[National Medicine Vitamin] The reform of China Innovation Pharmaceutical Payment System on the eve of medical insurance negotiations

Economic Observer reporter Qu Yixian on the evening of September 6, the State Medical Insurance Bureau announced the list of drug lists that passed the National Basic Medical Insurance Catalog in 2022. This also means that the annual medical insurance negotiations are about to officially start, and China's innovative medicine will face the annual examination immediately.

The National Drug Administration's 2021 review passed 47 innovative drugs, which hit a record high and high -speed innovative drug industry on high -speed development. A new drug has been successfully developed and approved for listing, and all parties hope to benefit patients to the greatest extent. Among them, medical insurance negotiations are the most important parts.

For innovative pharmaceutical companies, medical insurance negotiations have provided opportunities, but the industry generally believes that the "envelope price" of medical insurance negotiations too low affects the profit of the company and thus affects the sustainable development of innovation.

At the moment when the capital market is relatively negative and the topic of "going to the sea", it is particularly practical to discuss the payment of Chinese innovative medicines.

The theme of the Economic Observation News is based on the theme of Innovation Pharmaceutical Payment Reform, and invited 6 guests to discuss the above issues. They are:

Song Ruilin, executive chairman of the China Medical Innovation Promotion Association

Tao Libo, researcher at the Health Policy and Technical Evaluation Center of the Ministry of Medicine of Peking University

Li Ning, CEO of Junshi Bio

Cui Yan, senior vice president of Huang medicine

I wish the chief business officer of Yasheng Pharmaceutical

Qianye, Vice President of Magnesium Health Health

The issues behind the reform of innovative pharmaceutical payment include how to obtain "enlightenment" of medical insurance negotiations, how to calculate the pharmaceutical economics, whether the proportion of dynamic reimbursement is feasible, how to build a multi -party payment system, and how to improve the medical insurance negotiation mechanism.

Here is the record of dialogue on August 30:

Wen Zhao (Editor -in -Chief of the Economic Observation News): Today is the first game of the [National Medicine Vitamin] series of salons. The Economic Observer has always been very concerned about the topic of innovative medicines.

I personally understand that, on the one hand, for patients who are struggling with illness and their families, they expect more innovative drugs to enter the market faster and more conveniently, enter medical insurance, and to hospital It means to emphasize health, regain life, and return to normal life. On the other hand, we need to encourage more pharmaceutical companies and scientists to let them be willing to invest in the field of innovative medicines, so that real innovators get due returns, and form a positive incentive mechanism.

From these two aspects, we need to build a complete system of institutional systems, while encouraging innovation while continuously meet the needs of the market. The reform of innovative drug payment today discussed is part of this effort.

1. How does medical insurance negotiation affect enterprises

Song Ruilin: China's pharmaceutical innovation is still very young, and it has only gone through more than ten years, but in the past ten years, it has changed dramatically. It must be said that this change has also brought some new problems to the entire system. Because it grows too fast, it has not been synchronized with the innovative supporting system, so our theme today -medical insurance payment.

Our medical insurance payment was not prepared for innovative drugs, and it was more prepared for generic drugs, so we are accustomed to collecting collection, very accustomed to depending on the price, and are used to finding opportunities between competing products.

However, innovation is based on patents, and patents mean exclusive market rights, so how to make Chinese medical insurance and China's innovation trend is not only a problem faced by medical insurance, but also the market that innovative drug companies must face. Variety.

By 2022, China's pharmaceutical innovation has entered a new inflection point. What kind of innovation do we want? Do we innovate for innovation, or do we innovate to meet clinical needs? This problem returned to the desktop again. We originally solved "from nothing", and now we must solve "from there to best". This is the transformation facing the Chinese pharmaceutical industry.

In the process of transformation, how to make the whole society look at innovation rationally and treat innovation with innovative thinking? This is a problem that must be discussed today.

The State Medical Insurance Administration has done a lot of work since its establishment in 2018. We have not adjusted the medical insurance directory for 7 and a half years, which is a huge pressure on the Chinese pharmaceutical industry, because it has lost the directory of the directory without adjusting the directory. After the establishment of the National Medical Insurance Bureau, the reform of the medical insurance payment system has also made a lot of steps in the innovation field. At the beginning, it stipulated that it was adjusted once every two years. Later, it became once a year. From the date of promulgation, the previously approved innovative drugs can come to the negotiations. This "trilogy" is the reflection of the innovation -driven strategy established by the state in the medical insurance policy.

So why do you have many questions, many dissatisfaction and many expectations now, that is, our work is to refine.

For the current "three medicines", medical insurance, medicine, and medical treatment are consistent in the direction of the direction -work hard for clinical needs, or to make real innovation to fill the clinical gap. We do some ME-TOO drugs to perform effective clinical substitutions. There is no objection to this, but how to view the value of innovative drugs, how to reasonably determine its price, and what ways to use to truly make the people be affordable and the company's conspiracy to develop This is a balance.

What we want to discuss now is not to oppose innovation. No one is opposed. Everyone is an active supporter and promoter of innovation, but how to truly allow innovation to achieve our purpose and achieve the highest output with the minimum cost. This is what we need to think about. The problem.

Tao Libo: The advancement of medical reform after the establishment of the National Medical Insurance Bureau is quite obvious. From the perspective of economics, the State Medical Insurance Bureau is managing the price of pharmaceutical prices and has price management rights. Whether it is a collection of drug collection or new drug negotiations, it is pursuing the purchase of limited resources and valuable purchases. For the generic drug with many homogeneous competition, the main method is the bidding collection, who is purchased by who is low. For exclusive innovative medicines, it is obviously not able to use rigid prices to compete, so it uses one -on -one price negotiation. Now the negotiation window is opened every year, and after the approval of the innovative drugs, I have the opportunity to enter the medical insurance directory. There are opportunities to enter, but from the perspective of health economics, a reasonable price must be obtained.

How should this price generate? Many manufacturers report that the "enlightenment" is low, but how is the problem that is not low? How do you know where the right price is?

In medical insurance negotiations, manufacturers can judge their quotation based on internal costs. However, for medical insurance, medical insurance does not master the specific information of medicines, nor does it know how the manufacturer's internal costs are allocated, but there must be a reasonable price to conduct negotiations, which is also a great challenge for medical insurance.

The method adopted now is the full participation of experts and scholars, using several dimensions (including international price comparison, existing market price, cost effect analysis, budget impact analysis, etc.) to get the price calculated by a third party. This price is installed in the envelope. Finally, the negotiator uses this price to negotiate with the manufacturer. If the price of the manufacturer may be higher than the price, it may not be able to talk about it. In short, the core problem in it is the formation of the reserve price.

Now this system, I think the methodology is relatively mature, but there are indeed many specific technical issues that need to be improved further, so that the calculation of the reserve price of the negotiation can be more reasonable. We certainly want to promote the development of innovative medicines, which requires all parties to compromise with each other and promote each other, which is more complicated. However, I believe that the management department will have wisdom to find a suitable way. The academic community is also trying to discuss the appropriate method. The future practice will become more and more standardized.

Li Ning: Medical insurance negotiations must be greater than limitations for innovative drug companies. Since 2015, our country has established a mechanism for the negotiation of medical insurance leading innovation drugs. Previously, the medical insurance directory has not changed for 7 years. This stagnation has restricted the development of the entire industry.

After the negotiation mechanism is established, the benefit to innovative drugs is that after entering the medical insurance directory, in the process of implementing the medical insurance implementation, the market share can be gradually enhanced. In this way, the enterprise will have more reasonable expectations during the research and development process: can my R & D results be implemented, can feedback research and development, and can we get a relatively fast return? It is very important. If there is no good expectation, it will not be able to make a more reasonable plan for the entire R & D; if there is expectations, the purpose of encouraging enterprises to innovate will be achieved. This is why corporate innovation enthusiasm has improved after 2015.

But the other side brought by the negotiations is that access also means price reduction. So how much is reasonable? In different positions, everyone's consideration is different. Enterprises want to ensure that there is a reasonable profit space as much as possible, and the procurement of medical insurance hopes to be as low as possible.

Judging from some feedback from domestic biomedical companies, everyone always feels that the pricing is still low after entering the medical insurance. In particular, compared with European and American pharmaceutical companies that have been sold in China in China The first is the 1/5 to 1/10 of the European and American innovative drugs, which is not comparable. This is not only a matter of price, but also the recognition of the value of innovative drugs.

At present, some targeted therapy and PD-1 immunotherapy are multiple indications, that is, after the first indication comes out, there will be a second and third indications ... Multi-indications products are every The prices are reduced to participate in medical insurance negotiations.

We also understand that the core function of medical insurance is the basics of insurance. Everyone wants to do the best, maximum, and most comprehensive things with the least money, but the extension of medical insurance affects the development of the industry. The vast majority of innovative drug companies in our country are still relatively new SMEs. If they focus on prices, they do not pay attention to the enthusiasm of innovators and scientists and the healthy development of the industry. In the end, it is the interests of patients.

Another situation is that although medical insurance negotiations provides the possibility of rapid volume for innovative drugs, it does not mean that entering medical insurance can quickly land quickly, quickly realize hospital access, and even patients with medical insurance patients may not be able to use it. medicine.

Many companies have entered a cycle now: every year they are in medical insurance negotiations -hospital access work must be performed after being talked. The admission work in the previous round of hospital has not yet been completed, or the hospital has not opened a drug club. The price reduction is about to attack. In the case where the price is very low and the market operation is not fully operated, the cost brought by this part is also very large.

In response to these issues, the management department has also introduced some measures. For example, the "dual channel" mechanism issued in May 2021 has been implemented for more than a year. In particular, new drugs with special dosage types such as injection may have certain risks in the hospital's external drugs in the mode of social pharmacies, and the infusion channel has not been resolved.

Such issues such as the overall policy need to jointly introduce solutions. Only by considering the consideration can be solved and the enterprise can have the driving force for continuous innovation.

Cui Yan: First of all, innovative drugs enter the medical insurance directory through medical insurance negotiations, which can benefit patients as soon as possible. Secondly, after entering the medical insurance directory, quickly enter the medical market. Innovative drugs can obtain more real world data, thereby optimizing medication solutions and safety data. Form a virtuous circle from laboratory to clinical practice. From the perspective of an enterprise, entering the national medical insurance is expected to change the price, and to make up for the profit loss after the price reduction. However, from the time of data, some medicines have achieved volume, but there are still some medicines that are not as good as expected. In reality, many products that enter the directory still have problems that are difficult to enter the hospital and have difficulty in landing. Taking Hetong Medicine as an example, three innovative medicines have been listed now, two of which — 呋喹ibinib and Sovinib have entered the national medical insurance. The third product Savidi will conduct medical insurance negotiations this year. This innovation achievement fills global gaps and provides clinicians with more weapons that help patients to defeat the disease. The availability of innovative drugs is the key to clinical applications. Chinese patients, this is also the wish of our innovative pharmaceutical companies.

For enterprises, it is definitely the first choice to enter the medical insurance. Everyone hopes that after entering the medical insurance, the price will be exchanged by price to obtain the profit space. Judging from the two products that have entered medical insurance in our company, the price is basically reduced by 50%and 60%. It is a pity that it is far from reaching the expectations of innovative drugs to benefit more patients.

The best result of medical insurance negotiations is a win -win situation, that is, medical insurance can withstand, the people can afford it, and the enterprise also has room for profit, and reserves reserves for subsequent development. In this way, we can achieve the goal of innovative sustainability and the use of good medicine.

Regarding the limitations of medical insurance pricing, there is also a global consideration. He Huang Medicine announced a good news in August this year. A global three -phase study for the treatment of metastatic colorectal cancer has reached the main end point, and the pace of innovative drugs to go to sea is accelerating. Like all innovative drug companies, the larger market with innovative drugs is worldwide. So will China's medical insurance pricing affect the future pricing of the future? This is a question that must be considered.

Is the medical insurance negotiation determining the strategy or the strategic determination of resources? Medical insurance negotiations cannot just think of solving the needs of the moment, and should consider long -term demand from the perspective of national strategy. If the price reduction of innovative drugs in enterprises is very large, and the company does not have reasonable profit margins, where is the momentum of growing up in the future? If the innovative medicine does not have a good market performance and the company is not profitable, what does the capital market think? If the capital market is no longer optimistic about the field of innovation medicine, and the financing of innovative drugs will become a problem. Innovation may not continue, and it cannot achieve the wishes and goals of more patients. Therefore Consider China's innovation strategy.

Zhu Gang: Yasheng's first product, Orebatinib, is the first country in the world. It is the only TKI drug in China for T315I mutations chronic granulocyte leukemia. We are about to participate in national medical insurance negotiations this year, we are looking forward to it.

The dynamic update of the medical insurance catalog is very good, giving the innovative drugs as soon as possible to be included in the reimbursement of national medical insurance reimbursement as soon as possible.

From Yasheng, this is the first targeted drug to independently develop global layout. China is the first country to be listed. In Eastern Europe, Western Europe, North Africa, North America, Australia and other places, we will be approved in the next few years. The pricing of these countries does not necessarily refer to China's payment price directly, but they must depend on China's price.

Our first concern is that the price of medical insurance restricts the international layout. We have also made a simple research. Egypt, Algeria, the Philippines, and Indonesia, and Indonesia, and Brazil and Argentina in the South American market. Payment of a country. This was taken directly to our heads. It was the risk and pressure that China's original innovative drugs would soon face when entering the international market.

The second concern is the benchmark. We find that the benchmark or treatment method before the negotiation is relatively extensive. For example, EGFR's positive benchmarks, the first generation of Irisha, the second generation of Afininib, and the third generation of Oshitinib, are simply such a benchmark. Of course, these three generations do have a common target. But there are different situations, such as Orebatinib and the first generation of Emantinib, and the second generation of Dusaminib. Nilotinib is obviously different from indications. The only effective drug that treats T315i mutations fills domestic clinical gaps. It is recommended that the benchmarking should be considered from the perspective of accurate treatment of evidence -based medicine.

It is particularly noteworthy that innovative drugs such as Orebatinib to solve medicine -free and clinically needed medicines have no control drugs in China. Previously, CDE approved its key registered clinical period 2 test itself was also a high threshold, that is, it is possible to consider the registered clinical trial of single medicine without controlling medicine. Therefore, medical insurance negotiations should not be required to compare the price for this kind of innovative drugs that fill the clinical gap.

Third, Orebatini spent 13 years and nearly 2 billion yuan from research and development to listing. At the same time, we must continue to invest in clinical research, and the annual costs are more than two billion. The entire negotiation mechanism needs to consider maintaining a reasonable return expectations of an enterprise. Qian Ye: I participated in this salon today. Magnesium Health Health is more suitable for partners called innovative pharmaceutical companies. The cooperation between us can be said to be the cooperation of innovative payment to solve the problem of the payment of innovative drugs.

The national medical insurance and drug catalog negotiations. The biggest benefits in the past few years are the people. The Chinese people can take good medicines in the past few years. This is the biggest benefit. Earlier participants were also beneficiaries. When Roche first participated in the negotiations, its entire volume and price curve was very good. Of course, there were some changes in the back. The limit was very obvious. The safety of the medical insurance fund plate was a very important consideration. The degree of aging in China is increasing, the health needs of ordinary people are increasing, and the fund plate is sustainable.

In the past five years, we have cooperated with many pharmaceutical companies and found some interesting phenomena. In the first two or three years, basically all pharmaceutical companies said that cooperation with magnesium faith is a choice before entering medical insurance. After entering the medical insurance, we will not cooperate with you. Our admission strategy is to enter the medical insurance. In a few years, all pharmaceutical companies have such ideas.

But in the past two years, we found that different pharmaceutical companies have begun to adopt different access strategies, especially drugs with very high prices. When these pharmaceutical companies talk to us, the first question is not to go to medical insurance. They It will be said that it is evaluating whether to enter the medical insurance or not in the medical insurance in the future. The market for medical insurance is still a market for medical insurance. This trend has become more and more obvious in the past two years.

If we look at the longer period of time, the positioning of basic medical insurance is still widely covered by insurance, but it is not just the basic guarantee. It also assumes the role of innovative drug access to help the people solve the problem.

In the future, there are more and more technological innovations on the supply side of the pharmaceutical supply. Cell therapy has been listed one after another, and gene therapy products will come out immediately. The pricing of these products has been as high as one million. What is the first admission selection when these drugs are listed? This is a question that the entire payment system needs to answer.

Looking at the 10 or 20 years later, we hope that China can build a multi -level medical security system, and innovative drugs must also have different payment systems. Not only are magnesium faith health, we also hope that there will be many participation in the future. Innovative drug companies, insurance companies, and other participants, including patients and health groups, jointly build this system to form a system of helping and common prosperity.

2. Establish a separate payment system for innovative medicines

Tao Libo: Pharmaceutical economics calculation is basically aimed at exclusive innovative products, because if many homogeneous products compete with each other, pricing and procurement can be achieved through price competition. Only the application of drug economics.

How to calculate drug economics is a more complicated professional issue. Basically to do two things, one is a cost -effective analysis, that is, find a reference, compare the new drugs with the reference medicine, and see how much cost and the poor health effect. The higher the premium, the less efficacy increases, and the premium is less. The price / performance ratio is based on the price of reference drugs to calculate the reasonable pricing of new drugs. The choice of reference objects is very important. The other is the analysis of the influence of budget, that is, how many budgets and affordable buyers are available. For example, buying a house on Chang'an Street may be cost -effective, but it may not be affordable; buying a house in the suburbs is affordable, but it may lack cost -effective for those who go to work every day.

Drug economics determines the reasonable price of new drugs through these two dimensions. This is a price based on the perspective of the purchaser and consumer value. There are indeed some games. Therefore, there are places that attach importance to drug economics and there are some controversy.

Song Ruilin: After several rounds of medical insurance negotiations, we have been exploring a reasonable path. Obviously, the current way of negotiation access has exposed some problems.

The evaporation of the value of Hong Kong's 18A listed companies is now falling in the global BIOTECH company's value, why is the value of China's BIOTECH company's largest decline? This requires us to consider it carefully. To establish an ecological environment that supports researchers and investors, a new payment system is needed.

What does China want? Do you want to practice innovation to drive this national strategy? Is it necessary to enhance the research and development of drugs in China's independent intellectual property rights? Do you want to hold the health of 1.4 billion Chinese in your own hands? This is a strategic goal. Back to medical insurance, the central government's positioning for medical insurance is called national strategic purchase. Long-term vision.

We need to abandon an old -fashioned thinking now. When determining the payment system, what we think is not how to complete the task today, but how to come up with the most reasonable method under limited funds to achieve the most hoped goal.

Therefore, our Medicine Promotion Association has officially proposed to the State Medical Insurance Bureau that it is necessary to establish a new payment system for innovative drugs, and there are a few points to summarize:

First, the existing fixed proportion reimbursement system is reorganized, and the dynamic reimbursement ratio is determined according to the ability of medical insurance payment. For drugs with relatively high prices, the proportion of reimbursement can be appropriately reduced; for groups with difficulties in life, medical insurance can appropriately increase the proportion of reimbursement to reduce personal payment proportion Stress reflect social fairness. Now only 70%of the fixed reimbursement ratio, that is to say, the remaining 30%is self -payment, and of course the price is limited. The objective reality of medical insurance "doing its strength and doing its best" cannot be changed. Then medical insurance should decide how much I can pay for this medicine, but because there is no money, it is not worth the money you can pay.

Secondly, since it is a strategic purchase, there must be a strategic depth. So many experts have taken so many data and made so many evaluations. The price directly tells the enterprise that I can only buy this drug only at this price, so the enterprise will make an evaluation based on the volume of the future market, saying that I accept or not accept it.

If you accept it, according to the risk of sales performance after listing, for example, the price is set to 10 million boxes, and the result is sold for 15 million boxes. practice.

When the national major new drug creation special review, first -class experts said that the drug needs to be supported; when the State Drug Administration was approved, first -class experts said that the medicine should be approved and approved; when the medical insurance bureau was negotiated, it was still still the negotiations. First -class clinical experts say they should enter medical insurance. Finally, I went to the gate of the hospital and could not go to the hospital. This was a logical dilemma. No one explained.

For example, "dual channels", dual channels are to solve the problem, then the problem should be clear, why can't the single channel be solved? Doing "dual channels" indicates that the first channel did not open the door. Why didn't you open it? No one explores, this is a question that requires deep thinking and deep analysis.

Today's theme is [National Medicine Vitamin], which is actually a change. We have to launch new ideas. The strategic height of the country is really innovative. In the future, we cannot stand in the world. When he died, the people had nothing.

I hope that the Medical Insurance Bureau and enterprises can discuss related topics in public and transparent situations, especially the price of the price of drug economics reports from the price of the final negotiations. medicine. Otherwise, the enterprise goes to the drug economics expert to evaluate it. After the evaluation, the medical insurance bureau does not know whether the medical insurance bureau does not recognize the results.

This is the case of Western countries. The medical insurance department has determined several neutral third -party institutions, which are generally in universities. After finishing the results, the price is determined according to the results. Now that drug economics experts focus on doing them, and the Medical Insurance Bureau talks about the Medical Insurance Bureau. The two have not achieved connection. These are all problems.

Li Ning: From the perspective of an enterprise, medical insurance can divide the fund pool, or divide a part of the proportion alone as an attempt to pay for innovative drugs. There are also precedents in other countries. For a certain disease field, there are separate funds or innovative payment models. Time to review the rationality of payment and adjust according to the efficacy data, establish an open and transparent monitoring system, adjust according to real world data, establish an innovative payment model, co -owned or financial sharing, etc. This is more conducive to promoting to promote The development and innovation of the industry, all parties are more likely to reach consensus.

Cui Yan: In fact, our innovative pharmaceutical enterprises and medical insurance departments goals are the same, that is, let innovation results benefit more patients. Our CEO said: The most afraid of medicine is that the medicine is made, but ordinary people can't afford it. This is the sorrow of the medicine man. Therefore, once our innovative medicine is approved to be listed, we want to enter the national medical insurance. Even if the price reduction will lose the profit of the enterprise, we should also make ordinary people afford it.

But do I hope that the term "medical insurance negotiation" can become a medical insurance negotiation in the future? Because the current discounting price is opaque, companies cannot understand the reasonable payment capacity of medical insurance, and they may lose the opportunity to enter medical insurance. Patients may not be able to enjoy the support of medical insurance and use innovative drugs. I think the word "soul bargain" is particularly unfriendly to innovative medicines, making people who are sad for medical innovation. Reasonable prices are not only conducive to the sustainable innovation of enterprises, but also the guarantee of the quality and safety of patients in clinical treatment.

As an innovative pharmaceutical company, we hope that medical insurance negotiations are open and transparent. The tolerance of medical insurance, the ability of patients, and the pricing of the product of the company need to be organically combined and coordinated.

Therefore, it is necessary to build a separate payment system for innovative medicines. It is recommended to implement the elastic pricing model of innovative drugs. At the same time, it is also recommended to set up a buffer period and protection measures for domestic innovative drugs to support them. In order to encourage high -quality innovative drugs to enter the market quickly and benefit the Chinese people, at the same time, it also encourages Chinese pharmaceutical companies to improve the ability of innovation research and development.

As an innovative pharmaceutical company, what prices will definitely be considered by the market and they can bear it, so they will comprehensively consider all the costs and market promotion costs in the early stage to give a reasonable price. process.

Zhu Gang: step by step, the medical insurance bureau has budget restrictions. It can be operated directly. It does not matter how much money the Medical Insurance Bureau has, and it will pay so much money and does not destroy the fund plate of the Medical Insurance Bureau.

I added a lot of methods for payment and risk sharing. These methods have been done by Chinese folks. Enterprises have supported patients with PAP patients, including benefiting people's insurance and commercial insurance. Earlier to promote multi -party payment, the fund did not lose. It really doesn't work in the reform of the payment ratio. A game of chess nationwide. For example, 50%of medical insurance payment, enterprises use the method of sending medicines to take another 20%. This is a good way.

Song Ruilin: I added that for low -income people, medical insurance can increase the proportion of reimbursement; for secondary income, it can reduce the proportion, so that medical insurance funds can reduce risks, and the pressure of ordinary people is also released.

Zhu Gang: It is okay to reduce the reimbursement ratio of middle -income people. Openers guarantee to buy these people. In the case, the price of the ticket is higher, and the enterprise can afford it, even the bottom. For example, the budget of the enterprise is only 500 patients for medication next year, and some companies exceeding 500 are all bottom -up. These are good ideas.

Qianye: Based on the current protection scope of basic medical insurance, there is a series of security plans on the market. Some are insurance forms, and some are not insurance forms. Essence This is a very new insurance variety. It has been only two or three years since 2020, but it is constantly evolving. Basically, we will participate in it every year to launch some new changes.

Huiminbao can be understood as one million medical insurance as the earliest, mainly for healthy people. From 2021, it can be insured and paid, and at the same time, it will further expand the directory. By taking Shanghai Huibao as an example this year, the responsibility of the drug has been further updated, and it is included in very expensive medicines. In the guarantee, there are some medicines that first trial zones in Ledong, Hainan, and now there are.

Magnesium letter participation in the guarantee plan, the principles are the medicines or indications that the basic medical insurance has not yet covered. The characteristic of this inclusive commercial health insurance is that the pricing is relatively cheap, about 100 yuan, which is only equivalent to eating a meal outside, and many cities can be deducted from the medical insurance account, so it can also wake up some sleeping sleeping. Medical insurance funds, of course, it is the money of ordinary people.

On the other hand, its entire guarantee design is a superposition that is done on the basic medical insurance, because the basic medical insurance is limited to the reimbursement ratio on the one hand, and on the other hand, there are restrictions on drug selection. We include some particularly expensive medicines into the guarantee plan, and then add some medical service rights and interests to add things in, so that the people can get more sense. Our goal is not just middle -income people, but for insurance varieties covering 50,000 to 1 billion people.

This design can enhance the awareness of the Chinese people's insurance. For insurance companies, it may not be the main profitable product, and it is more an insurance product for penetration. On the basis of benefiting the people's security, more innovative products and more diversified in the future, so that the entire security level system will come out, basic medical insurance has supplements, and ordinary people with different payment capabilities also have different choices.

3. The negotiation access mechanism needs to be improved

Tao Libo: From the perspective of the proportion of medical insurance reimbursement, the middle class discussed earlier is a little less, and the low -income people are more reported. It will be difficult to operate because it is a basic guarantee. The whole people of the people, so this differentiated treatment may be difficult to operate.

If you want to be differentiated, you can actually achieve supplementary insurance. Supplementary insurance is to raise funds and guarantees, and buy another 100 or 200 yuan a year to buy a supplementary insurance. This insurance can ensure that the basic medical insurance does not cover medical products. I think this difference is more appropriate. Internal treatment of basic medical insurance must be differentiated, it will be more controversial.

As for the negotiation access, I just talked about whether the medical insurance could be quoted, and said how much I had to take it out to see if you could accept it and buy your medicine. This is a very interesting thing, just like a company has to recruit people, HR asked how much wages do you want, the candidate said how much salary you can give me, and no one of the two parties is willing to quote first, because the offer first is not good for those who are not good at first. Location.

The current medical insurance negotiation access, the thing that the manufacturer feels pain is to quote first. Medical insurance does not quote, so that manufacturers are quoted first, so manufacturers find it uncomfortable. But on the other hand, the medical insurance is bid first, and then the manufacturer sees it if he can accept it, and the medical insurance will be uncomfortable. Price negotiation is a process of distribution of interests. Whoever quotes first will suffer.

The key reason why the manufacturer first quotes first is that the manufacturer faces a Single Payer (unified payment party). The national basic medical insurance is the largest and relatively unique buyer, and facing many manufacturers and many suppliers. So many manufacturers want to sell medicines to medical insurance. Medical insurance is a big buyer, occupying the market advantage, so it can allow manufacturers to bid first.

Based on the basic principles of economics, the pricing of both supply and demand is a value between the cost of supply and demand value. The price cannot be lower than the cost of the supply, otherwise the loss will not be done; it cannot be higher than the demand value, otherwise it is not cost -effective to buy your product.

Medical insurance has invited many experts to calculate the price. In fact, the value of the demand is calculated, which is the upper limit of the pricing. Medical insurance has the upper limit of the price, allowing manufacturers to quote. The meaning of it is not to let the manufacturer guess the price, and to guess that I think it is wrong. Profit. If the manufacturer's offer is lower than the value of the demand, it can be sold. If the quotation is higher than the demand value, it means that the price that the supplier wants to exceed the price that the demand is willing to pay, and it will not be able to talk about it. This set of logic is very clear in economics. In this logic, manufacturers want to make medical insurance bid first, and I think it will be more difficult. Cui Yan: I have an immature idea that makes the procedures for medical insurance negotiations more open and transparent. For example: manufacturers can pay a price first; if the price is too high in the scope of the enlightenment, can the medical insurance negotiator be asked to ask a proposed price; if the manufacturer can accept it, the negotiation will be successful. Through negotiation, more reasonable prices are found to avoid the opportunity to enter medical insurance from the estimation of the enterprise. Patients can also have more medical insurance for innovative drugs.

Tao Libo: The price of manufacturers can be adjusted by itself. The base price of the medical insurance cannot be adjusted at will, because it is a third -party expert to calculate a good envelope price, and the negotiator cannot set it at will (not upstream).

Song Ruilin: This shows that the system is going to change. Why do you have a different point of view, that is, we have a assumption that the system cannot change, and China's economic development is moving forward in continuous system reform.

What is the difference between the Medical Insurance Bureau and commercial insurance companies? If it is a Commercial Insurance Company, it is a buyer and seller, but where is the strategic purchase of the State Medical Insurance Bureau's strategic purchase? No one study it on this issue. It only says that the medical insurance bureau cannot bid it because the bid is lost. This It is where I have a different point of view from Professor Tao.

Li Ning: We may want to jump out of "price negotiations", because everyone actually talks about "price", but the value of medicine. Drugs are a special product. It is not a consumer product. It is a demand product because patients need to cure. In the early stage, after the review of the national drug surveillance system and the evaluation of clinicians, it has decided which drugs are really qualified to sit at the negotiating table. This premise is that there are patients' needs. Medical insurance is actually hoping to improve the use efficiency of the fund and pay high -value medicines to benefit patients to the maximum. It is recommended that you should pay attention to the value of the product and the differences in the product.

Song Ruilin: I have visited the European Union specifically for this issue. The European Union's policy is that in the first year of enterprise pricing, I paid, but after one year of payment, I will judge the value of your medicine and the value in the catalog based on clinical data. The relationship, I want to look at the Delta value you raised to decide the purchase price I will give you the next year.

Back to a question that is always talking, what is the true meaning behind the procurement of innovative medicines? It is for industrial development. At that time, Santana sold 27,000 in 100,000, and now 70,000 yuan, did its value and price change? In fact, the market demand has changed, and it is impossible to maintain a high price.

Tao Libo: This method of medical insurance negotiations is an institutional path explored in the past few years, with clear economic logic. If this logic is not overturned, the key to the improvement of the future negotiation mechanism is that the calculation of the base price is more reasonable.

Of course, if you want to change the logic of supply and demand game logic that has been established in the current medical insurance negotiations, designing from a more macro and longer perspective, the horizons will be wider, and many things can be discussed further.

I agree that President Song said that foreign practices are more transparent: the report submitted by the manufacturer, how to calculate and result will be announced. Experts discuss, and the results of compromise are also announced on the Internet. This may be the fairness and transparency of everyone's hope.

But our country has not yet done so, I personally think there are two reasons. The first is that there are many new medicines. Every year, nearly a hundred medicines are negotiated, and they have to do so. The cost is very high. Second, whether the academic world is or the industry, everyone must have a clear consensus on the measurement method, so as not to form an irreplaceable result. Maybe everyone is also worried that manufacturer experts and medical insurance experts are put together. I do n’t know if they can achieve a mild compromise. If it is very needle to match Mai Mang, things are not easy to clean up. So the current mechanism and method are adopted.

Zhu Gang: From the operational level, combined with the entire environment, you can also follow the current game rules, but there must be a small fine -tuning. There can be enlightenment, but the payment ratio is not necessarily 70%. The price is very low because of medical insurance without money.

Song Ruilin: I am also the vice chairman of the China Rare Disease Alliance. I recorded a report for the China Rare Disease Summit Forum this morning. At present, there are about 40 rare medical drugs in our country that have been approved for listing, and 14 of them have not entered medical insurance. The rare patients behind them cannot get any help from medical insurance at all.

Because the pricing of rare medicines of the manufacturer is higher than 300,000, it is not possible to participate in negotiations, which is a bit problematic. If the price is 1 million, you will help 300,000, will it be pressured by 700,000? If 700,000 insurances are guaranteed by Huimin, companies donate some more, and social charity will give a little more. All our systems are a continuous process, and any modification in the process represents a progress. Tao Libo: From the perspective of health economics, what is paid attention to is the balance of supply and demand, that is, the supplier and the demander must reach the acceptable price of both parties.

The value of the value of the drug economy is the upper limit of value, which is a new drug compared with existing therapies and how much health income is increased to explore the pricing of new drugs. This is called value. Therefore, the price of pharmaceutical economics is the upper limit of the price, which is equivalent to consumers that consumers think it is not worth, and below this price is worth it.

The solution to the negotiation access is hidden in the heart. First, please ask the manufacturer to see the cost and the profit you want. It cannot be traded. This economics logic is very clear.

It is normal for both supply and demand to reach a price consistency and cannot be sold. This is normal. However, patients can not receive medical insurance payment, and their diagnosis and treatment will be affected. The medical burden will be very heavy. What should I do? This is a key issue that needs to be considered.

Song Ruilin: Today, the discussion is very good. The discussion should be the collision of the point of view. We can only find a more reasonable or reasonable choice in the collision. Drug economics experts are not responsible for negotiations, and the low prices of negotiations are not caused by pharmaceutical economics. Because the government's choice is to use the price given by drug economics as a reference, not as a basis for decision -making.

From the perspective of the industry, we must make a unique drug with market competitiveness in order to occupy an active position in the negotiations. It is not a game, but that all parties must strive to improve their ability and value, and finally achieve the common interests and common commons. point.

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