Which medicines are expected to enter medical insurance?How to renew the contract?

The adjustment of the medical insurance directory is related to each insured. The State Medical Insurance Bureau recently issued the "National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug Catalog Adjustment Work Plan for 2022" and related documents for comments, which means that this year's medical insurance directory adjustment work will be officially launched.

Which drugs are expected to be reimbursed in medical insurance? How to renew the contract after the drug agreement expires? These can find "answers" in the work plan.

More rare diseases, children's medicines, etc. are expected to enter medical insurance

According to the work plan, 6 categories of medicines outside the directory can apply for the adjustment of the medical insurance directory in 2022, including from January 1, 2017 to June 30, 2022. During the treatment of major changes in medicines; new cure pneumonia -related therapeutic drugs, etc.

Compared with last year, the medical insurance catalog adjustment in 2022 added new children's medicines, generic drugs, etc. Among them, the scope of children's drugs should be among the three batches of encouraging R & D and declared children's drugs issued by the State Health and Health Commission and other departments. Imitation drugs should be in two batches of encouragement of imitation drugs.

"More children's medication in medical insurance can reduce the burden on patients' medication." Zou Liping, member of the Standing Committee of the Pediatric Branch of the Chinese Medical Association, believes that this will also play a guiding role in the pharmaceutical market, encourage more enterprises to focus on the development of children's medication and bring the gospel to patients.

In the adjustment of the National Medical Insurance Catalog in 2021, after 700,000 yuan per need for the treatment of spinal muscle atrophy, Nosina Sodium injection liquid was negotiated with medical insurance for more than 30,000 yuan. Pay attention.

Up to now, more than 60 rare diseases in China have been approved for listing, of which more than 40 kinds have entered the national medical insurance catalog and involved 25 diseases.

The work plan is clear that the rare disease therapy drug approved by the State Drug Administration of the State Drug Administration before June 30, 2022 can apply for this year's medical insurance negotiations. sick.

Category to renew the negotiation agreement

During the dynamic adjustment of the medical insurance directory, the "soul bargaining" of drug negotiations has attracted much attention. The medical insurance department and pharmaceutical companies negotiated on the pharmaceutical payment standards, and directly decided whether the drug could enter the medical insurance and what price in the medical insurance. In 2021, there were 67 exclusive medicines outside the directory of the medical insurance, with an average price reduction of 61.71%.

According to the "Interim Measures for the Management of Basic Medical Insurance Drugs", in principle, the drug agreement is valid for 2 years. After the agreement expired, the actual expenditure of the medical insurance fund during the agreement period was analyzed and compared with the budget impact submitted by the enterprise before the negotiation, and the price was reduced according to the degree of difference, and the agreement was renewed.

The "Renewal Rules for Negotiated Drugs (Draft for Soliciting Opinions)" proposes three types of negotiating drug renewal rules for conventional directory management, simple renewal and renewal of negotiations, and detailed provisions of the three renewal methods.

According to the results of the renewal of previous years, it can be found that drugs that have been successfully renewed in negotiations are often more advantageous in terms of price. For example, 27 drugs that have been successfully renewed in 2019, the average price decreased by 26.4%; in 2020, 14 exclusive drugs renewed or renewed according to the rules, with an average price reduction of 14.95%.

Give full play to the leverage of the medical insurance fund

Since the establishment of the National Medical Insurance Bureau, it has carried out the medical insurance directory admission negotiations for four consecutive times. A total of 250 drugs have been added to the directory through negotiations, and the average price has decreased by more than 50%. By negotiating price cuts and medical insurance reimbursement, a total of about 150 billion yuan was reduced to patients in 2021.

On the basis of adhering to the dynamic adjustment of the medical insurance directory, the adjustment of the medical insurance directory is also making more attempts and explorations.

The work plan was proposed for the first time that non -unique medicines intended to be included in the medical insurance directory were simultaneously determined to determine the medical insurance payment standards using bidding and other methods.

The "Non -Exclusive Drug Bidding Rules (Draft for Soliciting Opinions)" proposes that corporate quotation cannot be higher than the provincial lowest bidding price and market retail price submitted during the declaration within 2 years before the application. For non -exclusive drugs that are included in medical insurance through bidding, those who have the lowest quotation of each enterprise are used as the standard for payment of drugs.

Some experts said that this will give full play to the leverage of the medical insurance fund, a positive impact on the structure and market price mechanism of the drug use, and further reduce the burden on the patient's medication.

In addition, this year's work plan clearly sets the identification time of exclusive medicines as June 30, 2022, which will better realize the "seamless connection" of new drug approval and medical insurance, and encourage new drug research and development.

According to Xinhua News Agency

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