According to the information office of the National Health Insurance Bureau, Aquiline injection has passed the preliminary examination, but it has not entered the medical insurance catalogue negotiation. Should high-priced drugs be included in medical insurance?
Let's talk about our views:
1. Medical insurance is a big pool, which should be used by more people. The orientation of medical insurance is to "guarantee the basics" and meet the most basic medical needs of ordinary people.
According to the latest data from the National Health Insurance Bureau, in 2020, the accumulated balance of the national basic medical insurance fund (including maternity insurance) was 3150 billion yuan.
And this money is evenly distributed to 654.38+04 billion people, and the amount that can be distributed is already stretched. When high-priced drugs are included in medical insurance, the balance will inevitably tilt to the other end of a few people.
This means that it takes thousands of people's medical insurance money to send medicine to one person, and it can't take care of more people. Take the injection of 6.5438+0.2 million anticancer drugs as an example. If it is included in medical insurance, it will occupy the medical insurance payment of nearly 2400 residents.
Moreover, some anticancer drugs or rare diseases are not only expensive, but also have few patients. In the face of the equality of life, it is an unsolvable problem whether it is reasonable for thousands of people to buy one person's medicine.
But we can be sure that the reality is cruel. If someone needs caviar, someone can't drink rice porridge. In the case of limited medical insurance funds, the state can only protect the welfare of most people as much as possible, which is cruel and fair, but it is also a choice that must be made.
2. Anti-cancer drugs are expensive, so it is impossible to reduce the cost. Drugs that can be included in medical insurance must be clinically effective and affordable by medical insurance funds and ordinary people.
Anti-cancer drugs and drugs for rare diseases have a good effect, but the price has been high.
Some people may ask: Why is it so expensive for pharmaceutical companies to sell life-saving drugs? Due to the huge cost of new drug research and development, the research and development process is also very difficult! Some new drugs take at least ten years from research and development to final listing, and cost billions or even billions.
The patent protection period of new drugs is generally 20 years. Excluding the time of research and development, pharmaceutical companies can only earn back the cost of initial investment in 10 at most. So it is not surprising that the price of anticancer drugs is high.
After all, medicine is a commodity, and the nature of clothes and shoes is the same. If only one enterprise in the world can produce clothing, and clothing is a necessity, the price must be astronomical.
It is obviously unrealistic for the medical insurance fund to bear such a high price. Anticancer drugs are so expensive, can insurance pay for them?
Since many anticancer drugs cannot be covered by medical insurance, is there any commercial insurance to reimburse them? Help us alleviate the huge economic pressure?
1. Critical illness insurance Critical illness insurance is a kind of payment insurance.
As long as the disease agreed in the contract is diagnosed and the payment standard is reached, the insured amount will be paid in one lump sum, and the money can be freely controlled. At present, the critical illness insurance on the market can basically pay for cancer, and some products can also cover some rare diseases.
Some friends here may ask: critical illness insurance is so expensive, even if you buy 1 10,000, a shot is not enough! The original intention of critical illness insurance is not to pay medical expenses, but to make up for the loss of income caused by serious illness as rehabilitation expenses, lost time and so on. Therefore, if you want to reimburse the medical expenses, in addition to the critical illness insurance, we also suggest that you buy millions of medical insurance.
2, millions of medical insurance As we said earlier, chemotherapy, radiotherapy, targeted therapy, immunotherapy, etc. are generally used to treat cancer. We went through many millions of medical insurance and found that most of them can reimburse the expenses incurred by these treatments.
In addition to seeing whether it belongs to the above treatment methods, whether the product can guarantee the purchased drugs. For example, anticancer drugs can only be bought in specific pharmacies and medical institutions. If the hospital does not have this medicine, it will be reimbursed through the protection of purchased medicine.
In the guarantee responsibility of medical insurance, the following conditions need to be met before reimbursement can be made: the terms include the responsibility of tumor immunotherapy, theoretically including CAR-T responsibility; This clause also needs to cover the responsibility of outsourcing drugs; And the list of drugs to be purchased should include the corresponding drugs or treatments. In the actual medical application scenario, the purchased drugs are basically involved, but some million-level medical insurance does not include this responsibility.
Therefore, it is recommended that you choose millions of medical insurance as far as possible, and have the responsibility to purchase drugs in hospitals. There will be more and more ways to treat diseases in the future, such as CAR-T therapy, but there will always be limitations in the timeliness of product upgrade response, including product design and update. Therefore, if the million-dollar medical insurance you buy can cover the drugs you buy, and the list of drugs you buy includes the drugs, you can apply for compensation.
Don't worry, millions of medical insurance on the market can basically reimburse the drugs purchased, and the types of drugs are relatively complete, which are generally sufficient.
3. Special drug insurance In addition to millions of medical insurance, special drug insurance can also reimburse the cost of anticancer drugs.
The difference is that the health information of special drug insurance is more relaxed and the price is very cheap. You can buy it for tens of dollars, but you can only reimburse the cost of specific drugs. Therefore, I remind you that the transfer of critical illness risk mainly depends on medical insurance and critical illness insurance.
It is suggested to consider purchasing this kind of special drug insurance as a supplement on the premise of configuring critical illness insurance and million medical insurance. The above is the way for ordinary people to reimburse 6.5438+0.2 million needles of anticancer drugs through insurance.