1. Are innovative drugs included in the medical insurance catalog?
Opportunities for those who are willing to "trade price for volume"
There has been a strong demand for patented drugs, especially domestically produced innovative drugs, to be included in medical insurance. However, it was generally believed that if innovative drugs enter medical insurance, it will significantly increase medical insurance expenditures.
The establishment of the national drug price negotiation system has solved this problem to a certain extent. The high price strategy of innovative drugs is due to their generally high R&D costs, and it is difficult to recoup R&D investment when there are only a limited number of drug users; however, entering into medical insurance will undoubtedly greatly expand drug sales, and "price-for-volume" is important for companies. Yan is undoubtedly a good choice.
Therefore, for those innovative drugs that are willing to significantly reduce their prices, they can be considered for inclusion in this adjustment to the medical insurance catalog.
2. Traditional Chinese medicine has received policy support:
It is hard to be optimistic about traditional Chinese medicine injections, auxiliary medicines and Chinese and Western compound preparations
The national level has issued a large number of supporting documents to encourage and support the development of traditional Chinese medicine, including research on traditional Chinese medicine materials, drug components, and drug activity.
However, the clinical use of Chinese patent medicines is still subject to many restrictions, especially in recent years when the country has approved many exclusive Chinese medicine extracts, monomers or compound new drugs. Many of these varieties cannot be included in the medical insurance catalog.
Of course, it is not appropriate to include all of these varieties in the new version of the medical insurance catalog, but some of them are effective and safe, especially those that have entered higher-level domestic disease treatment guidelines or clinical pathways. Important considerations.
On the other hand, traditional Chinese medicine injections, auxiliary medicines and Chinese and Western compound preparations are hardly optimistic. The abuse of traditional Chinese medicine injections is serious, especially some Chinese medicine cardiovascular and cerebrovascular injections lack clear indications. At the same time, the safety problems of many traditional Chinese medicine injections are serious, and the abuse aggravates the possibility of adverse events; some auxiliary drugs occupy a huge market. Medical insurance funds, but the effect is not significant; Chinese and Western compound preparations are academically controversial. It is not easy for these varieties to enter the new medical insurance catalog, and some of the varieties that have already entered may even be kicked out of the catalog.
3. Varieties that have been included in provincial medical insurance catalogs in many places:
The chance is not great, and those with large sales will have a greater chance and will also face price reduction pressure
Considering the medical insurance The selection of the catalog has always been a joint work carried out by experts across the country, so the varieties that have entered the provincial medical insurance catalog in many places undoubtedly have great opportunities.
Among them, those varieties that already have a large market size have greater opportunities. Although the pressure of reimbursement of medical insurance funds is not small, medical insurance is more important for social and people's livelihood attributes. The inclusion of varieties with larger sales volume can reduce the cost of patients. overall medical burden. Of course, these varieties will also face pressure to reduce prices.
4. Will the medical insurance payment price be implemented?
It remains to be seen, and it may be introduced at the regional level
Due to the liberalization of drug pricing, the original medical insurance reimbursement model can no longer adapt to the new drug price system. In the new round During the adjustment of the drug catalog, the industry is very concerned about whether the medical insurance payment price will be directly added.
For example, some people say that the new medical insurance payment model will pay a unified price for the same generic drug, which will undoubtedly have a huge impact on the original drug. In addition, there are also calls for the adoption of a disease-based medical insurance payment model.
However, considering the current market situation, it is difficult to implement it at the national level in the short term, and the medical insurance payment price is also difficult to unify due to the vast differences in medical insurance conditions and payment levels in various places. The possibility of introduction at the regional level cannot be ruled out.
5. Are OTC products supported in medical insurance?
There is considerable controversy, but it is unlikely that this type of product will be marginalized by medical insurance.
Recently, a lot of information has come out that OTC products will be the ones with the greatest impact from this medical insurance adjustment. category. The conservative view is that the new round of medical insurance will not add OTC varieties, while the more radical view is that OTC varieties will be kicked out.
The author does not agree with these views. As far as medical insurance itself is concerned, it is not just critical illness insurance for difficult and major diseases. It is also very important for the prevention and control of chronic diseases and early diseases. If OTC varieties are marginalized in medical insurance, many patients will no longer choose OTC medicines and go directly to hospitals for treatment, which will undoubtedly further increase the pressure on medical institutions.
On the other hand, OTC varieties are of great value for disease control and prevention of its progression. If medical insurance support for OTC varieties is reduced, many patients will interrupt or neglect disease control, leading to minor illnesses becoming serious and disease complications. This undoubtedly contributes to the overall inefficiency of medical security. Therefore, although critical illness medical treatment is important, it is not wise to support critical illness medical treatment at the expense of OTC.
6. Integration between several major directories?
Will it be integrated with the new rural cooperative medical care directory? How to coordinate with the Essential Drugs List?
Too many catalogs is a problem faced by both pharmaceutical companies and medical institutions. Many people don’t understand why China has so many drug catalogs related to medical insurance. Whether the new round of medical insurance catalogs can integrate several major catalogs is highly anticipated.
Prior to this, some regions such as Shandong had already piloted the integration of three guarantees into one. However, at the national level, it is still unclear whether directories such as the medical insurance directory and the new rural cooperative medical care directory can be integrated.
Since the directory has the problem of multiple management, the integration of the directory undoubtedly requires coordination and balance at the national level. At present, the directory is still led by the Ministry of Human Resources and Social Security, which means that it will be difficult for each directory to be integrated in the short term. Quick integration.
In addition, the early model would directly include the Essential Drug List in the Medical Insurance Category A, but the new round of Essential Drug List has become more numerous, and so many varieties have been included in the Medical Insurance Category A, which has a high reimbursement rate. It is estimated that it will be difficult to operate in practice, and it is possible that some varieties will be classified as medical insurance Category B to reduce the pressure of medical insurance reimbursement.