Shanghai implements the new version of the medical insurance drug catalog, and the nearly 20,000 yuan breast cancer injection is only 2,000 yuan

The patient, Mr. Huang, was prescribed dapagliflozin tablets at the Shanghai Tenth People's Hospital. The Paper's reporter Chen Sistu

From January 1, 2021, Shanghai officially implemented the new version of the National Medical Insurance Drug Catalogue. The insured people have used a number of good drugs and new drugs in the newly entered medical insurance directory, especially anti-cancer drugs and drugs for rare diseases.

On January 11, the surging news (www.thepaper.cn) reporter learned from the Shanghai Municipal Medical Insurance Bureau that since the implementation of the new version of the medical insurance catalogue for 2 weeks, the accessibility of medication for the insured masses has been enhanced, so that the masses have more sense of gain.

The total number of drugs in the new drug list reached 2860, including 1486 kinds of Western medicines and 1374 kinds of proprietary Chinese medicines, which was the largest in the past years. The catalogue covers a wider range of fields and the benefits of patients are wider, and the 74 new drugs outside the catalogue involve 21 clinical groups, including tumors, hypertension, diabetes, hyperlipidemia, psychosis, hepatitis C, AIDS, rare diseases, etc.; of which 67 exclusive drugs outside the catalogue are successfully negotiated, with an average price reduction of 61.71%. The 27 drugs developed and produced by Shanghai enterprises have been included in the scope of national medical insurance drug reimbursement through negotiations. In addition, the new version of the catalogue cancels the payment limit for some of the original drugs in the catalogue, and greatly improves the scope of clinical use of drugs.

In order to smoothly land the new version of the national medical insurance drug catalog, Shanghai has actively promoted a number of measures to ensure drug allocation through "data first, accurate positioning, and coordination".

First, through the transaction data of medical institutions, analyze the national negotiated drug treatment field one by one, guide medical institutions to combine their own professional characteristics, and give priority to the selection of rare diseases, tumors and anti-epidemic negotiated drugs in procurement to meet the needs of clinical drugs.

The second is to learn from enterprises and hospitals about the supply of negotiated drugs in Shanghai and the progress of admission, open green channels in a timely manner, hang up new drugs on the network, and synchronously adjust the settlement system to ensure that new negotiated drugs can be bought, used and reported.

Taking the breast cancer treatment drug elibulin mesylate injection as an example, before being included in the new version of the catalog, the drug was nearly 4,000 yuan, and the total cost of each course of treatment for patients was about 16,000 yuan, and patients needed to use it at their own expense. After being included in the new version of the catalog, the drug has dropped by 80%, and the insured persons of retired employees who purchase the drug in the tertiary hospital will pay less than 1,000 yuan per course of treatment, and the personal self-responsibility will drop by about 90%, which greatly reduces the burden of drug costs on insured patients.

In the process of adjusting the catalogue, the medical insurance department has also reduced the self-responsibility ratio of more than 1,300 kinds of Class B drugs in the catalogue, and it is expected to reduce the burden on patients by 1.9 billion yuan in 2022.

The patient, Mr. Huang, is one of the beneficiaries. He was diagnosed with type II diabetes in 1998 and in recent years has controlled his blood sugar by taking dapagliflozin tablets.

"After this catalog adjustment, for the drug of dapagliflozin tablets, the proportion of individual self-responsibility is reduced from the original 20% to 0%, and the burden of drug costs is further reduced." Mr. Huang said.

In addition, taking the paltozumab injection for the treatment of breast cancer as an example, after the adjustment of the self-responsibility ratio, the burden of medical expenses on patients is reduced by nearly 10,000 yuan per year.

Xu Qing, director of the oncology department of Shanghai Tenth People's Hospital, told the surging news reporter that the unit price of patuzumab injection before it was included in medical insurance was 18800 yuan, and only 4950 yuan after being included in the national medical insurance, and the proportion of patients' personal self-responsibility decreased, only 1980 yuan, and the price reduction reached about 90%. Not only that, this drug was originally limited to patients with advanced breast cancer, but it can also be used for adjuvant therapy after early surgery, and the decline in drug costs has benefited many patients.

Jin Chunlin, director of the Shanghai Municipal Health and Health Development Research Center, said that the adjustment of the medical insurance drug list is a key task of medical security and is related to the well-being of the people. Shanghai has solidly promoted the normalization and institutionalization of the national medical insurance drug catalogue, uniformly implemented the new version of the national medical insurance drug catalog, and reduced the self-responsibility ratio of drugs, reflecting that the Shanghai medical insurance department has always adhered to the responsibility of protecting the people's health, effectively promoted the reform of "three medical linkages", and effectively reduced the burden of the people's medical treatment and medication costs.