This year's medical insurance negotiations, not only the price reduction, but also to do PPT

On the evening of June 29, the "National Basic Medical Insurance, Work Injury Insurance Insurance, and Maternity Insurance Drug Catalog Adjustment Work Plan for Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drugs in 2022" was officially announced, which means that the fifth round of medical insurance negotiations were officially launched.

As in previous years, the negotiation work is still divided into five stages: preparation, declaration, expert review, negotiation/bidding, and announcement results. According to the time plan of the plan, if the progress is smooth, the negotiation work will launch the declaration on July 1, the results will be announced in November, and the implementation of the landing on January 1 next year will be implemented.

The Jianzhi Bureau noticed that in 2022, medical insurance negotiations were appropriately tilted with special groups such as patients with rare diseases, children, etc., and the payment standards were determined simultaneously when they were admitted to non -exclusive drugs, and the negotiation rules were changed to renewal products.

Moreover, before the negotiations, the list of drugs that passed the form of review will be announced in the form of "announcement". This makes the varieties and processes of medical insurance negotiations more transparent, which is conducive to accepting the supervision of the whole society.

Compared with previous years, the biggest difference is that the application for the application for the application must be submitted by July 14, and at the same time, the slideshow (PPT) of the declared product should be submitted to clearly fill in security, effectiveness, economy, innovation, and fairness. Many of them will be related to the price reduction basis of enterprises.

This year's "inner volume" is not only reflected in the price, but also in PPT skills.

Fill in five types of information in PPT

Price is the key to shortlisted

This medical insurance negotiations put the threshold to the widest as usual: as long as it is January 1, 2017 to June 30 this year, the new general name, new indication or functional attendance, and national base approved by the national drug regulatory department, and national base The drug directory and the six categories of drugs in the "First Batch of Rare Diseases" can be declared.

Since last year, the National Medical Insurance Administration has required to fill in the market price of the medicine during the application, but the "original price" last year has not been announced.

This year, the National Medical Insurance Bureau further required enterprises to produce PPT in the application process and fill in the sales amount from January 1st to June this year.

This data will provide an important reference basis for expert review.

What's more important is that in the enterprise PPT, compared with drugs in the same field in the directory, the economy advantages and lack are required. Analysts pointed out that the application between similar innovative drugs and the materials of the two parties confirmed each other, allowing experts to better understand the characteristics of the application product and make a more rational analysis of the negotiation price.

Of course, the National Medical Insurance Bureau also set up a template that does not contain economical application. The industry generally believes that if the declared enterprises do not clarify the economy of the declaration variety, more doubts will be lost in the hearts of the review experts. Competition of similar varieties will be compared to compare Lost.

Clinical value and pharmaceutical economics are an important indicator of the medical insurance directory. The industry generally believes that after filling in sales, the more large sales, the more rigid prices are cut.

For those who are included in the "non -exclusive variety" bidding, the declaration price shall not exceed the provincial minimum medium -level price within two years, and the quotation of similar varieties shall take the minimum value. In other words, if competitors reported lower prices, the Medical Insurance Bureau will be included in the minimum price. The possibility of being "dragged into the water" by an enterprise.

However, there are good news: if the enterprise quotation is 70%lower than the willingness to pay for medical insurance, medical insurance is willing to bottom out with 70%. This shows that the price reduction of medical insurance negotiations is the bottom line.

The price renewed varieties must be reduced

Rare disease drug policy is unclear

In addition to the newly entered varieties, how to keep the renewal variety in the directory is also the focus of this negotiation.

There are three renewal plans given by the National Medical Insurance Bureau this year: incorporated into the conventional directory, re -negotiation and simple renewal. Among them, the exclusive drugs that have been successfully negotiated in 2018 and have not adjusted the payment standards and the scope of payment in the two consecutive agreements, which can be directly included in the conventional directory.

If the actual payment of medical insurance during the agreement period exceeds a certain percentage of the estimated value, or the scope of payment is adjusted due to increasing the indications, the medical insurance may increase the payment of more than 100%in the next two years, and the re -negotiation process will be started.

There is no need to re -negotiate and does not meet the varieties of the conventional directory conditions, which will be included in a simple renewal.

Generally speaking, the exclusive variety in the existing medical insurance directory, if the newly approved adaptation leads to the increase in sales, may trigger further price reductions during renewal.

The State Medical Insurance Bureau even directly draws five grades. Regardless of whether the scope of medical insurance payment is adjusted, as long as the annual sales reaches the corresponding standards, the renewal products need to be reduced in proportion.

At the same time, the price reduction of the price reduction and the increase in the price reduction of indications, at the same time announce the information of the shortlisted varieties to the society, and require enterprises to fill in the actual market sales. This series of measures show that the State Drug Administration has become more and more mature when negotiating in medical insurance price negotiations, which can be more convinced by enterprises and society.

As the largest payment party in the Chinese pharmaceutical market, the bargaining ability of the State Medical Insurance Bureau is beyond doubt. In the past four years, 250 drugs have been included in the directory by negotiation, with an average price reduction of more than 50%. Every year "soul bargain" will become a hot topic in society.

Relatively speaking, the medical insurance department representing the country is a strong party and the enterprise is a disadvantaged party. The medical insurance negotiations for several years have made the medical industry aware of the determination of medical insurance control, and many companies are afraid of: they are afraid that the products are bargained sharply, and they are more afraid that the product cannot enter the medical insurance.

Especially last year, a rare disease was cut from 700,000 to 33,000 yuan, which made a rare disease drug manufacturer in the niche market panic.The country has been encouraging the research and development of rare diseases, but at the medical insurance side, too low prices may damage the enthusiasm of the industry.The Jianzhi Bureau found that in the medical insurance negotiations this year, as long as the rare medical drugs were listed before June 30 this year, they could participate in the negotiations, but they did not set up negotiating rules for rare diseases.

According to industry statistics, there are as many as 170 varieties that meet the standards of medical insurance declarations this year.If you want to enter the medical insurance catalog, you must choose the strategy of "change the market at the price".

The public account of the Jianzhi Bureau can get "PPT" to get:

Example of applying for drug abstract slides (including economics)

Writing ｜ Lei Gong

Edit ｜ Jiang Yun Jia Ting

Operation ｜ Valley

Illustration | Visual China

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