable needs of negotiating drug supply guarantee, clinical use, etc. through two channels: designated medical institutions and designated retail pharmacies, and synchronously incorporating them into medical insurance payment. As of the end of December 2022, 209000 designated hospitals and pharmacies across the country have been equipped with catalog negotiation drugs, making it more convenient for patients to purchase negotiation drugs.
Medical insurance drug catalog adjusted to reduce patient burden by over 500 billion yuan
It is understood that the continuous optimization of the medical insurance drug catalog has significantly improved the level of medication security for the public. Overall, the number of drugs in the catalog has significantly increased, and the scope of protection is constantly expanding. Among the top 20 categories of medical institution expenses, there are now few auxiliary drugs with uncertain therapeutic effects and easy abuse, and they are replaced by therapeutic drugs for major and chronic diseases. Especially in recent years, medical insurance negotiations have promoted a large number of exclusive varieties of anti-cancer drugs and rare disease drugs to be included in medical insurance at appropriate prices. For five consecutive years, directory adjustments have been made, combined with medical insurance reimbursement for included drugs, resulting in a cumulative reduction of over 500 billion yuan for patients.
