The adjustment of the national health insurance catalogue is unprecedented, and the first attempt to negotiate the price reduction of the drugs in the catalogue. In the future, the annual adjustment of the medical insurance drug catalog will become the norm, and it is expected to further expand the breadth and depth of medical security in terms of "cost-effectiveness", effectively reduce the economic burden of patients, and allow the people to enjoy the results of the reform.

A few days ago, the National Medical Insurance Bureau and the Ministry of Human Resources and Social Security announced the "National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug Catalog (2020)" (referred to as the "Catalog"). In this adjustment, 119 kinds of drugs were transferred in and 29 kinds of drugs were transferred out. Finally, there were 2800 kinds of drugs in the catalogue, including 1426 kinds of western medicine and 1374 kinds of Chinese patent medicine. The proportion of Chinese and western medicine was basically the same. The new version of the catalogue has been officially implemented since March 1 this year.

The adjustment of the national health insurance catalogue is unprecedented, and the first attempt to negotiate the price reduction of the drugs in the catalogue. A total of 162 drugs were negotiated, the most in history. The newly transferred drugs include 96 exclusive drugs and 23 non-exclusive drugs, involving 31 clinical groups, accounting for 86% of all clinical groups. Experts said that the newly shortlisted drugs have achieved "higher cost performance" in terms of price reduction and clinical effect ".

What impact will the adjustment of the national health insurance catalogue have on the common people? The reporter interviewed the relevant person in charge of the National Health Insurance Bureau, experts and business people.

Dramatically Decreased Drug Prices

According to the National Health Insurance Administration, a total of 162 drugs have been negotiated in this "Catalogue" adjustment work, and 119 drugs have been successfully negotiated, with a success rate of 73.46. The average price of successfully negotiated drugs has been reduced by 50.64. Take the most concerned anticancer drugs as an example. In 2018, the National Health Insurance Administration organized special access negotiations for anticancer drugs. Finally, 17 drugs were successfully included in the catalogue and the agreement expired at the end of 2020. Fourteen exclusive drugs were renewed or renegotiated according to the rules, with an average drop of 14.95 percent and individual first-line anticancer drugs by more than 60 percent.

"It is estimated that the price reduction of 14 anti-cancer drugs is expected to save more than 3 billion yuan for cancer patients in 2021. This adjustment has added 17 new anti-cancer drugs, including new and good drugs such as lenvatinib, and the level of protection for cancer drugs in the catalogue has been significantly improved." Xiong Xianjun, director of the Medical Service Management Department of the National Health Insurance Administration, said that the successfully negotiated drugs involved 31 clinical groups, accounting for 86% of all clinical groups, and patients benefited a wide range.

"The new oncology drugs in 2020 are all mainstream drugs newly launched in the past two years, with clear clinical indications." Shi Yuankai, deputy dean of the Cancer Hospital of the Chinese Academy of Medical Sciences, said that the "Catalogue" basically covers the mainstream treatment drugs for cancers in major organs. Common lung cancer and breast cancer drugs have increased, and some uncommon tumors have available drugs.

When talking about the use of drugs for children, Ji Xiaohua, chief physician of the Department of Pediatrics of Xiyuan Hospital of the Chinese Academy of Chinese Medical Sciences, said that this medical insurance negotiation included a total of 7 pediatric drugs, which fully considered the safety and effectiveness of the drugs. The drugs are mainly oral liquids and granules., Easy for patients to take. The supplementary drugs for children are the most commonly used in clinical practice. As the respiratory system and digestive system diseases account for a large proportion of pediatric outpatient clinics, the adjusted drugs are specially included for these two diseases.

The National Health Insurance Bureau estimates that most of the new 119 drugs are exclusive drugs that have been negotiated to achieve price reductions, and the increase in fund spending in 2021 is expected to be roughly the same as the space made by the negotiation and transfer of drugs. On the other hand, from the perspective of patient burden, through negotiation of price reduction and medical insurance reimbursement, it is estimated that the burden of patients can be reduced by about 28 billion yuan in 2021.

The economic improvement of medical insurance

The reporter learned from the National Health Insurance Administration that from October to December 2020, on the basis of enterprise declaration, the National Health Insurance Administration established a database of drug evaluation. After the expert review stage to the negotiation stage, the drug to be negotiated is measured. During the period, enterprises are invited to communicate face-to-face one by one, fully listen to the opinions and suggestions of enterprises, and organize negotiation experts to carry out their work intensively.

"Simply put, it is to guide pharmaceutical companies to give the lowest acceptable price under the negotiation rules." Gong Bo, director of the medical price and bidding procurement department of Shanghai Medical Security Bureau, said that the negotiation responsibility of striving for the maximum profit for the insured should not be ignored because of personal sympathy, and the negotiation should never be "stopped" in the negotiation ".

"Our fund calculation team should consider various factors comprehensively and comprehensively in the calculation process as much as possible, broaden the breadth and depth of the calculation, objectively evaluate and evaluate the true value of the negotiated drugs, and at the same time take into account the fund's affordability to give a reasonable negotiated price. In order to protect the basic medical needs of the people, so that the vast majority of patients can enjoy the results of negotiated drugs." Zheng Jie, director of the Beijing Medical Insurance Center and leader of the National Medical Insurance DRG Payment Technology Guidance Group, said.

In fact, when the drug negotiation set the application conditions, it had already taken precautions: first, to better meet the clinical needs; second, to better connect with the new drug approval work, to realize the "seamless connection" between drug approval and medical insurance review, to reflect the guidance of encouraging the creation of new drugs; third, to take care of the continuity of clinical medication.

Even in the original list of drugs, but also to continuously improve the economy. A feature of the negotiations was the first attempt to negotiate a price reduction for the drugs on the list. According to the procedures, the evaluation experts selected 14 exclusive drugs with high prices or costs and more fund occupation for price reduction negotiations. All 14 drugs were successfully negotiated and retained in the Catalogue, with an average price reduction of 43.46 per cent. Xiong Xianjun said: "my country will carry out the adjustment of the medical insurance drug catalog every year, which will become the norm, and expand the breadth and depth of medical insurance inthe'cost-effective."

Support New Drug Declaration

It is worth noting that in order to better meet the needs of patients for newly listed drugs, the adjustment of the medical insurance catalogue will include all drugs listed before August 17, 2020, and 16 new drugs listed in 2020 will be included in the catalogue. People in the business community said that this negotiation has released a clear orientation that supports new drugs and is centered on the needs of patients. While ensuring that patients use reduced-price drugs, they have also made efforts to ensure that patients use new drugs in a timely manner, which further encourages enterprises. Confidence in developing new drug research and development.

"Everyone knows very well how difficult it is to innovate, especially to make original new drugs-the drug development cycle takes at least a decade or even decades; the high investment, high risk, and long return on investment cycle. If you don't get into health insurance in time, it will seriously affect the development and even survival of pharmaceutical companies." Huang Yuesheng, chairman of Beijing Wuhe Boao Pharmaceutical Co., Ltd., the holder of mulberry total alkaloid listing license, said that the "catalogue" adjusted and implemented the enterprise declaration system, and the channels were more smooth and efficient.

Thanks to the reform of the adjustment policy of the medical insurance catalogue in 2020, the new blood sugar-lowering drug "mulberry total alkaloid" has the honor to become one of the few varieties approved in that year, when the country talks about health insurance. Huang Yuesheng said: "Although the price of the product was reduced as soon as it was launched, as a representative of the company, we still feel the recognition and strong support of the National Medical Insurance Administration and experts for innovative drugs. We are willing to invest in the market with a small profit to promote the healthy development of the industry."

"Medical insurance negotiations and related supporting policies aim to give enterprises a stable expectation of exchanging quantity for price, while reducing drug prices, reducing the economic burden of patients, and reducing the pressure on medical insurance funds, while giving enterprises a reasonable profit space for continuous innovation and development." Huang Bin, vice president of AstraZeneca in China, for example, AstraZeneca's osimertinib tablets are the third generation of targeted drugs for the treatment of non-small cell lung cancer, which has obvious clinical advantages over the previous generation products. After successfully passing two rounds of medical insurance catalog negotiations for new indications in 2018 and 2020, the current domestic price of osimertinib tablets is far lower than that of other countries and regions, which fully reflects the commitment to benefit patients as much as possible.