In recent years, the national medical insurance has clearly put forward the policy idea of "dynamic adjustment ", and plans to update the medical insurance drug catalogue every year to leave enough room for the development of innovative drugs.
On September 18, the National Medical Insurance Bureau issued the "2020 National Medical Insurance Drug catalogue Adjustment through the form of examination of the list of declared drugs "171 drugs were approved for listing between January 1,2015 and August 17,2020.
Because of the great influence of medical insurance access and reimbursement on the pharmaceutical market, every adjustment of medical insurance policy has become a hot issue of concern to the whole industry.
On the one hand, the use of innovative drugs can reduce indirect expenditure related to disease, reduce the economic burden of patients and society, and bring social value. But at the same time, whether innovative drugs should be included in health insurance only low price theory, new product innovation value geometry, the same category of products into the directory, whether the hospital needs to purchase and other specific operational issues remain to be discussed.
Thanks to the reform of the domestic drug review and approval system, the speed of approval of domestic innovative drugs has been obviously accelerated in recent years, but whether the medical insurance can bear the burden behind the examination and approval, and whether the innovation of innovative drugs can bring additional health benefits to patients. Become the whole industry to face the problem.
Hu Shanlian, a professor of health economics at the School of Public Health of Fudan University, said at the Fifth China Pharmaceutical Innovation and Investment Conference that in recent years, China has accelerated its drug listing review and more new drugs have been listed. There is great pressure on health care, which needs to consider how so many innovative drugs can benefit more people. The medical insurance pricing of drugs, on the one hand, needs to consider leaving profit space for enterprises and the supply of subsequent R & D capabilities, but also to consider the economic affordability of patients.
<unk1> "Germany's recent assessment of the additional health benefits of innovative drugs that have come in through the Federal Joint Commission over the past two years has led to the discovery that 50 per cent of drugs do not generate additional health benefits, warning the world of the need to continuously observe the innovative value of drugs. If health care costs more than 1000 yuan a year and does not bring additional health benefits to patients, such as prolonging total life span and improving quality of life, the cost is meaningless. On the contrary, the cost of spending 10,000 yuan more to reintegrate the person into society and have a higher quality of life is worth the money ." Zhao Kun, deputy director of the National Health Commission's Drug and Health Technology Evaluation Center, said at the meeting.
It believes that innovative drugs need to break through, fill in clinical gaps and meet clinical needs, otherwise it is difficult to be regarded as innovative value.
Zhao Zhigang, director of the pharmacy department of Beijing Temple of Heaven Hospital, said at the meeting that innovative drugs need to judge whether they are true or false ." Drug innovation costs not only the enterprise's own resources, but also the resources of evaluation and health insurance. It is necessary to assess whether such innovation is worth it ."
After the approval of innovative drugs, it is generally difficult to be admitted to hospital. The proportion of drugs in hospital, the limit of hospitalization expenses and the limit of outpatient expenses have become the difficulties for innovative drugs to enter the hospital. Why should hospitals introduce drugs in the context of zero-difference rates? The hospital has no motivation ." Chen Hao, director of the Center for Drug Policy and Management Research, Tongji Medical College, Huazhong University of Science and Technology, said.
Fan Lin, senior director of Hengrui's medical and public affairs department, said at the meeting that, taking Hengrui's PD-1 inhibitor, Carrellizumab, for example, its approval time missed the 2019 health care catalogue adjustment time limit, so that as of last month, the country's top 500 hospitals, Access rate was only 8.8. "For innovative drugs, access to the health care catalogue will certainly help it accelerate access to health care institutions ."
But at the same time, the hospital also faces, in recent years, the same target innovative drug blowout, the same target, the same mechanism of innovative drugs into the hospital procurement link, obviously unrealistic. "There are now six PD-1 inhibitors and two PD-L1 inhibitors in the country, are hospitals to introduce ?" Zhao Zhigang asked at the meeting.
In 2020, a number of societies, including the Committee of Experts on Drugs and Health Products of the Center for Health China Research and the Professional Committee on Therapeutic Drug Monitoring and Research of the Chinese Society of Pharmacology, jointly developed the Rapid Guide for Drug Evaluation and Selection in Chinese Medical Institutions, according to which hospitals can rate drugs, which can be judged in terms of drug characteristics, efficacy, safety and accuracy. "Hospitals can use the guidelines to score drugs, we recommend 60-70 between hospitals have alternative varieties of drugs do not introduce ,60 points below the recommendations do not introduce ." Zhao Zhigang believes that the score also reflects the value and innovation of drugs.
In addition, under the background of basic medical insurance in China, a large number of innovative drugs want to solve the problem of admission and reimbursement of drugs in hospitals through medical insurance negotiation. At present, many places in China have begun to explore the establishment of multi-system inclusive health insurance, such as Zhuhai's "Great Love boundless ", Foshan's" Ping an Buddha "and so on, and this is also a direction of future innovative drug reimbursement.
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