Since the issuance of the "Overall Plan on the Implementation of "Class B and B Tube" for Novel Coronavirus Infection, the prevention and control of the new crown epidemic has been adjusted to "Class B and B Tube" from January 8, 2023.
Due to the high incidence of influenza in winter and the peak of population flow during the Spring Festival, there is a superimposed risk of respiratory infectious diseases such as novel coronavirus infection combined with influenza, the National Health Insurance Administration and other four ministries and commissions issued the Notice on Optimizing the Medical Security Policy for Treatment Costs of Patients with Novel Coronavirus Infection after the Implementation of "Class B and B Tube" (Medical Insurance Fa [2023] No. 1) on January 7, 2023, clarifying that hospitalized new crown patients will continue the "Class B tube" policy, and the new crown virus treatment drugs will continue the temporary payment policy for medical insurance. Enforcement until March 31, 2023.
The above Notice answers the question of "protection of treatment costs for new crown patients", but after the end of the policy implementation period on March 31, where will the protection of new crown patients go?
Recently, the National Health Insurance Administration and many ministries and commissions issued two heavy documents to answer the above questions.
According to the Notice on Further Improving the Protection of Medical Expenses for New Crown Patients (Medical Insurance Fa [2023] No. 11), patients admitted or treated after April 1 will implement the new policy, and the original Medical Insurance Fa [2023] No. 1 will be suspended simultaneously, and relevant policies will be adjusted according to the development of the epidemic.
In response to the public's concern about the protection of new crown treatment drugs, relevant policies are answered.
In accordance with the requirements of the Notice on Improving the Price Formation Mechanism of New Crown Treatment Drugs and Implementing Categorical Management (Medical Insurance Office Fa [2023] No. 8) issued by the National Health Insurance Administration, after April 1, new crown treatment drugs will be classified and classified management, and Class A drugs will be temporarily included in the scope of medical insurance payment.
The person in charge of the Department of Pharmaceutical Administration of the National Health Insurance Administration explained that according to the requirements of classified management, the new crown treatment drugs currently included in the temporary medical insurance payment scope include deuterium remidevir hydrobromide tablets (Mindve), synthegravir tablets/ritonavir tablets combination packaging (Senoxin), and reitvir tablets (Leruiling) will also be included in the temporary payment scope after no objection is announced.
Together with Azvudine tablets, which have been included in medical insurance, up to now, the medical insurance of the 4 domestic new crown oral drugs that have been listed can be paid.
Dr. Zou Jianjun, executive director, deputy general manager and president of global R&D of Junshi Biologics, told the health industry that under the promotion of national policies, domestic new crown oral drugs have very good efficacy and safety, are not inferior to imported drugs, and have a greater price advantage than foreign drugs. "I think that even if there are further fluctuations in the epidemic, the health of mainland patients can be guaranteed, because our medicines are more accessible, and the safety and quality are very good."
3 domestic new crown oral drugs have been actively adjusted to less than 630 yuan per course of treatment
According to Document No. 11 of Medical Insurance [2023], after April 1, there are two main changes in the cost protection of new crown patients:
First, the cost of treatment for new crown patients has been adjusted from "temporary special benefit" to "routine medical benefit". In other words, after April 1, the cost of new crown treatment for patients is no longer fully covered, and the financial subsidy for patients' personal burdens is no longer provided.
In this regard, the person in charge of the Department of Pharmaceutical Administration of the National Health Insurance Administration introduced that in order to adapt to the stable entry of new crown infection into the low epidemic situation, the Notice clearly returns special protection policies such as "full coverage of inpatient expenses" and "special protection for primary outpatient clinics" to conventional medical insurance policies, and the insured patients who meet the specified new crown medical expenses will implement the same medical insurance reimbursement policy as more than 20 other Class B infectious diseases.
At the same time, in order to avoid the heavy economic burden of individual patients due to their serious illness and higher costs, the Notice specifically proposes that all localities should strengthen the monitoring of medical expenses of new crown patients, and provide timely medical assistance to patients who meet the conditions for assistance and have a heavy personal burden.
Second, for the protection of new crown drugs, a temporary medical insurance payment policy is implemented.
According to the latest policy, the new crown treatment drugs outside the medical insurance list implement price-based hierarchical management:
For Class A drugs, each provincial pharmaceutical procurement platform will display its name font or background in green to guide priority procurement, and the medical insurance department can give temporary medical insurance payment policies based on epidemic prevention and control needs;
For Class B drugs, each provincial pharmaceutical procurement platform displays its name font or background as yellow;
For Class C drugs, each provincial pharmaceutical procurement platform displays its name font or background in red, and prompts the purchasing unit of the corresponding risk in a conspicuous way such as a pop-up window.
In other words, after the implementation of the hierarchical management policy on April 1, only Class A drugs are allowed to be included in medical insurance reimbursement. The cost of treatment is high, the initial quotation or evaluation adjustment is not in accordance with the regulations, or the evaluation result is obviously unfair and unreasonable, the new crown treatment drugs will no longer be reimbursed by medical insurance.
It is understood that the new crown oral drugs that have been marketed in China are currently in a 4+2 pattern. That is, 4 domestic drugs (including azvudine tablets, deuterium remidemir hydrobromide tablets, prenotovir tablets/ritonavir tablets combination packaging, leiretgravir tablets), 2 imported drugs (nematevir tablets/ritonavir tablets combination packaging, monoravir capsules).
Among them, azvudine tablets have been included in the "2022 National Medical Insurance Drug List", and the price of the new crown treatment course after medical insurance negotiation is 350 yuan.
According to the policy, the course cost of Class A drugs is not higher than 1.8 times the reference standard, that is, not higher than 630 yuan / course (350 yuan * 1.8).
A person familiar with the matter told the health industry that the reason for the implementation of the classified management mechanism is mainly to improve the bridging mechanism between the initial price and payment policy of new crown treatment drugs, and guide enterprises to reasonably set prices.
According to the data released by the National Health Insurance Administration, the existing 3 domestic new crown oral drugs have been actively adjusted to less than 630 yuan per course and included in Class A management.
What are the considerations of the National Health Insurance Administration behind the release of the document?
The National Health Insurance Administration's improvement of the price formation mechanism and medical insurance payment policy of new crown treatment drugs at this time may be due to three reasons:
First of all, the relevant policy stipulates that "the temporary payment policy for medical insurance for new coronavirus treatment drugs will be implemented until March 31, 2023". In other words, after April 1, 2023, the protection of new crown treatment drugs will be implemented according to the 2022 medical insurance drug list.
In the current medical insurance catalog, only azvudine is a new crown small molecule oral drug. The establishment of a temporary payment mechanism has solved the problem of medical insurance payment for drugs that have been marketed but have not yet been officially included in the catalog.
Second, in the past three months, the number of oral drugs on the market in the mainland has doubled, and domestic drugs are "full of stamina", accounting for two-thirds of the number of drugs on the market.
With more drug choices, market competition will inevitably become more intense, and the establishment of a new classification management mechanism will help to balance "effectiveness, safety, economy, innovation and fairness" to the greatest extent, in line with the strategy of purchasing the value of basic medical insurance.
Third, the overall epidemic situation in the country has entered a low epidemic level. According to the Chinese Center for Disease Control and Prevention on April 8, the number of positive new coronavirus nucleic acid tests nationwide fluctuated and declined after reaching a peak (6.94 million) on December 22, 2022, and dropped to 2119 on April 6, 2023. Under the new situation of epidemic prevention, it is also necessary to formulate new medical security strategies.
In fact, as early as December 2022, at the beginning of the release of the "Class B and B Management" policy, some medical insurance experts told the media that free treatment of the new crown is a medical security measure in an emergency state, and after the optimization of epidemic control, medical insurance "reimbursement" also needs to return to normal management, and new crown treatment can be implemented in accordance with the current normal state of medical insurance reimbursement and management policies.
It is reported that in the future, the National Health Insurance Administration will continue to seek truth from facts, closely track changes in the epidemic, and improve medical expense protection policies according to the prevention and control situation.
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Author | and stars
Executive Producer | Chapter Beihai