Source: Science and Technology Daily
"Every small group should not be abandoned" "My tears are about to fall"... The negotiation "golden sentence" of the drug negotiation experts in the national medical insurance directory touched the whole network, and the negotiation video has recently been hot searched.
Screenshot of CCTV news video
On December 7, the National Medical Insurance Bureau made an interpretation of the "reserve price" issue with the highest social concern.
How is the reserve price calculated?
In the video, Zhang Jinni, a negotiation expert of the National Medical Insurance Bureau, repeatedly admitted that the negotiation team has zero space for the reserve price to be adjusted.
Where did the "floor price" she mentioned come from?
A successful negotiation depends on the determination and charm of the negotiating table, behind which is a strong support team. Before the "soul bargaining", the medical insurance party and the enterprise must carry out a lot of preparatory work, repeatedly arguing, reviewing, measuring and communicating. These are the basis for the creation of the reserve price.
The information on which the reserve price is based comes from the enterprise on the one hand. The National Medical Insurance Bureau said that before the negotiation, enterprises submitted calculation data according to a unified template, mainly including: basic drug information, relevant safety, effectiveness, economy and other information, intended price, and corresponding evidence materials.
On the other hand comes from the market and patients. For example, based on the rational drug needs of patients, the clinical value of drugs, the degree of innovation, market competition and other factors.
The calculation of the reserve price relies on scientific evaluation methods. Zheng Jie, head of the 2021 National Medical Insurance Negotiation Drug Fund Calculation Expert Group, said: In the 4 national medical insurance drug negotiations that have been carried out, the medical insurance negotiation work mechanism is becoming more and more perfect, and the measurement and evaluation methods are more scientific.
"The fund calculates and establishes a set of standardized and standardized models, comprehensively considering the reasonable drug needs of the insured, the clinical value of the drug, the degree of innovation, market competition and other factors, and based on evidence-based evidence, the drug is comprehensively and multi-angled scientifically evaluated." Zheng Jie said.
Why doesn't the reserve price directly brighten?
In the video, the negotiation experts have guided the company to make an offer many times, so why don't they ask the company directly if they know the "reserve price"?
The reporter of Science and Technology Daily reviewed the video of the medical insurance negotiations in previous years, and there was a detail that attracted the attention of the reporter. At the scene of a tumor drug negotiation, after the first round of quotations by enterprise representatives, the medical insurance negotiation expert opened a sealed envelope on the spot and said: How much price we calculated by the experts, we ourselves do not know, come and see.
Video screenshot of the focus interview
According to the National Medical Insurance Bureau, the process of the negotiation site was interpreted: first of all, the enterprise side quoted, and the enterprise side had two opportunities to quote and confirm. If the price after the second confirmation of the enterprise is higher than 115% (exclusive) of the negotiated reserve price of the medical insurance party, the negotiation fails and is automatically terminated. For example, the price after the second confirmation of the enterprise is not higher than 115% of the negotiated reserve price of the medical insurance party, and it enters the negotiation link between the two sides.
Zhang Jinni said that the "adjustment space for the reserve price is zero" is due to this clause: the price finally agreed upon by the two sides must not be higher than the negotiated reserve price negotiated by the medical insurance party.
The National Medical Insurance Bureau said that the ultimate success of the negotiation depends on whether there is an intersection between the bottom line of the medical insurance side and the enterprise side. Using the negotiation mechanism to guide enterprises to quote the lowest price they can accept is the responsibility of health insurance negotiators.
It can be seen that the final price of a successful negotiation is not necessarily the "reserve price", but the most affordable price for the medical insurance fund, acceptable for enterprises, and the most favorable price for the people.
What kind of reserve price is a good "reserve price"?
Zheng Jie said bluntly that it is not the lowest price, but the reasonable price. Through calculation, find a price that most patients can use, and benefit the people to the greatest extent, so that the negotiation is meaningful.
In addition to making the people spend less money, the medical insurance negotiations that benefit the people to the greatest extent also let the people use new drugs and good drugs.
The National Medical Insurance Bureau said in its interpretation: In recent years, the national medical insurance drug list has been adjusted, mainly for drugs newly approved and listed in recent years.
For example, China's original innovative drug GanluTener capsule (a new drug for alzheimer's disease treatment), which is supported by the "Major New Drug Creation National Science and Technology Major Project", has entered medical insurance after negotiation. According to the data, the drug passed the expert review on the negotiating table last year, but the negotiation failed. This year, the drug price reduction of 66.92% was included in the catalog.
Relevant data show that the dynamic adjustment mechanism of the medical insurance catalog stimulates the research and development of innovative drugs and original research drugs in China, which is conducive to The "dividends" of scientific research for Chinese patients as soon as possible. Relevant data show that in 2017, it will take 4-9 years for new drugs to enter medical insurance, shortened to 1-8 years in 2019, and 0.5-5 years in 2020.
In view of the effectiveness of innovative drugs, the National Medical Insurance Bureau said that in addition to accepting a large number of data and corresponding evidence submitted by enterprises, it will also ask the drug regulatory, health and other departments to provide drug support materials to provide support for the review before the negotiation. In addition, enterprises will be further encouraged to carry out real-world research on drugs, and more real-world research data will be relied on in the future in the adjustment of the catalogue. (Science and Technology Daily reporter Zhang Jiaxing)
Source: Science and Technology Daily WeChat public account