Since the establishment of the National Medical Security Administration in 2018 and the start of negotiations on the list of medical insurance drugs in the mainland, "soul bargaining" has become the norm. The annual national health insurance negotiations have left many famous scenes and bargaining sentences.
During the negotiation of the National Medical Insurance Drug List in 2023, Li Xuri, the head of the negotiation team of the National Medical Security Administration and the director of the Pharmaceutical Service Management Division of the Zhejiang Provincial Medical Security Bureau, led the negotiation.
Li Xuri: After we negotiated this time, there may be an evaluation on the Internet, that is, the smell of gunpowder in this negotiation is weak, and the warmth is strong. The warmth is strong, and I think it may reflect the full communication and friendly communication between the two sides in the negotiation process. In fact, we are not relaxed in the price we are negotiating this time than before.
This year, a total of 143 drugs participated in the negotiation of the National Medical Insurance Drug Catalog, of which 121 successfully obtained the "admission ticket", with a success rate of 84.6% and an average price reduction of 61.7%, and the success rate and price reduction are basically the same as in 2022. Twenty-five medical insurance negotiators, including Li Xuri, were divided into five groups to undertake the medical insurance negotiation of these drugs. They are mainly from local medical insurance departments, and they are randomly selected from the expert pool before the negotiation. Li Xuri was selected for the first time to participate in the national medical insurance negotiations and served as the leader of the negotiation team.
Li Xuri has been responsible for pharmaceutical prices and bidding and procurement in Zhejiang Province, and has also participated in the negotiation of the medical insurance drug list in the province, so he is no stranger to related businesses. Before the negotiation, the National Health Insurance Administration organized a special negotiation training. On November 17, 2023, the negotiation of the National Medical Insurance Drug List officially kicked off. 168 drugs were qualified for negotiation or bidding, the largest variety in the history of medical insurance negotiations.
Li Xuri: As a representative, I think I need to prepare more for the accumulation of my own business before usual. Because after we come to this negotiation, which group you are in, and then which drugs you want to talk about every day, are all drawn on an ad hoc basis.
Li Xuri: These are unknown, and we start negotiations at 9 o'clock every morning, draw lots at 8:30 o'clock, and only after the lottery will we know what the list of drugs you want to talk about today is, but the specific basic information of which drug is related to it is after the end of the last game, the organizer will give the relevant basic information, we basically use the gap between the two negotiations to quickly familiarize ourselves with the relevant basic information of the drug that will be discussed.
When the negotiation team enters the negotiation site, they will receive a sealed envelope containing the "envelope price" of the negotiated drug, that is, the negotiated reserve price. Before the formal negotiation, the National Health Insurance Administration organizes relevant experts to fully communicate with the enterprises that intend to participate in the negotiation around the calculation of the payment standard of the product to be negotiated, which is called "pre-negotiation". After the pre-negotiation, the medical insurance department calculates the cost effect of the drug, the budget impact, the burden of the medical insurance fund and other factors, and obtains the highest price that the medical insurance fund can bear, that is, the negotiated reserve price sealed in the envelope.
Li Xuri: According to the procedure, there will be an opening statement, and we will open this envelope in front of the representatives of the enterprise, so that the company will also know that the members of our negotiation team did not know the reserve price before that. For the five members of our negotiating team, we knew from that moment what kind of price could be negotiated.
According to the rules of national medical insurance negotiation, enterprises have a total of two quotation opportunities, if the two quotations do not fall within the range of 115% of the envelope reserve price, then the negotiation fails, otherwise, enter the next stage of negotiation, the two sides start a "tug of war", but the final transaction price must not be higher than the reserve price.
Li Xuri: The task of our negotiation team is how to guide the company's quotation to gradually fall into our reserve price. But you can't tell it directly, and if you tell it directly, you don't need to negotiate. Because although the calculation of the medical insurance party has gone through a complete procedure in the early stage, it is difficult to determine how much may be the most appropriate. From the perspective of the enterprise, there may be his expectations, but in the end, for example, the medical insurance party can accept it, and he may not be very confident in his heart, so we can gradually adjust the quotation through negotiation guidance, and can enter the reserve price originally set by our medical insurance party, so that the negotiation is successful.
Each negotiation is scheduled to last 30 minutes, but the actual negotiation sometimes takes more than 2 hours, and the long negotiation tests the physical strength and patience of both parties. On November 18, 2023, negotiations on oral drugs for the treatment of diabetes officially began. This is an original innovative drug developed by a Chinese pharmaceutical company and launched in China, which has been verified before marketing and can be stopped for one year after patients take the drug for 52 weeks.
The first offer made by the representative of the enterprise was 5.54 yuan.
Li Xuri: When I saw this offer, my first feeling was that the company's determination and sincerity to come in this time were relatively large, and the offer was also more realistic. In the past, when companies quoted, they might quote a relatively high price first, and then let you keep chopping, so when I first heard this offer, I was still more or less surprised.
Reporter: But when you saw the materials broadcast at the time, you didn't have too many expressions at the time.
Li Xuri: This is the negotiation process, we may have to control our expressions. If I'm surprised, then the company will think that the offer may not be about the same, so there may not be enough motivation to continue to decline.
Li Xuri: We have a rule in the first round, after entering the range of 115% of the floor price, we will clearly tell him that you have entered the range of 115%. At this time, the business side actually only needs to divide by 1.15 to know the lowest price.
Li Xuri: At that time, the quotation was still a certain distance from the bottom line price of the envelope, so I also guided. However, the enterprise side may want to reduce as little as possible under the premise of being able to negotiate, and our medical insurance party wants to let the company reduce a little more and strive for more patients under the premise of negotiation, so sometimes the price reduction of the enterprise side is reduced little by little.
Corporate negotiator: We wondered if we could be allowed to quote at the number 5.52, because 12 years ago, our product was developed under the code name HMS552, which is 552. When we said 552, it meant "I love."
The corporate negotiator returned after leaving the discussion room, and the negotiator made a bid with a homophonic meme, and choked up at one point.
Reporter: But for enterprises, will they feel that they have already expressed such great sincerity, and they have to bargain again, and they are not worried that they may not talk about or end this negotiation for such reasons?
Li Xuri: If we guide downward, the enterprise is indeed unacceptable, indicating that there is still a certain gap between the two sides, and this time it may not be possible. But generally speaking, after the company quotes, he really wants to enter the scope of medical insurance payment, which may be more realistic. The biggest weight of our medical insurance side is to be included in the medical insurance if the negotiation is successful, and the volume is exchanged for price. From the perspective of the enterprise, it will definitely not trade at a loss, and if the price is a little higher, the profit margin may be a little bigger. This is that we may have different considerations from different perspectives, and we can gradually reach an agreement through negotiations. Because in general, our medical insurance should also adhere to the basic insurance on the basis of supporting enterprise innovation.
After that, the corporate negotiator applied for a second time to leave the meeting. Li Xuri and the members of the negotiation team can also take the opportunity to discuss the next step.
Li Xuri: We also observe what to do if we are willing to surrender, and what to do if we are unwilling to surrender. We also look at what we say, and if there is room for price reduction, I think we should still fight for the patients.
Starting from 5.54 yuan, after several rounds of quotations, the final price of this drug was fixed at 5.39 yuan.
Reporter: Actually, it's a dispute over a few cents.
Li Xuri: 1 dime and 5 cents, in fact, 1 cent and 2 cents are sometimes a relatively large number for some medicines. Diabetic patients need to take medication for a long time, unlike some medicines, such as colds, which may be fine for two or three days. My hometown is also from the countryside, and some prices may be lowered, and we are not so sensitive to our general patients, but for some families who are relatively old and whose economic conditions are not very good, it can still reduce the burden a little, so I think it is better to fight for us or try to fight for more space for patients.
In addition to commonly used drugs, among the drugs successfully negotiated in this round, there are 15 drugs for rare diseases, the number of which has reached a new high in the past three years, covering a total of 16 diseases, filling the gap in drug protection for 10 diseases, involving Gaucher disease, severe myasthenia and other diseases that have not been solved for many years and have a large social impact. Although Li Xuri did not draw drugs for rare diseases in this negotiation, he still remembers a "soul bargain" two years ago.
Many people also met Zhang Jinni, the negotiator of the National Health Insurance Bureau and the director of the Pharmaceutical and Medical Device Procurement Supervision Division of the Fujian Provincial Medical Insurance Bureau, through this sentence. In this national medical insurance negotiation in 2021, she and the corporate negotiators went through 8 "tug-of-wars" and an hour and a half confrontation, and a drug for the treatment of the rare disease spinal muscular atrophy, nusinersen sodium injection, was successfully reduced from 700,000 yuan to 33,000 yuan per bottle. After being included in the medical insurance, as a local medical insurance expert, Li Xuri is also paying close attention to the implementation of this drug.
Li Xuri: This drug was successfully negotiated in 2021, and in 2021, its total sales volume was only 342 injections, the price at that time was 700,000, and the annual sales volume was 240 million. After the negotiation in 2021 and after the inclusion of medical insurance payment, its sales data in 2022 will be 14,000 needles, and the price will be 33,000 injections, so its sales will be 460 million. From the patient's point of view, the number of patients who benefited from the insurance was probably less than 300. In 2022, the number of people benefiting from the entire patient will reach more than 3,000, an increase of more than ten times, we have more patients who can use this drug, and the price has dropped significantly, and our medical insurance reimbursement has been superimposed, the cost has dropped greatly, and our patients, medical insurance, and enterprises have achieved a win-win situation.
On December 13, 2023, the National Health Insurance Administration held a press conference to introduce the adjustment of the 2023 National Medical Insurance Drug Catalog, which added a total of 126 new drugs, including tumor drugs, anti-infective drugs, chronic disease drugs, rare disease drugs and drugs in other fields, and 1 drug was transferred out of the catalog. After this adjustment, the total number of drugs in the catalogue will increase to 3,088. In the past six years, the National Health Insurance Administration has added a total of 744 drugs to the medical insurance catalog, of which 446 have been newly added through negotiation, covering all 31 therapeutic areas in the catalog. Behind this, it embodies the painstaking efforts and efforts of all medical insurance experts, including Li Xuri, to facilitate the negotiations.
Li Xuri: Through our efforts, most of the drugs we talked about have also entered the scope of payment of medical insurance, and patients can also use the drugs newly included in the medical insurance catalog, with more choices and lower costs, I think the efforts of the past few days are worth it, and I feel very gratified.
Li Xuri: For me personally, in my own work in the future, for example, how I promote the implementation of national drugs, I may have talked about it and not talked about it, and I will work harder to promote the implementation of national drugs.
(CCTV News Client)