Every reporter: Li Biao Every reporter: Li Xuanzhang Every editor: Chen Xing
html On June 29, the National Medical Security Administration announced the "2022 National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug Catalog Adjustment Work Plan" and related document, which marks the official launch of the fifth round of adjustment of the national medical insurance drug catalog since the establishment of the National Medical Insurance Administration.The documents released this time include the "2022 National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug Catalog Adjustment Work Plan" and the "2022 National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug Catalog Adjustment Application Guide" and "Negotiation Drug Continuation" Contract Rules" and "Non-exclusive Drug Bidding Rules".
" Daily Economic News " reporter noted that compared with previous rounds of catalog adjustments, this adjustment has the characteristics of optimizing the scope of application, improving access methods, improving renewal rules, and optimizing work processes.
A doctor at a community health service center takes medicine in a pharmacy. Photo source: Photo by Xinhua News Agency reporter Lin Bifeng.
Appropriate tilt to special groups such as rare disease patients and children.
Regarding the background of this catalog adjustment, the relevant policies have been clearly interpreted. Since this year, my country’s economy has The complexity, severity, and uncertainty of the development environment have increased, and it is crucial to effectively protect and improve people's livelihood. On the basis of an in-depth summary of previous rounds of catalog adjustment work experience, we adhere to the positioning of "basic protection" and comprehensively consider factors such as fund and patient affordability, drug value, and steadily improve the level of protection.
"Daily Economic News" reporter found that 's catalog adjustment this time has optimized the scope of application: appropriately tilting towards special groups such as rare disease patients and children. does not set a time limit for "approval for marketing after January 1, 2017" for the application conditions for rare disease drugs. At the same time, it has added that drugs included in the national encouraged generic drug catalog and the encouraged research and development application list of children's drugs can apply for this year's medical insurance catalog.
According to CCTV Finance's " first time " report in February: Currently, there are more than 7,000 known rare diseases in the world, with more than 300 million rare disease patients, and more than 20 million rare disease patients in China. 70% of rare diseases have their onset in childhood, and childhood diagnosis is crucial.
In the adjustment of the national medical insurance catalog last year, the "sky-high price drug" Nosinaxin Sodium Injection , which is used to treat the rare disease spinal muscular atrophy and costs 700,000 yuan per injection, was priced at less than 700,000 yuan per injection after medical insurance negotiations. The price of 33,000 yuan entered the catalog.
Wei Zining, editor-in-chief of "Medical Reform Circle" and director of Beijing Sanyi Zhiku Hospital Management and Development Research Institute, said in a telephone interview with a reporter from "Daily Economic News" that the above changes will help enterprises develop and process innovative drugs. Invest heavily in rare disease drugs. "For patients, this means that more rare disease drugs may be included in the medical insurance catalog, which can reduce the burden on families."
Payment standards are determined simultaneously when accessing non-exclusive drugs
In terms of access methods, this time Adjustments have been made: the access method has been improved, and payment standards have been determined simultaneously when non-exclusive drugs are admitted.
Interpretation of relevant policies shows that this solves the problem of non-exclusive drugs being unable to be included in the catalog due to the high prices of individual companies. Drawing on the principle of negotiation, experts calculate and determine the willingness to pay for medical insurance, and then companies make independent quotes. As long as one company participates and the price is lower than the willingness to pay for medical insurance, the generic name can be included in the directory, and the lowest bid is used as the payment standard for the generic name ( If the lowest quote is lower than 70% of the willingness to pay for medical insurance, 70% of the willingness to pay for medical insurance will be used as the payment standard). Relevant departments will guide local governments to explore and improve management measures, and support the priority use of varieties under the same generic name whose price is not higher than the payment standard, effectively reducing the burden on patients and better performing the protection function.
Wei Zining said that because most of the drugs in the medical insurance catalog are essential drugs, from the perspective of enterprises, this can encourage enterprises to increase their efforts in drug production and supply; for patients, the accessibility of drugs will be improved and the burden will be reduced. Further lightening allows the base medicine to return to its essence.
Wei Zining also added: "Anyone who can use essential medicines should use all essential medicines, and any medicine that can be used in the medical insurance catalog should all be used in the medical insurance catalog. The state should take measures in this regard and encourage it from a policy perspective."
In addition, in terms of renewal rules, non-exclusive drugs (regardless of whether the agreement has expired) and exclusive drugs that have experienced two agreement periods (4 years) but have no change in payment standards and payment scope will be included in the regular catalog management; for this year Drugs that adjust the scope of medical insurance payment but have little impact on the fund budget (not exceeding 1 times) can also be easily renewed. The above practices are conducive to stabilizing the expectations of enterprises and society.
Daily Economic News
Daily Economic News
