The drugs included in Class B of the National Drug List of Basic Medical Insurance, Work Injury Insurance and Maternity Insurance (20 17 Edition) are mostly tumor-targeted drugs that patients crave, as well as drugs for treating cardiovascular diseases, hemophilia and other major diseases. Compared with the average retail price in 20 16, the average price of negotiated drugs decreased by 44%, with the highest decrease of 70%.
This is the first national negotiation on medical insurance access in China. For patients, it is undoubtedly a "rain" to just reduce the price of drugs into medical insurance; For medical insurance funds and pharmaceutical companies, they can also get * * * benefits from it.
The price of drugs has dropped sharply, benefiting patients.
Apply for a visa, buy a plane ticket, exchange money, bargain, cold chain transportation ... 1 Years ago, a netizen shared his experience of buying Herceptin in New Delhi, India. In order to buy some medicine, I ran all the way and was exhausted. Even so, the cost of buying medicine is lower than that of buying medicine in China. Several netizens replied that after reading the "Raiders" of buying medicine, they also planned to go to India to buy medicine.
After being included in the medical insurance catalogue this time, the single price of Herceptin dropped to 7600 yuan. According to the minimum out-of-pocket ratio of 20% for the insured patients, the minimum cost for each drug is only 1500 yuan, which is equivalent to a one-way ticket to Delhi.
Drugs like Herceptin are "targeted drugs" to treat tumors. The so-called targeted drugs refer to drugs that can "target" specific lesion sites and accumulate or release effective components at the target sites. Targeted drugs have become ideal drugs to treat cancer because of their high curative effect and small side effects.
For a long time, some cancer patients have to rely on imported targeted drugs and some innovative drugs to continue their lives. However, due to patent restrictions, these drugs are often extremely expensive and cannot be reimbursed through medical insurance. Faced with the burden of "buying life with money", many people choose to give up, and some are forced to join the "drug purchasing army" and buy imported drugs or low-priced "generic drugs" from neighboring countries such as India.
Most of the 36 drugs successfully negotiated this time are still in the patent protection period, including western medicine 3 1 and Chinese patent medicine 5, of which anti-tumor drugs account for half of the country. According to the reporter's statistics, these drugs * * * involve 10 foreign pharmaceutical companies, and the domestic sales of various drugs reached hundreds of millions or even billions of yuan in 20 15 years alone.
For Class B drugs that enter the medical insurance catalogue, patients only need to pay part of the expenses themselves, and the specific reimbursement ratio varies according to local policies and specific drugs. Jinhua, director of Jilin Medical Insurance Bureau, said that patients pay a small part and the medical insurance fund bears most of the expenses. The negotiated payment standard greatly reduced the price of drugs and further reduced the economic burden of patients.
Fair negotiation of institutional innovation
It is reported in Britain that pharmaceutical companies cut prices after "long" and "very difficult" negotiations, which shows that major pharmaceutical companies in the world are cooperating with the China government to reduce drug prices, although this has slowed down the income growth of some products.
In April this year, Ministry of Human Resources and Social Security published a list of 44 drugs for negotiation. Judging from the final result, the success rate of negotiation reached 8 1.8%. It is reported that the negotiation site was quiet and serious, and the bargaining was particularly harsh, which exceeded the company's expectations. Some business people came out with sweaty hands.
According to the relevant person in charge in Ministry of Human Resources and Social Security and the experts involved in the negotiation, before the negotiation, two groups of experts from the medical insurance side evaluated and calculated the economy of drugs and the affordability of the medical insurance fund. On the one hand, it analyzes the clinical value, surrounding market price and reference of similar drugs. On the other hand, using the "big data" of medical insurance operation, this paper measures the impact of the drugs under negotiation on the medical insurance fund after being included in the catalogue, and puts forward suggestions on this basis as the main basis for negotiations.
For pharmaceutical companies, materials such as drug information and drug prices should be submitted according to the declaration list. At the same time, the medical insurance provider will also feed back the expert review conclusions, as well as the payment scope and policy conditions after the drugs enter the catalogue, so that enterprises can propose amendments.
Entering the negotiation stage, the medical insurance institution will separately organize negotiators to negotiate prices with business representatives. Pharmaceutical companies have two opportunities to bid. If the lowest quotation is more than 15% higher than the expected payment price of medical insurance, the negotiation will be suspended. On the contrary, the two sides can negotiate further. The final payment standard cannot exceed the expected payment standard of medical insurance.
To be sure, this drug access negotiation is only the beginning. The people expect more drugs just needed and life-saving drugs to enter the medical insurance catalogue, and the drug negotiation mechanism and system will be normalized.
Multi-win needs to be implemented urgently.
Experts believe that entering the medical insurance drug list at a high price is a "win-win" for medical insurance, enterprises and insured persons, which will promote the positive transformation of the roles of medical insurance departments, pharmaceutical manufacturers and doctors.
For pharmaceutical companies, the sales volume of drugs entering the medical insurance catalogue after the negotiation is expected to further increase, realizing "price for quantity". Especially for foreign pharmaceutical companies, with the increasingly fierce competition in the same indication market, they may face competition from domestic generic drugs in the future, so it is the best choice to participate in negotiations and be included in the medical insurance catalogue. At the same time, this move can also encourage more domestic enterprises to invest in new drug research and development.
Ministry of Human Resources and Social Security had previously requested that the basic medical insurance fund for 36 kinds of drugs and the sharing ratio of insured persons should be determined by each co-ordination area. According to the previous regulations, local medical insurance departments have the right to adjust the list of Class B medical insurance drugs designated by the state by 15%, and the payment ratio can be determined according to local conditions. However, this time in Ministry of Human Resources and Social Security, it was made clear that the social insurance authorities of all provinces (autonomous regions and municipalities) shall not transfer the relevant drugs out of the catalogue, nor shall they adjust the limited payment scope.
The next step is to consider the compatibility between regional policies and existing policies, including the connection with the provincial medical insurance catalogue, the connection with the centralized procurement system of public hospitals, the rationalization of the procurement and distribution channels of social pharmacies, the outpatient deductible line, the capping line, and the settlement of the self-payment ratio, so as to maximize the social benefits of the negotiation results.