Star products such as bevacizumab are quite popular
At the end of December, the news of the adjustment of the drug catalogue of key monitoring stirred up the medical circle.
The Health Commissions of Heilongjiang Province and Shanxi Province have successively issued the "Notice on the Selection of the Second Batch of Key Monitoring Drug Catalogues", requiring public general hospitals at or above the second level in the province to report the names of key monitored drugs, and clearly limiting the deadline to December 30 and January 3, 2022.
Shanxi Province directly named five hospitals, including Bethune Hospital, Shanxi Provincial People's Hospital, and Shanxi Coal Central Hospital, and stipulated that hospitals that have not submitted a directory will be notified by the whole province, and in the next 3 years, they will be classified into "key supervision units for rational drug use" for key supervision.
In this regard, the Shanxi Coal Central Hospital told the Health Bureau that it did not understand the specific situation.
As early as September this year, the National Health Commission issued a second round of documents to focus on monitoring the adjustment of the drug list, but like Shanxi and Heilongjiang, there may still be provinces that have not reported data. The National Health Commission had to "supervise the workers" and set the deadline for reporting before January 7, 2022.
The lethality of the "key monitoring directory" is far greater than that of collection, and those listed in this directory are almost directly kicked out of medical insurance. In 2019, the National Health Commission promulgated the first catalogues, and pharmaceutical companies such as Kang Enbei and Shuanglu Pharmaceutical were subsequently seriously injured.
For the second batch of key catalogs, the National Health Commission has become cautious, not only delaying the catalog, but also emphasizing that the provinces should submit them, and strive to be objective and detailed. Now that 4 months are almost over, the journey of a thousand miles has not yet taken the first step, and it is no wonder that the National Health Commission is beginning to be anxious.
The game is still going on.
There are already regional public lists, but most of them are collection varieties
The second batch of local selection of the directory launched in September this year, some provinces are very active.
On September 21, Fujian, the province where the new medical reform "took the lead", took the lead in issuing a document requiring hospitals to complete the screening of key monitoring drugs by October 10 and report to the Fujian Provincial Health Commission. In November, Qinghai Province also launched a selection process, stipulating that in addition to recommending 30 key monitoring varieties, hospitals must also report the top 30 lists of 7 types of drugs used in hospitals in the past year, such as auxiliary drugs and Chinese medicine injections.
Some regions have already directly announced the list of reports.
In early November, the website of the People's Government of Hanyin County, Shaanxi Province, published the key monitoring drugs screened by the County People's Hospital.
Source: Hanyin County People's Government official website
From this key monitoring catalog, it can be seen that antibiotics, proton pump inhibitors, nutritional drugs are the focus of monitoring, and varieties with large amounts such as albumin are also included.
Interestingly, among the 30 drugs, omeprazole, paclitaxel, gefitinib, insulin glargine and other products have entered the national collection. The star product of anti-tumor class, bevacizumab, is also impressively listed. Zhongkang data shows that the market size of bevacizumab is expected to reach about 10 billion yuan.
Such a "key monitoring directory" undoubtedly throws the problem to the National Health Commission.
The first batch of national key monitoring catalogues are actually all auxiliary drugs, and the National Health Commission and the Medical Insurance Bureau are relatively simple to operate. Two months after the release of the catalog, the National Medical Insurance Bureau transferred 8 varieties out of medical insurance, including vinpocetine, murine nerve growth factor, bone peptides, etc. The market size of these 8 varieties in 2018 was close to 22 billion yuan.
However, the second batch of key monitoring catalogues may involve a large number of commonly used drugs, collective drugs, and high-priced anti-cancer drugs, will they be kicked out of medical insurance in the future like the first catalogues?
In fact, according to the regulations of the Health Commission, when screening key monitoring drugs, hospitals need to conduct comprehensive comparisons based on clinical value and specifications, current use status, amount of use and other factors, and then recommend the top 30 drugs. However, in practice, "large clinical dosage" may become the main criterion.
For example, bevacizumab mentioned above. As of the beginning of December this year, Dongyao Pharmaceutical and Fuhong Henlin two biosimilar drugs have been approved for listing, and the domestic bevacizumab has reached 9 models, with a high unit price and fierce competition, which is a biosimilar with a high demand in the industry.
If such varieties are reported to the National Health Commission, whether they will be included in the national key monitoring has become the focus of the industry.
How to choose is a difficult problem
Squeezing the medical insurance fund, the flood of clinical irrational drugs, and the introduction of the first batch of key monitoring catalogues are actually the trend of the times.
The original intention of setting up a key monitoring directory is to exclude some varieties from medical insurance and make room for innovative drugs with good efficacy. Therefore, it is inevitable that "the amount of use is large" becomes an important principle. Moreover, the auxiliary drugs themselves have the space of gold sales and curative effect "black box", and the auxiliary drug industry is impeccable.
However, the second batch of catalogues, according to the International Health Commission, to include anti-cancer drugs, anti-infective drugs and other varieties, if you still pay attention to the standard of the amount of use, its rationality should be marked with a question mark.
This may also be the reason why Heilongjiang, Shanxi and other places have not been able to report the list.
In particular, in the sales of drugs in public medical institutions disclosed in some provinces, most of the drugs in the forefront are actually the main therapeutic drugs. After comparing the list of the top 20 drugs with monthly sales released by Fujian Province in the past six months, the Health Bureau found that Roche's injection of trastuzumab, bevacizumab injection, Bayer's rivaroxaban tablets, Sanofi's insulin glargine and so on continued to appear on the list.
Source: Fujian Provincial Medical Insurance Bureau
The annual drug sales ranking catalogue in Zhejiang Province is also a similar situation, and most of the publicized drugs have not only been included in the national medical insurance directory. Even as the only proprietary Chinese medicine Bailing capsule in the top 20, its similar product Bailing tablets were recently included in the list of proprietary Chinese medicines.
These varieties are all potential collection products in the future, if they are monitored at this time, how will they be coordinated in the future? It's like a mysterious Möbius ring, which is head-scratching.
Moreover, the industry has been concerned about whether proprietary Chinese medicines are "key monitoring". After the introduction of the first batch of key monitoring catalogues, provinces and even medical institutions are still adding more than 200 key monitoring varieties, and Chinese medicine injections such as Ginseng Fuzheng Injection, Placental Polypeptide Injection, and Gu Hong Injection have become the focus of attention of various provinces.
The National Health Commission has not included proprietary Chinese medicines and traditional Chinese medicine injections in the reported varieties. Whether these varieties are in line with the principles of "clinical use rationality" and "use amount" is also debatable.
At present, the only thing that can be determined is that after the release of the catalog, it will be another "bloody storm".
#The second batch of key monitoring directories ##集采 #