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Provincial Supplementary Medical Insurance Directory is transferred by 40%, 20%, 20% within three ye

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On September 27th, the latest news came from the industry. The National Medical Insurance Bureau held medical service management training in Wuhan on September 26-27. The training mainly explained the medical insurance drug list policy and made requirements for implementation. In addition, it also standardized and discussed DRG, medical insurance code, and payment standards for two-medicine drugs.

Provincial supplementary medical insurance drugs were transferred within 3 years, according to 40%, 20%, 20%

At the meeting on the morning of September 26, the adjustment method for the province's supplementary medical insurance drug list was reported:

The catalogue of local additions was completed in three years according to the principle of 442, and was carried out according to 40%, 40%, and 20% of the supplementary amount of each province.

Monitor the auxiliary medicines and move them out of the catalog first.

According to the notice of the National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug List published by the National Medical Insurance Bureau on August 20 this year (Medical Insurance issued [2019] No. 46) document:

Clear local authority, all localities should strictly implement the "Drug Catalogue", do not set up their own catalogues or use alternative methods to increase the number of drugs in the catalog, nor adjust the scope of payment of drugs in the catalogue. For Class B drugs that have been increased in accordance with the regulations in the original provincial drug list, they should be gradually digested within 3 years. In the process of digestion, the provinces should prioritize the adjustment of the scope of payment for drugs that are included in the national key monitoring scope.

The way in which the Provincial Supplementary Drug List 442 was transferred was based on the spirit of the above documents.

Before the provincial level has 15% adjustment authority, about 200-300 provincial supplements

The medical insurance issued [2019] No. 46 document issued, once the industry atmosphere was tense. The medical insurance drug list has been implemented in five versions, namely the 2000 version, the 2004 version, the 2009 version, the 2017 version, and the newly released 2019 version. After the previous three national catalog adjustments, 15% of the adjustment space will be given to the provinces. After some drugs fail to enter the national version of the catalog, there is also the possibility of entering the province's supplementary catalogue.

However, with the 2019 version of the catalogue adjustment and the medical insurance issued [2019] No. 46, the conventional medicines not only lost the opportunity of supplementing the provinces, but also were transferred from the provincial supplement catalogue within three years. In particular, the 20 drugs that entered the key monitoring list announced by the National Health and Health Commission, in addition to being transferred to the new catalogue (8), will be “prioritized” in the next three years.

The Wuhan meeting called for a three-year rhythm of 40%, 40%, and 20% of the province's supplementary numbers, which clarified the future fate of this type of medicine. Therefore, in the following period, the provinces added 200-300. Drugs will be entered one by one into the recalled list.

Three types of varieties will become high-risk varieties that have been adjusted out

So, which varieties are likely to enter the list that is called out?

First of all, it is to focus on monitoring drugs. Excluding the 8 varieties that have been transferred from the national version, the remaining 12 are “delimited” in the provincial supplement. The provinces are also gradually introducing their own key monitoring catalogues, so it is very likely that they will be “prioritized” to enter the provincial key monitoring catalogues and even the municipal-level catalogues. (Specific provinces' key monitoring catalogues can be sent in the WeChat dialog box with the words “Key Monitoring”, which can be received in the monitoring catalogue for 6 years.)

Secondly, the varieties with large purchase volume and high purchase amount will be transferred to the medical insurance catalogue with great probability. Chinese medicine injections and non-therapeutic nutritional drugs with large sales volume are among the first. In fact, this type of variety will also appear in the second batch of key monitoring and rational drug use lists of the National Health Care Commission. In addition, some varieties seem to have little sales in the country, and there is no obvious water, but in some provinces, sales are not small, and even the national market sales of certain drugs are mainly supported by these individual provinces.

Furthermore, clinically over-indications are used or susceptible to abuse, approvals are revoked, and there are better alternatives. In addition to the above two drugs of the same nature (speaking is more money), the varieties that are clinically used or susceptible to abuse are also high-risk groups, not only through the clinical path, but also the medical insurance payment party to control. According to the 28th rule, the above two types of varieties are not too many in number, and they account for a small proportion of the two or three kinds of provincial supplements, but the sales amount accounts for a large proportion. These drugs have been messed up, and the remaining quotas will be reserved for batches, quality, and production problems. This idea is in fact consistent with the National Health Insurance Bureau's adjustment of the catalogue. In this year's 2019 edition, 150 kinds of books were transferred, of which about half were drugs that were revoked by the State Drug Administration, and the rest were mainly drugs with low clinical value, obvious abuse, and better substitution.

Structural adjustment will become the main new normal in the next three years

Not only in the medical insurance directory, the provincial supplement catalogue will be transferred one after another, and there is also a very obvious structural adjustment in the governance level of the entire pharmaceutical industry.

The first review, the same variety must be completed in 3 years.

In the management of the approval of the stock of drugs, the work of conformity evaluation of generic drugs has been speeding up. According to the announcement of the State Drug Administration on the evaluation of the quality and efficacy of generic drugs (No. 102, 2018), the time is subject to quality. Rationally adjust the relevant work time limits and requirements, and stipulate the generic drugs containing the basic drug varieties approved before the implementation of the new chemical registration classification. After the first variety has passed the consistency evaluation, the same varieties of other pharmaceutical manufacturers should Completion of the consistency assessment within 3 years.

4+7 collection and expansion of the procurement funds will provide drug protection for basic drugs, innovative drugs and clinically urgently needed drugs.

At the level of drug procurement, the country is currently carrying out 4+7 purchases and expansions. The 25 varieties are compared with the prices at the end of 2018. The average price of medicines is reduced by 59%, and the total purchase amount is 3.369 billion yuan. In addition to raising the price of medical services and improving the salaries of medical staff, it will make room for other medicines, such as basic medicines, innovative medicines, and drugs that are urgently needed but expensive, which is the use of procurement methods to achieve the use of medicines. bird.

Clinical use of drugs to strengthen the clinical pathway, implementation of key monitoring + Chinese patent medicine limit management.

In the field of clinical drug use, the health and health department has strengthened the implementation of clinical pathways, and implemented key monitoring and management of drugs that are easily abused. On this basis, it is extended that Western medicine can not issue Chinese patent medicines without systematically learning Chinese medicine. . This will greatly limit the use of certain drugs. In addition, medical insurance payment reform and catalogue adjustment will lay the foundation for more rational and efficient use of limited medical insurance funds in the field of medical insurance. Future medical insurance will continue to strengthen the dynamic management of records, intelligent monitoring of medical insurance and payment management.

It is foreseeable that the next three years will be the last three years of difficult transformation of the industry. After three years of expiration, the window will be ruthlessly closed, which will have a major impact on enterprises and personnel in the pharmaceutical industry. I hope we can see the situation, re-adjust our mentality and positioning, and meet the key challenges in three years!