The local medicine is transferred out of the medical insurance directory because the medical insurance fund is not enough?National Medical Insurance Bureau response

Recently, some media released news such as "some medicines will be transferred out of local medical insurance catalogs at the end of the year", which has aroused some social attention. Why do these drugs call out the medical insurance directory? Will it affect the patient's medication? CCTV reporters interviewed the relevant person in charge of the Medical Service Management Department of the National Medical Security Bureau on related issues.

Question: In September last year, the General Office of the State Council issued the "Fourteenth Five -Year Plan" National Medical Security Plan ", which proposed that" the scope of basic medical insurance for basic medical insurance in 2022 is basically unified. "

Answer: Since the establishment of the State Medical Insurance Bureau in 2018, it has always attached great importance to the management of medical insurance and drug catalogs. The medical insurance drug directory access method has been reforming major reforms. Increase more new medicines into the scope of medical insurance.

The first is to actively use the advantages of medical insurance strategy in terms of admission negotiations. Relying on the world's most populated drug markets, integrating the national dosage to carry out price negotiations, many "sky -high drugs" talk about "civilian price", and most drugs have obtained the world's lowest price. Through access negotiations, 250 drugs have been added to the catalog in 4 years, with an average price reduction of more than 50%. The second is to establish a dynamic adjustment mechanism. The adjustment cycle has been sharply reduced from the longest eight -year in the past to one year. It has been included in 507 new medicines for 4 years, and 391 curative effects are uncertain. To 2860 species. Third, in terms of pharmaceutical structure, the shortcomings such as tumor drugs, chronic diseases, rare diseases and children's medication are gradually supplemented. The drug structure and efficacy level in the medical insurance directory are greatly optimized. promote. Fourth, focus on implementing the "dual -channel" mechanism, clarify the responsibility of medical institutions as the main body of negotiating drugs, and incorporate designated retail pharmacies into the scope of the supply guarantee guarantee of negotiating drugs, so that patients will use negotiating medicines as soon as possible, which greatly enhances the availability and nature of negotiating medicines. Essence In general, in recent years, the scope of medical insurance drug protection has expanded significantly and the level has been significantly improved, which effectively reduces the burden of medication for patients with insurance.

While steadily expanding the national medical insurance category, in response to the problems of imbalanced development of the medical insurance industry, the National Medical Insurance Bureau regards the unity and standardization of the improvement of the medical security system as a key task. The Opinions of the CPC Central Committee and the State Council on Deepening the Medical Security System issued in February 2020 clearly stated that it is necessary to gradually realize the basic unified scope of medical insurance for medical insurance. The "Government Work Report" in 2022 also included the scope of medical insurance for medical insurance for this year's work tasks. According to the requirements of the Party Central Committee and the State Council, the National Medical Security Bureau actively and stably promotes the basic unified work of the scope of medical insurance for medical insurance, comprehensively considering various factors such as the affordability of medical insurance funds, clinical and mass medication habits, and drug renewal cycle. The three -year "digestion" plan of the medicine, that is, from 2020, gradually transferred the medicines that were adjusted in accordance with regulations in the first provincial drug catalog in the first provincial drug catalog according to the proportion of 40%, 40%, and 20%in the third year of the first year. By the end of 2022, the scope of medical insurance for medical insurance will be basically unified.

At the beginning of the establishment of the basic medical insurance system, in response to the situation where the national medical insurance and drugs were small and the drug habits between regions were large, the state allowed provinces to increase some medicines by themselves in accordance with the actual situation of local economic and social development, medical needs, and medication habits. , But it cannot exceed 15%of the number of "category B drugs" of the national catalog, which is a strategy for the right of the medical insurance environment at that time. In recent years, my country's medical security business has developed rapidly, and the national medical insurance catalog has been dynamically adjusted every year. In 4 years, more than 500 new medicines and good medicines have been included in the directory, and the drug prices have been greatly reduced after negotiation. This is not the past, local supplements can basically be better replaced by the drugs in the national catalog, and it is not of great significance to continue to retain local supplements. Balance.

Therefore, the basis of the scope of medical insurance drugs is basically unified, which is an important measure to solve the problem of imbalance and inadequate problems in the field of medical security in my country. First, it is conducive to enhancing the fairness of my country's medical security system, the balance and inclusiveness of medical security treatment. Second, it is conducive to the formation of a national unified drug purchase market and better play the role of medical insurance strategy. The third is to help more new medicines and good medicines in the medical insurance directory in time to free up room and provide more quality medical security services for the general public. Fourth, it is conducive to improving the convenience of seeking medical treatment in different places, improving the medical insurance service experience, and enhancing the well -being of people's livelihood.

Q: What is the progress of the "digestion" of medical insurance supplements in various places?

Answer: As of June 30 this year, 15 provinces in the country and the Xinjiang Production and Construction Corps have completed the "digestion" task of supplementary drugs in advance, including the remaining 16 provinces, including Beijing, including Beijing. It is the end of this year. In other words, by the end of 2022, all provinces across the country will complete the "digestion" of local supplementary drugs to achieve basically uniform scope of medical insurance for medical insurance. Generally speaking, the advancement of this work is smooth and orderly, and clinical and mass medication is basically not affected.

Question: Some netizens said that "the local drugs transferred some medicines out of the medical insurance directory because the medical insurance fund was not enough." What do you think of this?

Answer: Of course not. I have answered the purpose and significance of the "digestive" drugs. Here I will introduce the general situation of the National Medical Insurance Fund. In 2021, the national basic medical insurance fund (including maternity insurance) revenue of 2.88 trillion yuan and 2.4 trillion yuan. Generally speaking, the national medical insurance fund's balance of payments is balanced, slightly balanced, the scale of income and expenditure is compatible with the level of economic development, and the fund guarantee capabilities are stable and sustainable. In fact, it is the strong guarantee of the medical insurance fund that since the establishment of the State Medical Insurance Administration in 2018, many new drugs have gradually transferred to the medical insurance directory, achieving a significant expansion of medical insurance drug guarantee and significantly improved levels. Question: Please talk about the situation of "digestion" drugs in Beijing this time.

Answer: Regarding the third batch of "digestive" drugs in Beijing, most of the media reports are objective, and some of the media have highlighted the "mixing drugs to mix the drug with ammon and ibuprofen, etc." during the reposting news, which has attracted social attention The main reason is that there are some misunderstandings. The "ammlopen" transferred from Beijing this time is actually "ammonia flat drops". Clinically to the mainstream of ammlopine is tablets or capsules. Dozens of companies are produced. The variety, the drip pills that are brought out are almost unused clinically. Data show that from September last year to June this year, the Beijing Medical Insurance Fund actually paid nearly 300 million yuan in various dosage types of ammlopine, while dripping dosage was 0. The "ibuprofen" involved is actually "ibuprofen gel". The "ibuprofen" in the existing national medical insurance and drug directory has capsules, tablets, oral fluids, particles, ointments, etc. Multi -dosage forms can fully meet the needs of clinical medication.

In general, including Beijing, including Beijing, "digestion" in various provinces across the country has supplementary drugs with lower prices and better quality alternatives in the existing national medical insurance directory, and the impact of the transfer is not great. In the next step, we will strengthen the "digestion" of drugs across the country, guide the conversion and connection of local directory and national catalogs in various places, and guide medical insurance for pharmaceutical institutions to choose better alternative medicines in the national directory to avoid causing clinical drugs. influences.

Question: In the early stage, we also noticed that the National Medical Insurance Bureau has started the adjustment of the medical insurance directory in 2022. Please talk about the characteristics of this year's catalog adjustment.

Answer: In 2022, the National Medical Insurance Drug Catalog adjustment will conscientiously implement the decision -making and deployment of the Party Central Committee and the State Council, based on the characteristics of the situation this year, adhere to the general tone of stability, stabilize the general tone, and maintain the overall stability, access conditions and workflows of varieties, access conditions and workflows. Basically, continue to optimize, improve, and improve. The main characteristics are the following four aspects:

The first is to optimize the scope of declaration. Properly tilted to special groups such as patients with rare diseases and children. Implement the "Government Work Report" requirements for "strengthening rare diseases" requirements, and do not set up the time limit for "approval of listing after January 1, 2017" for the application conditions for rare diseases. Drugs applying for children's drugs can declare this year's medical insurance directory. The second is to improve the admission method. Non -exclusive drug access determines the medical insurance payment standards at the same time by bidding, and solves the unspeakable price of universal drugs due to the high price of individual enterprises in the past. The third is to improve renewal rules. Non -exclusive medicines and exclusive drugs that have undergone two agreement periods but have no change in payment scope and payment standards are included in conventional directory management; medicines that have a small impact on the fund but have little impact on the fund this year can also be simply renewed. The above practice is conducive to stabilizing the expectations of enterprises and society. The fourth is to optimize the workflow. Based on the expert review work, it is more mature and the application data is more comprehensive. The optimization and integration of the evaluation link into a joint review of the comprehensive group and the professional group experts will make the review work more scientific and efficient.

Our goal is to adjust the work of the medical insurance and drug governance system and governance capabilities through the directory, and strive to achieve more optimization of the drug directory structure, more scientific and standardized management, more efficient payment, more fair and more fair, and help solve the people to see a doctor for medical treatment and seek medical treatment. Later worries.

This article is comprehensive from CCTV News

WeChat editor: nano

- END -