Supporting clinical use of innovative drugs, how to optimize the reform of DRG payment?

Innovative drug research and development is difficult and investment is high. Once successful, it can effectively reduce the pain of patients and improve the quality of life. It is the new hope and new demands of many patients at present. In order to meet the basic medical needs and clinical technological progress of the masses, since the establishment of the State Medical Insurance Bureau, it has carried out the admission negotiations of medical insurance drugs for four consecutive times, and has included hundreds of new drugs with high clinical value into the directory. But we also have to see that there is a certain gap in the clinical application of Chinese innovative drugs compared with developed countries. With the reform of payment methods such as DRG, medical institutions may change the current extensive and scale expansion operating mechanisms, and may to a certain extent to suppress the clinical application of innovative drugs to a certain extent.

In the DRG payment system, the weight of the disease group is determined based on historical medical expenses data. Because many medical institutions have used less innovative drugs in the past, and there are fewer historical data of clinical treatment costs, the weight coefficients and payment standards of the corresponding disease groups currently calculated did not fully consider the treatment costs of innovative drugs. Inpatient patients used innovative drugs in the hospital At this time, the cost generated may exceed the payment standards of the corresponding disease group, which in turn causes medical institutions to be reluctant to equip high -priced innovative drugs.

The purpose of the state to promote the reform of payment methods is to ensure that the masses obtain high -quality medical services and improve the efficiency of fund use. In order to alleviate the restrictions of the new payment method for the premium and use of negotiating drugs for medical institutions, the State Medical Insurance Bureau and the National Health Commission jointly issued the "Notice on the Normalization of National Medical Insurance negotiations to continue to do a good job in the implementation of negotiated drugs" in September 2021 It is clearly proposed that "the diseases that implement the reform of payment methods such as DRG shall promptly adjust the weight of the disease according to the actual use of the drug." In this context, localities have also begun to explore the reasonable payment methods of innovative drugs in the DRG payment system. Beijing uses a separate payment method for some innovative drugs, and does not packed and paid with the DRG group. Recently, the "CHS-DRG Pay New Drug New Technology Except for Payment Management Measures (Trial)" is further clarified to further clarify the application for pharmaceutical declaration except for payment scope; Fujian Province refined the treatment scheme of the corresponding disease group with more innovative drugs, and formulated multiple charging standards for each plan. The foreign DRG payment system mainly achieves the transitional payment of innovative drugs through short-term payment tools and long-term payment mechanisms. For example, in Germany's G-DRG Enter the payment model.

In the author's opinion, on the basis of existing policies, you can learn from domestic and foreign experience at home and abroad to optimize the DRG payment system for innovative drugs. First of all, update the DRG groups of innovative drug -related diseases in a timely manner. For innovative drugs with appropriate clinical effects and cost effects, you can choose a full and representative medical institution to carry out clinical use of related data calculations, tissue pharmacy, clinical, and pharmaceutical economy Experts such as learning and medical insurance management jointly discuss the determination of the results and weights of the grouping. Secondly, explore the construction of an innovative drug transition payment model under the construction of the DRG paid system, and optimize the top -level design of the relevant policies. According to the experience of pre -experience at home and abroad, short -term payment can be used as except the project payment method of the project or the supplementary payment method based on the payment method of the project. After 2-3 years of clinical data accumulation The weight of the disease group is gradually transformed into a long -term DRG group packaging and payment. It should be emphasized that whether except payment or supplementary payment must be clearly clarified, the access conditions and payment standards of innovative drugs must be clarified, the review steps and processes are standardized, and the implementation of policy implementation is strengthened.

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