Why didn't the negotiation site directly show the reserve price? The National Medical Insurance Bureau unveils the charm and value of "soul bargaining"

Beijing, December 8 news recently, "700,000 one-shot sky-high drug into medical insurance" on the hot search, has become a hot spot of concern from all walks of life. In order to enable everyone to have a more comprehensive and objective understanding of the adjustment of the medical insurance drug list, the relevant person in charge of the Department of Pharmaceutical Management of the State Medical Insurance Bureau accepted an interview and deeply interpreted the work arrangements and relevant considerations of the 2021 National Medical Insurance Drug Catalogue Access Negotiation (referred to as the drug negotiation, the same below).

According to the relevant person in charge of the Department of Pharmaceutical Management of the National Medical Insurance Bureau, the adjustment of the national medical insurance drug list in 2021 began in May and ended at the end of November, after more than half a year. From the perspective of the process, it is mainly divided into five stages: preparation, declaration, expert review, negotiation, and announcement of results. The negotiation stage includes two links: First, organize experts to use pharmacoeconomic methods, consider factors such as the affordability of the fund, and scientifically calculate and determine the negotiated reserve price of each drug, that is, the highest price that the medical insurance fund can afford. The second is to organize experts to consult with enterprises on the spot and confirm the results on the spot. The successful drugs in the negotiation were included in the list, and the results of the negotiations were determined to be a unified national medical insurance payment standard.

(Figure from CFP)

The main purpose of drug negotiations is to give full play to the role of strategic purchase by the medical insurance department, negotiate and negotiate with enterprises on drugs included in the scope of negotiations, and comprehensively achieve the goal of improving the efficiency of fund use and reducing the burden on patients, and use limited medical insurance funds to maximize the effectiveness of protection. At the same time, through the value purchase and strategic purchase of medical insurance funds, the pharmaceutical industry is guided to take the road of innovative development.

The negotiated reserve price is calculated by experts organized by the medical insurance department. On the one hand, for drugs that have obtained negotiation qualifications, the medical insurance department organizes relevant enterprises to submit calculation materials according to a unified template, mainly including: basic information of drugs, relevant safety, effectiveness, economy and other information, intentional prices, and corresponding evidentiary materials. On the other hand, the medical insurance department organizes experts in pharmacoeconomics and medical insurance management to carry out scientific calculations from the perspectives of drug cost effect, budget impact, and medical insurance fund burden, etc., forming the highest price that the medical insurance fund can bear, that is, the negotiated reserve price, as the basis and bottom line for negotiators to carry out negotiations.

In response to the "negotiation site does not allow the enterprise to quote, the expert directly shows the reserve price, to see if the enterprise can accept it is not more direct?" According to the current negotiation rules, the on-site negotiation is jointly participated by the enterprise side and the medical insurance party, and the enterprise side is mainly negotiated by the authorized negotiator and the medical insurance party, and the negotiation result is determined on the spot.

First quoted by the enterprise side, the enterprise side has 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. The price finally agreed upon by the two parties must not be higher than the negotiated reserve price of the health care provider. During the negotiation process, the authorized representative of the enterprise can ask for instructions by telephone or other means, but should give a clear opinion on the spot. After the negotiation, regardless of whether an agreement is reached, the two sides sign the confirmation of the result on the spot.

The ultimate success of the negotiation depends on whether there is an intersection between the bottom line of the health care provider and the corporate side. From a practical point of view, the responsibility of the negotiator of the medical insurance party is to use the negotiation mechanism to guide the enterprise to quote the lowest price it can accept. That is to say, negotiators strive to obtain more favorable prices for the people within the scope that the fund can afford and the enterprise can accept, which is the charm and value of "soul bargaining".

In addition, for the 94 drugs that were successfully negotiated in this year's adjustment, the payment scope has all been consistent with the instructions. In the next step, according to the progress of the pilot, under the premise of ensuring the safety of the fund and the fairness of patient medication, in accordance with the principle of reducing the increment and digesting the stock, the National Medical Insurance Bureau will gradually restore the payment scope of more drugs in the catalog to the drug instructions.