Where is the new catalogue of medical insurance drugs: a 15 percent increase in the number of new anti-cancer drugs


Release time:

2017-02-24

The 2017 version of the medical insurance drug catalog adds 339 new drugs, which can also be applied to work-related injury insurance and maternity insurance participants. Adjust the catalogue to give more emphasis on drugs for children, innovative drugs, cancer and other major diseases. The catalogue also mentions 45 drugs to be negotiated, and after the price reduction is negotiated, the eligible drugs to be negotiated will be formally included. The new version of the medical insurance drug catalog expands the scope of drug protection, which is conducive to reducing the burden of drug expenses of the insured, and effectively delivers more people's livelihood dividends.

-- Editor

Eight years later, the 2017 version of the medical insurance drug catalog, which affects hundreds of millions of insured patients, has been released. The Ministry of Human Resources and Social Security officially announced the 2017 version of the national basic medical insurance, work injury insurance and maternity insurance drug catalog on February 23. The new version of the catalog expands the scope of basic medical insurance drug protection, which is conducive to reducing the burden of drug costs outside the catalog of insured persons, and will also promote the progress of clinical drug technology.

Including western medicine, Chinese patent medicine 2535 drugs

Why a new version of the drug catalogue? Chen Jinfu, Director of the Medical Insurance Department of the Ministry of Human Resources and Social Security, said that the national basic medical insurance, work injury insurance and maternity insurance drug catalogues are the basic policy standards and important safeguards for social insurance such as medical care, work injury and maternity. Since the establishment of the basic medical insurance system, the state has adjusted and issued three versions of the drug catalogue in 2000, 2004 and 2009 respectively. The current catalogue was drawn up in 2009 and contains 2196 kinds of drugs, including 1164 kinds of western medicines and 1032 kinds of proprietary Chinese medicines, covering most commonly used clinical drugs. However, the long-term non-adjustment of the drug catalogue has also led to a series of problems such as the heavy burden of drug costs outside the catalogue of insured personnel, disconnection from clinical drug demand, and the inability of innovative drugs to enter the catalogue, which urgently requires the adjustment and release of a new version of the drug catalogue.

The biggest change in the new catalog is reflected in the increase in varieties.

The 2017 edition of the drug catalogue is structurally composed of four parts: ordinary cases, western medicine, Chinese patent medicine and Chinese herbal pieces. The example is the explanation and explanation of the layout format of the drug catalog, the specification of the name and dosage form, and the limitation of the scope of payment. The western medicine part includes chemical drugs and biological products, the Chinese patent medicine part includes Chinese patent medicines and ethnic medicines, and the Chinese medicine decoction pieces part adopts the exclusion method to stipulate that the fund will not pay for the decoction pieces. A total of 2535 drugs were collected in western medicine and Chinese patent medicine, 339 more than the 2009 edition, an increase of about 15%. Among them, there are 1297 western medicines and 1238 proprietary Chinese medicines. The traditional Chinese medicine decoction pieces have not been adjusted, and the provisions of the 2009 edition of the drug catalogue are still used.

The new version of the catalogue applies not only to basic medical insurance participants, but also to work-related injury insurance and maternity insurance participants. In order to implement the National Occupational Disease Prevention and Control Plan and the Circular on Printing and Distributing the Opinions on Strengthening the Prevention and Control of Peasant Workers' Pneumoconiosis, special consideration has been given to the use of industrial injury insurance drugs in the formulation of the catalogue: on the one hand, the drug demand for occupational diseases and other special diseases has been fully considered, and drugs such as tetrandrine for the treatment of pneumoconiosis have been added; on the other hand, the "Remarks" column of 5 drugs such as botulinum toxin A injection in the drug catalog is marked as "restricted work injury insurance". These drugs are limited to the work injury insurance fund and do not belong to the payment scope of the basic medical insurance fund. That is to say, the scope of use of work injury insurance should exceed the scope of use of basic medical insurance.

Pay attention to children's drugs, drugs for major diseases, and support innovative drugs, traditional Chinese medicine and ethnic medicine.

What is the focus of the new version of the drug catalog? Chen Jinfu said that the adjustment of the catalog highlights the following five aspects.

Pay more attention to children's medication. 91 new varieties of drugs for children have been added, and the number of drugs or dosage forms clearly applicable to children in the drug catalogue has reached 540, strengthening the guarantee of drug use for children.

Increase support for innovative drugs. The innovative development of the pharmaceutical industry means the development and production of drugs with better quality, better efficacy and lower cost. For this reason, the catalogue adjustment will focus on the new drugs listed after 2009, and further tilt the innovative drugs among them. From 2008 to the first half of 2016, most of the innovative drugs and biological products approved in China were included in the scope of the 2017 edition of the drug catalogue or the scope of negotiated drugs, and only a few varieties were not included because they did not fall within the scope of medical insurance payment (vaccine) or had low clinical recognition.

Focus on drugs for the treatment of major diseases. Commonly used drugs for the treatment of major diseases such as cancer, severe mental illness, hemophilia, diabetes, and cardiovascular and cerebrovascular diseases have basically been included in the drug catalog or negotiated drug scope.

Strong support for traditional Chinese medicine, ethnic medicine. On the basis of adhering to the equal emphasis on Chinese and Western medicine, we will increase support for Chinese medicine and ethnic medicine. The proportion of Western medicine and Chinese patent medicine in the 2017 edition of the drug catalog reached 51% and 49%, basically the same. Experts from Tibetan medicine, Mongolian medicine and Uiga medicine were specially organized to review Tibetan medicine, Mongolian medicine and Uiga medicine. 41 new ethnic medicines were added, an increase of 90%, which was significantly higher than other medicines.

With the 2015 national negotiations on drugs to do a good job of convergence. Tenofovir, icotinib, gefitinib and other three drugs were included in the drug list by expert review. In addition, we strongly support the basic drug system. The vast majority of national essential drugs are included in the Class A part of the drug list, and the payment ratio is higher than that of Class B drugs.

After the implementation of the new version of the catalog, the expenses incurred by the insured persons using western medicines, Chinese patent medicines and Chinese herbal medicines outside the catalog shall be paid in accordance with the relevant provisions of basic medical insurance, work injury insurance, and maternity insurance. If the anti-HIV drugs provided free of charge by the state and the anti-tuberculosis drugs, antimalarial drugs and anti-schistosomiasis drugs involved in the national public health project are used by the insured and are within the scope of public health payment, the basic medical insurance, work injury insurance and maternity insurance funds will not be paid.

45 drugs to be negotiated, included in the catalogue after appropriate price reduction

In addition to the 2535 drugs, the new catalogue also mentions 45 drugs to be negotiated, which has attracted the attention of all parties.

Chen Jinfu explained that some patented and exclusive drugs are clinically necessary and have definite curative effects, but they are more expensive. If it is included in the drug list according to the existing market price, it may bring certain risks to the fund. Therefore, it is necessary to explore the establishment of a negotiation access mechanism for these drugs. After negotiation and appropriate price reduction, the eligible drugs will be officially included in the drug list.

In this catalogue review, 45 drugs to be negotiated were determined through procedures such as consulting expert review and selecting expert voting. Nearly half of these drugs are tumor-targeted drugs, covering common tumors such as leukemia, lung cancer, gastric cancer, and colorectal cancer. Others are drugs for major diseases such as cardiovascular and cerebrovascular diseases, rare diseases, and diabetes. "in the next step, after confirming whether the relevant enterprises have the intention to negotiate, we will announce to the public the list of drugs to be negotiated and organize negotiations in accordance with relevant procedures, and bring the agreed varieties into the scope of payment of the medical insurance fund. to ensure the smooth operation of the fund while better ensuring the clinical drug needs of the insured." Chen Jinfu said.

When will the new version of the drug catalogue be implemented? It is understood that the medical insurance drug catalogue is divided into catalogue A and catalogue B. The cost of drugs in List A shall be paid by the basic medical insurance fund in accordance with the regulations, and the payment shall be guaranteed in all the overall planning areas of the country; the drugs in List B shall be appropriately adjusted by the provinces, autonomous regions and municipalities directly under the Central Government according to the economic level and drug use habits, and the proportion of medical insurance fund payment shall be determined by the overall planning areas. In accordance with the relevant provisions of basic medical insurance, all provinces (autonomous regions and municipalities) may make appropriate adjustments to the Class B drugs in the national medical insurance drug catalogue in accordance with the regulations, and issue the medical insurance drug catalogue of their own provinces (autonomous regions and municipalities). This means that after the new version of the national medical insurance drug catalog is published, local catalogs will also be determined. Chen Jinfu said, "We require that this work should be completed by July 31, 2017. After the release of the drug catalogues of all provinces (autonomous regions and municipalities), the co-ordinating areas should begin to implement the new version of the drug catalogue within one month."

Chen Jinfu revealed that after the release of the catalogue, the Ministry of Human Resources and Social Security will begin to study and improve the management methods of medical insurance drugs, establish a normalized and dynamic access mechanism for medical insurance drugs, do a good job in the organic connection of catalogue access, payment standards, use management and other links, gradually realize the whole process management of medical insurance drugs, adapt the scope of protection to the actual clinical drugs and the progress of medical technology, and form a normal adjustment mechanism of the catalogue.

It is understood that the adjustment of the drug catalogue took more than half a year, and a basic database for evaluation was established, with 165000 pieces of drug registration information and 17000 varieties and dosage forms of Chinese and western medicine. A total of 381 consulting experts, including 6 academicians, were selected from more than 4200 experts. Finally, 3522 selection experts from 25 provinces across the country voted and selected the list of alternative drugs by electronic voting at the same time, according to the selection of votes

 

High and low, determine the catalog variety. (Our reporter Bai Tianliang)