The National Medical Insurance Administration reveals the truth of high drug prices: the industry should not be constrained by public opinion

On July 5th, the official WeChat public account of the magazine of the State Medical Insurance Bureau's magazine "China Medical Insurance" published an article "Cognitive Misunderstanding of Rare Drug Price Price", mentioned:

"There is a popular point of view in the industry, that is, rare diseases should be set at high prices. There are two arguments. One is that the R & D cost of rare diseases is generally much higher than ordinary drugs. Second, the market space is small, so it is difficult to recover costs. It affected some public opinion and had potential constraints on policy formulation. "

Obviously, it is one of the important goals of this article to clear the constraints of policy formulation and eliminate some obstacles for medical insurance negotiations this year.

In 2021, the scene of medical insurance negotiations was impressive. The Nosina sodium injection of nearly 700,000 yuan/needle, after 8 rounds of price negotiation, eventually successfully negotiated at a price of 33,000 yuan, a decrease of more than 90%. After this decline was announced, it triggered industry discussion. Some companies are worried that negotiations will be too strong in the future.

Some voices may have a certain impact on national medical insurance price negotiations this year. In the 2022 medical insurance directory adjustment plan, six types of drugs such as rare diseases and children's medicines were clearly included in negotiations. At that time, the negotiation pressure of the State Medical Insurance Administration will be great.

The National Medical Insurance Bureau now does to release sounds in advance, allowing enterprises to "give up fantasy" and actively participate in price negotiations. Xiong Xianjun, the director of the former Medical Service Management Department of the State Medical Insurance Bureau, once commented: "All negotiations are based on the basis of equality and mutual respect. The pursuit of medical insurance is not the lowest price, but a reasonable price."

Marketing cost far exceeds research and development

Reveal the truth of rare diseases

PD-1, CAR-T and other innovations, high prices, and rare treatment of drugs will definitely be the focus of medical insurance price negotiations this year.

The pharmaceutical industry has always had a general saying: Innovative drug research and development has invested huge investment, especially rare diseases, with small number of patients and small market space. Pharmaceutical companies are difficult to recover costs. Therefore, innovative drugs and rare diseases should be priced at high prices.

but it is not the truth. It is clearly stated in the article "Cognitive Misunderstanding of Rare Drug Price Price" that although the overall cost of rare medical drugs such as research and development, production, and sales is high, the gross profit margin of rare diseases still exceed 80%, far exceeding the pharmaceutical industry industry, far exceeding the pharmaceutical industry industry. 16%average.

Another truth is that the high -level sales cost is the culprit that leads to high pricing of rare diseases.

Article Example: Enterprises often have knowledge and publicity of medical professionals by holding various medical lectures, expert forums, intra -hospital conferences, academic salons and other methods. The cost of medical education in the rare disease field is much higher than that cost.

According to the statistics of the article: Sanofi, Albervi, and Takeda's global marketing expenditure in 2021 were US $ 10.33 billion, US $ 12.349 billion, and US $ 6.559 billion, respectively. The marketing costs of these multinational pharmaceutical companies far exceed R & D expenses.

These three companies also have rare diseases in China to wait for medical insurance. In December 2020, the Vennakra tablets of Albervi were approved by the State Drug Administration to treat acute myeloid leukemia; Bugininib, Takeda Pharmaceutical in March 2022, was approved to be listed in China. This is a treatment ALK Positive lung cancer drugs have been certified by the American FDA.

The article pointed out that because the relevant enterprises only emphasized the high cost and rationality of the drugs in the propaganda, the ultra -high profits and huge returns that may exist in the pricing of drugs have greatly affected the public's correct pricing of rare medical drug pricing pricing for the pricing of rare medical drugs. Cognition.

In order to obtain more profits around the world, pharmaceutical companies passed to the outside world for public relations, and the real reason behind it is that related rare disease products are in a monopoly position in treatment. At the same time, European and American countries have high economic level and strong payment capacity. There are fewer patients with absolute patients. For example, there are only 1,100 patients with rare diseases in the UK. These factors are conducive to maintaining high pricing of rare diseases.

On the one hand, on the one hand, it still belongs to developing countries. In addition, at 1.4 billion population bases, a single rare patients are absolutely large, and the article calculation is at least 25 times that of the United Kingdom.

The article uses Bo Jian's price reduction last year to enter the medical insurance. Nosyasheng sodium as an example: The drug entered the directory and achieved rapid volume. From January to May 2022, the number of patients covered more than 2,000, which was more than five times before entering the directory. It has achieved good economic benefits.

The Kenji Bureau was informed that before, the National Medical Insurance Bureau had estimated that the annual fee for rare diseases was calculated at 4 times the per capita GDP computing, and it should not exceed 300,000 yuan.

Rare disease medicine into medical insurance

The price of 50 products "melee combat"

This year's medical insurance negotiations will have a soul bargain. The Jianzhi Bureau sorted out the innovative drugs approved by the listing from July 2021 to 2022, and more than 50 products met the standards for medical insurance negotiations.

Content source: Corporate Announcement, Official Information of the State Drug Administration

In June of this year, Albervi reduced 10mg and 14 -piece Vana carats from the original 4860 yuan to 3835 yuan, down 21%. A person close to Albervis revealed to the Jianzhi Bureau that this has expressed the sincerity of the company's medical insurance.

In the increasingly fierce PD-1 war, in 2022, 5 products received the "admission ticket".As the world's first PD-1 dual-resistant, if the Kadinilicabeta injection can enter the medical insurance catalog, this may directly affect the clinical use of PD-1 clinical transformation and upgrading and eliminate products of the original market.As a purchase order, the State Medical Insurance Bureau calculates the medicine to be included in the medicine to avoid the scope of medical insurance expenditure beyond the purchase.

Huang Huabo, director of the Medical Service Management Department of the State Medical Insurance Bureau, has publicly stated that the focus of medical insurance negotiations is to include drugs with high clinical value, reasonable prices, and better meet basic medical needs into the directory, so that patients will use new drugs and good medicines faster.

Writing | Lei Gong

Edit ｜ Jiang Yun Jia Ting

Operation | Valley

Illustration ｜ Visual China

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