Can't enter medical insurance?How to cope with competition rules for non -exclusive varieties?

On June 29th, the "National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug Catalog Adjustment Work Plan" ("Work Plan") and related documents were officially announced on the website of the National Medical Security Bureau, which means that the medical insurance directory in 2022 is 2022 Formally enter the adjustment period.

Compared with the medical insurance directory from 2019 to 2022, it can be found that the transfer of medical insurance directory in 2022 has changed again. The transfer standard for western medicine and Chinese medicines in the directory still refers to Article 9 and 10 of the 2020 "Interim Measures for the Management of Basic Medical Insurance Drugs".

This medical insurance adjustment is good for patients with rare diseases and children. There is no time limit for the application conditions for rare medical drugs. The time limit for "approval of listing after January 1, 2017" is set. The last time it clearly encouraged rare diseases to be used in 2019, or the 2019 medical insurance directory adjustment rules. After a year, the adjustment of the medical insurance directory is clear again. The state encourages imitation drugs and encourages the research and development of drugs to apply for children's drug lists to be included in the medical insurance directory. The optimization of the directory shows that the adjustment direction is still properly tilted to clinical shortage drugs.

This article focuses on the bidding rules of non -independent products in the 2022 edition.

Scope of incorporation: only newly entered medical insurance

According to the rules, the non -exclusive products are bidding for non -exclusive products are non -unique medicines that are newly included in the medical insurance catalog, and do not include selected drugs and government pricing drugs in national collection.

In 2022, medical insurance has a new bidding rules for non -independent products. It is expected to be "drugs in the latest version of" New Coronatte Virus Pneumonia Diagnosis and Treatment "," Pharmaceuticals Including the "National Basic Drug Catalog (2018 Edition)" Before June 30th, the drugs were approved by the State Drug Administration to be listed and "incorporated into the encouragement of imitation drugs or encouraging R & D and declared a list of children's medicines".

Bidding concerns: Do you want to participate in the offer?

The industry expressed concern about the bidding of non -independent products: Which of the products that are higher than the price quotation of medical insurance payment are compared with the lowest price quotation product, which future market prospects are greater? After the bidding for medical insurance negotiations, can it be purchased directly in various provinces? The bidding for medical insurance is not the purchase of volume. How much can enterprises benefit after the price reduction?

According to the rules, the medical insurance organizer organizes the calculation of experts to calculate according to the procedure, and proposes the willingness to pay for medical insurance as the entry threshold for the general -purpose drug. As long as one company's offer is not higher than the willingness to pay for medical insurance, the general -purpose drug is included in the Class B directory of the medical insurance, otherwise the general -purpose drug will not be included. Enterprise quotations cannot be higher than the provincial lowest bidding price and market retail price submitted during the declaration within 2 years before the declaration deadline.

Compared with the comments draft, the final adjustment plan adds a new bidding clause. If the drug is included in the drug catalog through bidding, the lowest person in each enterprise quotation is used as the payment standard for the general -purpose drug. If the corporate quotation is lower than the 70%of the willingness to pay the medical insurance, 70%of the medical insurance payment will be used as the payment standard for the drug. It can be seen that the key to determining whether the product can enter the medical insurance directory and the payment standard is that the medical insurance organization calculates experts to evaluate the general -purpose drug to determine the willingness to pay for medical insurance.

In view of the first time that this is the new rules of medical insurance payment, the industry does not know what the medical insurance payment will be reduced by the medical insurance payment.

In addition, companies that require participation in bidding should promise to supply drugs for medical institutions nationwide in the country's designated pharmaceutical institutions cannot exceed the quotation of participating bidding. And companies involved in bidding must ensure market supply, and no reasonable reasons shall not be interrupted.

Fast renewal: It is expected to enter the conventional directory

According to the interpretation of the "National Basic Medical Insurance, Work Injury Insurance, and Maternity Insurance Drug Catalogs in 2022" and related documents, the non -unique pharmaceuticals of the drug directory (the general name approved by the national drug supervision department is permitted, as of 2022 6 On the 30th, the same is the same), whether or not it expires, it is expected to be included in the conventional directory management. For such non -exclusive products, the national collection drugs determine the payment standards according to the collection policy; non -unique medicines that are not unique in national collection of drugs encourage various provincial medical insurance departments to adjust the general -purpose drugs in the province according to the price level of generic drugs Payment standards.

In 2018, the exclusive medicines that have not adjusted the payment standards and payment scope of the two consecutive agreement (4 years) have not been adjusted to the conventional directory management in 2018, and the current payment standards can be temporarily implemented. This means that the two agreement cycles (4 years) have not increased the scope of medical insurance adaptation. Products that do not have price reductions at the first renewal will enter the regular catalog of medical insurance.

This medical insurance negotiation product also includes a simple renewal model. Only the exclusive drugs, the actual expenditure of the annual fund from 2022 to 2024 has not exceeded 200%of the fund expenditure budget, the fund expenditure budget increased reasonably in the next two years, the market environment has not changed significantly (The price or treatment cost in the same treatment field is significantly high, the price of the actual sales price at home and abroad or the conversion of the medicine is significantly lower than the current payment standards, and this round of adjustment has the same type of competing products through the review, which may be compared with the price. Big influence, etc.).

The simple model is adjusted as the classification standard according to whether the payment range is adjusted, and the ratio of the fund's actual expenditure to the fund expenditure budget will be based on the actual expenditure of the fund, and the fund expenditure added value of the fund expenditure and the original payment scope of the fund expenditure and the original payment scope will be adjusted. Compared with the actual expenditure of the fund, the final payment standard is determined.

If the payment standard needs to be reduced, it also needs to be linked to the actual expenditure of the fund or the added value of the value of the fund expenditure budget at the same time: the amount reaches the highest grade when the amount is more than 4 billion yuan, and the corresponding decrease of the payment standard increases by 10 percentage points. This is the first time that the medical insurance renewal is based on gradient price reduction model, with a maximum price reduction ratio of 25%. If the negotiating drugs enter the regular catalog of medical insurance, only the actual expenditure of the fund does not exceed 10%of the fund expenditure budget can the price may not be reduced by gradient. In June 2022, the National Medical Security Bureau also announced the announcement of the "Inquiry of Data Medical Insurance Payment Data Inquiry" module during the agreement. In the area to screen and query.

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The 2022 version of the medical insurance directory adjustment has a lot of new ideas. After entering the medical insurance catalog, the fund expenditure that will bring a large increase is mainly from the medical insurance negotiation directory product. The budget management of the medical insurance negotiation directory products will be managed, which will curb the market growth of medical insurance negotiation products after entering the medical insurance.

After the medical insurance negotiations, the market has a significant growth in product renewal, and the non -exclusive product that newly enters the medical insurance by exploring the willingness to pay for medical insurance payments, which has a large pressure reduction pressure. The industry may need to think: What stage of the product is it suitable for entering medical insurance, the growth period of the product or the maturity of the product? Because the budget of the super fund expenditure affects the decline in the simple renewal of the medical insurance, the medical insurance budget is calculated by the enterprise, so the enterprises in the medical insurance negotiation directory need to have a very strong market control, especially the market evaluation of the patient flow is very accurate After all, there are more medical insurance budgets, and the price reduction pressure of that year is high; and the medical insurance budget has been reported less, then the subsequent super budget will face greater price reduction pressure in the future.

Edit: Yu Rujin

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