┃Source: Wuhan Evening News Hu Qiongzhi
Recently, a video of the "soul bargaining" of medical insurance drug negotiations has once again triggered a hot search. At the same time, the results of the adjustment of the national medical insurance drug list in 2021 show that the average decline of 67 drugs that entered the medical insurance list for the first time through negotiations hit a record high.
What the hell is going on with health care negotiations?
How does the "soul bargain" come about?
Is "soul negotiation" a price reduction?
What does this negotiation have to do with us?
Recently, the reporter interviewed Zheng Jie, head of the 2021 National Medical Insurance Negotiation Drug Fund Calculation Expert Group and director of the Beijing Municipal Medical Insurance Center, to talk about the national medical insurance negotiations.
01
What expenses can be reimbursed by Medicare and which medical expenses cannot be reimbursed are determined by the Medicare Catalog.
Three major directories
In order to ensure the basic medical needs of the insured, the state stipulates the reimbursement scope of basic medical insurance for drugs, diagnosis and treatment items and medical service facilities, commonly known as the "three major catalogs". Usually, when we buy drugs and can take medical insurance reimbursement, it is into the medical insurance directory.
Zheng Jie introduced that after the establishment of the National Medical Insurance Bureau in 2018, in the process of adjusting the medical insurance catalogue for four consecutive years, it was clear that exclusive drugs with high clinical value, breakthrough efficacy but expensive prices must be included in the medical insurance catalogue through negotiation, that is, "every advance must be discussed".
Why are the same new drugs
Into the Medicare Directory
Some need to be negotiated
Some don't need to negotiate?
Zheng Jie explained that some drugs are particularly high-end, such as life-saving anti-cancer targeted drugs, tumor immune drugs, and special drugs for chronic diseases, which are urgently needed by the people. However, due to the long research and development cycle, high cost and patent protection period, the price of such drugs is often particularly frightening.
Without medical insurance, the vast majority of the people can not afford to use; the original price of medical insurance, medical insurance fund can not afford.
This requires the medical insurance department to negotiate with pharmaceutical companies to determine a reasonable medical insurance payment standard, reduce the price of more new drugs and good drugs and include them in the medical insurance directory in a timely manner to reduce the economic pressure on patients.
02
As a "super buyer" in the pharmaceutical service market, the medical insurance fund needs to spend 800 billion yuan per year on drugs, and only drugs that enter the medical insurance directory can be reimbursed by medical insurance.
Medical insurance negotiations are to give full play to the role of strategic purchases, and negotiate with enterprises on drugs included in the scope of negotiations with enterprises with "national medical insurance usage".
"China's huge market size is the biggest chip in the hands of health insurance experts," Zheng jie said.
It is understood that at present, medical insurance negotiations have become an important catalyst for innovative drug release.
03
"Health insurance negotiations are exclusive to both buyers (health insurance) and sellers (businesses), and there is a lack of market pricing game." According to reports, before the negotiations, the National Medical Insurance Negotiation Pharmacoeconomics Group and the Fund Calculation Group conduct parallel calculations on the drugs to be negotiated and formulate the reserve price of the drugs.
"Explore consumer utility through value assessment, explore corporate costs through international price comparisons, cost accounting, etc., and explore payment standards close to the cost line through the pressure mechanism of self-quotation."
In Zheng Jie's view, the charm and value of the soul bargaining lies in the fact that the negotiation experts of the medical insurance side use the negotiation mechanism to guide enterprises to quote the lowest price they can accept within the scope of the fund, and strive for a more favorable price for the people.
Zheng Jie said
Some people think that health care negotiations are "bargaining"
The lower the better
It's actually about the job
Grossly misinterpreted
"Medical insurance negotiations are not the pursuit of the lowest price, but a reasonable payment standard", "value purchase" is an important principle to be followed in the adjustment of the medical insurance drug list.
If the amplitude of "bargaining" exceeds the affordable range of pharmaceutical companies, resulting in the eventual inability to enter medical insurance, or affecting the quality of drugs, the most harmful is actually the patient.
In addition, combined with factors such as the per capita disposable income of urban and rural residents in China, comprehensively considering the patient's personal affordability, through calculation to find a most patient can afford, the price, the maximum range of benefits to the people, such negotiations are meaningful.
04
·
Drugs that were originally expensive in price were prescribed at civilian prices and in line with the positioning of "guaranteeing the basics", and successfully entered the catalog after negotiations. "The medical insurance negotiations have raised the protection of drugs for major diseases to a new height and achieved a higher level of 'basic insurance'."
Zheng Jie introduced that in recent years, through negotiations, more highly recognized, newly listed and highly clinical value drugs have been transferred into the catalog, and the guarantee capacity of cancer, rare diseases, tumors, chronic disease drugs and women's and children's drugs has been significantly improved, and the full coverage of the treatment field has been basically achieved.
The reporter learned that the 74 drugs newly included in the medical insurance catalogue adjustment involve a total of 21 clinical groups, supplementing the drug needs of tumors, chronic diseases, anti-infection, rare diseases, women and children.
"Many anti-cancer drugs such as Abexili and daritoliumab have entered the medical insurance list, filling the gap in protection and raising the drug protection for related diseases to the level of international mainstream drugs."
After the domestic Alzheimer's drug Ganlut sodium capsules and 7 drugs for the treatment of rare diseases have entered the medical insurance for only two years, the price has dropped sharply, which will benefit nearly 10 million patients.
For example, 700,000 injections of 1 injection of Sodium Northinacine were significantly reduced after negotiation, and the cost fell below 300,000 yuan. Coupled with Medicare reimbursement, it has reached the range that most patients can afford.
The medical insurance drug list always adheres to the principle of "going in and out". This time, 11 kinds of drugs with low clinical value, strong replaceability and small procurement volume on the national procurement platform in recent years were transferred.
Zheng Jie said that after adjustment, a large number of innovative targeted drugs and tumor immune drugs have been included in medical insurance. The structure of the medical insurance catalogue is more optimized, the level of medication is more abundant, and "the substitution and upgrading of drugs in the same treatment field" is realized.
"The protection capacity of key areas has been further improved, the protection capacity of basic medical insurance has reached a new height, and the benefits of patients have become more obvious."
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