1, adriamycin liposome has not been widely included in medical insurance because of its drug specificity; 2. Adriamycin liposomes are still non-medical insurance drugs and are not reimbursed in most areas; 3. Although doxorubicin has been included in the scope of medical insurance, its liposome form is not generally accepted as a medical insurance drug because of its particularity and cost. 4. According to the Interim Measures for the Administration of Medication in Basic Medical Insurance, the inclusion of drugs in the medical insurance catalogue requires expert review and submission of materials such as pharmacoeconomics, and adriamycin liposomes may still be in this process.
Update the medical insurance drug list;
1. Formulation principle of drug list: The formulation of drug list usually considers the efficacy, safety, economy and clinical necessity of drugs;
2. Drug review process: if drugs are to be included in the medical insurance catalogue, they need to be reviewed and negotiated by experts to determine whether they meet the inclusion conditions;
3. Drug price factor: high drug price may affect the possibility of inclusion in the medical insurance catalogue;
4. Drug patents: Patented drugs are usually expensive, and there may be an exclusive market during the patent protection period;
5. Drug substitution: If there are many similar drugs on the market, the substitution of new drugs will affect its decision to be included in medical insurance;
6. Drug clinical trial data: insufficient or unqualified drug clinical trial data may affect its decision to be included in the medical insurance catalogue.
To sum up, the reasons why doxorubicin liposomes are not included in medical insurance mainly include the low general acceptance caused by its particularity, the present situation of non-medical insurance drugs in most areas, and the review and approval process stipulated in the Interim Measures for the Administration of Medication in Basic Medical Insurance. These factors * * * together lead to its current failure to be widely included in the scope of medical insurance reimbursement.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 28
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.