How can drugs be squeezed into the new health insurance catalogue with only one chance in 5 years?

The Ministry of Human Resources and Social Security recently released the "2016 National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug Catalog Adjustment Work Plan (Draft for Comment)." After 7 years, the adjustment of the health insurance catalogue will start again. The "Draft for Comments" clearly stated that the current round of medical insurance drug catalog adjustment will be completed before the end of 2016.

In this adjustment, it is expected that about 300 new drugs will be added to the national medical insurance catalogue, including new drugs with higher clinical value, drugs with more local B supplements, and drugs for major diseases, children, emergency rescue and occupational diseases are also expected to be transferred to the new medical insurance catalogue.

According to officials from the medical insurance department of the Ministry of Human Resources and Social Security, the adjustment of the medical insurance catalogue is divided into three stages. The first stage is the identification of a list of drug candidates. The Ministry of Human Resources and Social Security will consult experts to determine the list of alternative drugs to be transferred into and out of the medical insurance catalogue and to negotiate the scope of alternative drugs. About 400 consulting experts are recommend by relevant academic groups and industry associations.

In the second stage, experts will be selected by electronic voting to transfer in and out of the medical insurance catalogue. These experts will be randomly selected, totaling 20,000.

In the third stage, experts will determine the varieties transferred in and out according to the voting results, and strive to complete the adjustment of the medical insurance drug catalogue by the end of 2016.

Up to now, the adjustment of the medical insurance catalogue is in the first stage of determining the alternative list. The adjustment results will be announced in the first half of 2017, and the provinces will complete the addition of the provincial medical insurance catalogue in 2017-2018.

"This catalogue adjustment is the sole responsibility of experts, and the Ministry of Human Resources and Social Security and other administrative departments will not interfere with the review. The review takes into account both Chinese and Western medicine, and the increase in the number of both is basically balanced, with clinical demand as the guide, and the scope and level of medication is reasonably determined according to the fund's affordability and the level of burden on the insured. In terms of reimbursement ratio, Category A is fully reimbursed and Category B pays a certain percentage." The aforementioned Ministry of Human Resources and Social Affairs official said.

For enterprises, there are no more than three issues that people are concerned about or worried about:

One is whether the drugs originally in the three catalogues can be retained in the new catalogue after the merger;

Second, how can those who did not enter the directory enter the new directory;

Three is the possibility of patented drugs into the catalog.

Expanding it to say:

One, can continue to stay in the catalog. Because in general, after this adjustment, the number in the new catalog has increased, so as long as the following three situations do not exist, they should not be "kicked" out innocently.

(1) is the quality of drugs do not pass, there have been drug safety problems.

(2) is the drug efficacy is really not, or similar varieties of higher efficacy.

(3) is the selection of experts must "kick" varieties.

II. On the question of how to squeeze into the new "catalogue", there is a prevailing view on the Internet: enterprises that have only prepared for the "draft for soliciting opinions" are already a big step behind well-informed enterprises. The well-informed people have finished their preliminary communication, and the catalogue has been basically determined before soliciting opinions. Of course, the time should be short. In order to avoid complications, it is better to get rid of those who do not know how to do communication work. This is competition.

However, "basic certainty" is not a final determination. If there are indeed unreasonable points or obviously imperfect links, there is still the possibility of correction; moreover, not most companies that are truly well-informed and have communicated in the early stage Although the competition is fierce, the public talk is fierce, and the effect may be better.

Besides, there is a 400-person expert consultation team to provide consultation on drug classification and data analysis, demonstrate the technical points of drug evaluation, and put forward opinions on the scope of alternative drugs. The number of selected experts reached 20000. The draft for comments requires that no less than 30% of the experts participating in the selection are from secondary and lower medical institutions; in principle, no less than 50 experts in each drug group. In this way, early communication is at best top-level communication. If the selection experts fail, or many selection experts raise objections, the possibility of "coming from behind" is still quite high.

3 How likely are patented drugs to enter the catalog. According to the cognition of ordinary people, patented drugs are definitely drugs with high prices, and of course they are also drugs with better curative effects. It is possible to refuse to predict that the patented drug will enter the new "catalogue", but it is still very difficult, for three reasons.

(1) It is determined by the purpose and basic requirements of the new medical reform. The basic requirement of the new medical reform is "low level and wide coverage". The main purpose is to make more people affordable with limited medical insurance funds. Despite the good efficacy of patented drugs, it may be more appropriate to enter the health insurance catalog from a pharmacoeconomic point of view. However, from the point of view of single-expense reimbursement and overall regional control, health insurance payments will certainly prefer low-cost generic drugs.

(2) It is the pharmacoeconomics problem mentioned above. The relevant government departments are very aware of this, so they have made great efforts to promote the consistency evaluation of generic drugs. The purpose is also very clear: choose low-priced generic drugs in the health insurance catalogue, and try to receive the same effect as the original drug.

(3) Is the current amount of China's health insurance base really can not afford the widespread use of high-priced patented drugs. Earlier, there were media reports that the accumulated balance of the medical insurance pooling fund in the six regions of Beijing, Tianjin, Hubei, Chongqing, Guizhou and Xinjiang Construction Corps was less than six months of expenditure.

It is not impossible for patented drugs to enter medicine. There are two ways. One is to reduce the price to not much higher than that of generic drugs. Under the premise that the price is almost the same, I believe most people will give priority to patented drugs with more reliable quality and curative effect. But in this way, it is bound to damage the economic interests of the patent drug production company. Another way is to make patented drugs irreplaceable. Only some patented drugs can cure a certain disease. If there is no other choice, the possibility of entering medical insurance will be greatly increased at this time, and will not damage the interests of enterprises.