Let patients use good medicines faster this year’s national medical insurance catalog adjustment work plan is officially announced

Today (29th), the State Medical Insurance Bureau announced the "National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug Catalog Adjustment Work Plan" in 2023. This is the medical insurance drug directory adjustment work since its establishment.Why adjust the national medical insurance catalog? What real benefits can the people bring? How fast is the speed of innovative drugs from approval to incorporated medical insurance?

This year’s catalog adjustment work plan is officially announced

The adjustment scope of the drug directory in 2023 is from January 1, 2018 to June 30, 2023, and the new general -purpose drugs listed on the market approved by the State Drug Administration Department have changed significantly.The medicines for the certification documents of the drug, and the medicines incorporated into the "National Basic Drug Catalog (2018 Edition)".Among them, for drugs incorporated into the "Encouraging Improved Drug Catalog", a drug that is included in the "Encouraging R & D and Application for Children’s Drugs", and rare disease treatment drugs, there is no restriction on the approval time.

Ding Jinxi, Executive Deputy Dean and Professor of the Graduate School of China Pharmaceutical University: When doing clinical trials, there are very few patients with rare diseases, and children are the same.Then after it is listed, its cost recovery is also slow. One is that it is difficult to develop and the other is sales difficulty, so we have some tilt policies in medical insurance access.

In addition, this year’s directory adjustment work plan no longer uses the new crown medicine as a drug application condition, but instead declares in accordance with the type of general innovative drugs.According to the "Work Plan", the company will officially open the declaration from July.For drugs that have passed formalities, the State Medical Insurance Administration will organize and conduct joint review by experts in pharmacy, clinical, pharmaceutical economics, medical insurance management, and work injury insurance management.After review, 4 categories of results are formed to directly transfer, intend to negotiate or bidd in, to be directly transferred, and to be handled by renewal rules.After the relevant drugs are expected to be negotiated or bidded on the spot, the final directory adjustment results will be announced in November this year.

New medicine is quickly included in medical insurance to meet the needs of clinical medication

In the adjustment of the National Medical Insurance Catalog in 2022, 108 new negotiations and bidding drugs were added. There were 105 new drugs listed in the past 5 years. A considerable number of medicines were approved and included in the medical insurance directory that year.In the past five years, 70 major drug creation special drugs participating in the negotiations have successful in 66 negotiations, and the success rate has reached 94%, which quickly achieves clinical applications.

Medical insurance has greatly increased new drug expenditures to guide enterprises to pay attention to research and development

By establishing a medical insurance access and renewal mechanism for the new drug as the main body, the waiting time for new drugs to be included in the medical insurance directory has been shortened from the average of nearly 5 years to less than 2 years in the past.The expenditure of medical insurance for new drugs increased from 5.949 billion yuan in 2019 to 48.189 billion yuan in 2022, an increase of 7.1 times.The company’s initial research and development investment was reasonable, and the enthusiasm of innovation was greatly improved.

Ding Jinxi, Executive Deputy Dean and Professor of the Graduate School of China Pharmaceutical University: Usually a three -level hospital, there are only about 1,500 kinds of product rules, so when the newly listed products enter the hospital, the hospital will hold a pharmacy management committee.It studied this medicine unsuitable admission to the hospital.Then when it is judging whether this medicine can enter the hospital, one of the very important criteria is to see if it is in medical insurance.The efficacy, quality, and economy of admission to the medical protection have been demonstrated and guaranteed.After the second medical insurance negotiation, the price first dropped a lot, and the price dropped, and a large part of the country was reimbursed. That is to say, the patient’s own paid by himself was very small. Of course, he was willing to buy it.Opening, the company is still very willing to participate in negotiations and enter medical insurance.

Hospital pharmacy "dual channel" equipped with negotiating medicines

"Dual channels" refer to the mechanism of meeting the reasonable needs of negotiating drug supply and clinical use through two channels: two channels of designated medical institutions and fixed -point retail pharmacies, and simultaneously incorporated into the medical insurance payment mechanism.As of the end of December 2022, 209,000 designated hospitals and pharmacies across the country have been equipped with directory negotiating drugs. It is more convenient for patients to buy negotiating drugs.

The medical insurance and drug directory adjustment to the patient’s burden reduction exceeds 500 billion yuan

It is understood that the category of medical insurance and drugs is continuously optimized, and the level of drug guarantee for the masses has been significantly improved. On the whole, the number of drugs in the directory has increased significantly, and the scope of protection has continued to expand.Among the top 20 varieties of medical institutions, there are few auxiliary drugs that have uncertain effects and easy to abuse, and they are replaced by therapeutic drugs for major diseases and chronic diseases.Especially in recent years, medical insurance negotiations have promoted a large number of exclusive varieties of anti -cancer drugs and rare medical drugs to include medical insurance in a suitable price. The catalog adjustment for five consecutive years, and the medical insurance reimbursement of the drugs is superimposed.

Source: CCTV News Client

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