Guiding “sky-high priced drugs” to be prescribed at “popular prices”, the latest adjustments to the medical insurance catalogue!

Nusinersen Sodium Injection, a well-known "sky-high-priced drug" that costs 700,000 yuan per injection, has been included in the new medical insurance catalog after a significant price reduction after negotiations; Daratumumab Injection, whose annual treatment cost exceeds 1 million yuan, has been reduced to less than 300,000 yuan after negotiations and has also been included in the new medical insurance catalog; ...

On December 3, the National Healthcare Security Administration announced the results of the adjustment of the national medical insurance drug catalog in 2021. Shi Yuankai, deputy director of the Cancer Hospital of the Chinese Academy of Medical Sciences, interpreted the adjustment catalog one by one. He said that through negotiations to guide these "sky-high-priced drugs" to reduce their own prices, coupled with medical insurance reimbursement, the treatment cost burden of patients will be reduced a lot.

Source: National Health Insurance Administration

"The expensive cost of drugs not only brings a heavy burden to the people, but also poses risks to the security of the fund." Zheng Jie, head of the 2021 National Medical Insurance Negotiation Drug Fund Estimation Expert Group, said that through strict access to drugs outside the catalogue and guiding reasonable price reductions of drugs, the saved funds can be used to purchase more cost-effective drugs and achieve a higher level of "basic protection."

To reduce drug costs, centralized procurement and catalogue access are a negotiation "combination punch"

A reporter from Science and Technology Daily learned from the National Medical Insurance Administration that the total number of drugs in the 2021 National Medical Insurance Drug List is 2,860, including 1,486 Western medicines and 1,374 Chinese patent medicines. There are still 892 Chinese herbal medicine pieces. This adjustment has gone through the stages of initiation, application, review, and negotiation. After expert review, 74 new drugs have been included in the medical insurance drug list, and 11 drugs have been removed from the list.

In terms of guiding drug price reductions, through measures such as guiding moderate drug competition and exchanging volume for price, 67 new exclusive drugs outside the catalogue were reduced in price after negotiations, with a drop of 61.71%; 27 drugs in the catalogue were also successfully negotiated and their prices were reduced.

"Some people think that negotiation is about bargaining, the lower the better. This is a distortion. Fund calculation does not pursue the lowest price, but a reasonable price." Zheng Jie said that to calculate the price of specific drugs, it is necessary to comprehensively consider reasonable drug demand, clinical value of drugs, degree of innovation, market competition and other factors, and conduct a comprehensive and multi-angle scientific evaluation of drugs based on evidence-based evidence.

It is reported that since its establishment, the National Medical Insurance Administration has conducted four national medical insurance drug negotiations, and a standardized and normalized model has been established for fund calculation. In order to continuously improve the medical insurance level of the people on the basis of fund sustainability, the National Medical Insurance Administration has reduced the burden of drug costs through measures such as volume-based procurement and catalog access negotiations.

Change the cage and replace the bird, and promptly include new and good drugs in the catalog

According to reports, in the four years since the adjustment of the national medical insurance drug catalog, a total of 507 drugs have been added to the national medical insurance payment scope, and a number of "miracle drugs" and "zombie drugs" have been removed from the catalog. In this year's catalog adjustment, 11 drugs in the original catalog with low clinical value, strong substitutability, and small purchase volume on the national procurement platform in recent years were removed from the catalog.

By guiding moderate competition among drugs and exchanging quantity for price, some drugs in the catalogue were reduced in price again, freeing up fund space for purchasing more cost-effective drugs, and successfully achieving an upgrade in drug security.

The 74 newly added varieties precisely fill the drug needs for tumors, chronic diseases, anti-infections, rare diseases, women and children, etc., involving a total of 21 clinical groups.

"A large number of newly launched drugs have been included in the medical insurance. For example, many of the 18 cancer drugs are drugs with new targets and new mechanisms. Their previous high prices put them out of reach for many patients," Shi Yuankai explained.

For example, the domestically produced new drug vometinib for the treatment of lung cancer was just approved for marketing in March this year. It is a third-generation epidermal growth factor receptor tyrosine kinase inhibitor drug used for patients with gene-sensitive mutations caused by first-generation drugs. Its inclusion in the medical insurance catalogue gives lung cancer patients more choices while reducing their burden. Abemaciclib tablets are the first cyclin-dependent kinase 4/6 inhibitor drugs included in the national medical insurance catalogue. By evaluating the clinical value, patient benefits, and degree of innovation of this new mechanism drug, it will be included in medical insurance, allowing more breast cancer patients to afford good and new drugs and achieve a higher quality of life through persistent treatment.

Say no to "sky-high drug prices"

According to statistics, since 2018, Beijing’s medical insurance fund has paid about 4 billion yuan for national negotiated drugs, bringing huge benefits to the people.

"But since we are still a developing country, the level of medical insurance fund raising and the guarantee capacity are still very limited. As far as I know, according to the limited payment scope, the annual treatment costs of all drugs in the current national medical insurance catalogue do not exceed 300,000 yuan." Zheng Jie said that in future catalogue adjustments, the National Medical Insurance Administration will continue to prevent sky-high priced drugs from entering medical insurance.

For example, a miracle anti-cancer drug that was hotly discussed in the media some time ago and costs 1.2 million yuan per injection failed to pass the review due to its lack of economic feasibility, as it far exceeded the fund's affordability and the affordability of ordinary people, and ultimately did not qualify for negotiations.

"The primary working principle of the catalogue adjustment work is 'basic protection'," Zheng Jie stressed that making full use of limited funds to better meet the people's growing medical and health needs has put forward higher requirements for medical insurance work.

74 new drugs added to the national medical insurance catalog

After the adjustment, the total number of drugs in the national medical insurance drug list is 2,860, including 1,486 Western medicines and 1,374 Chinese patent medicines. The number of Chinese herbal medicine pieces remains at 892. During the adjustment, the National Healthcare Security Administration has always adhered to the functional positioning of "basic protection", taking the affordability of the fund as the "bottom line" that must be adhered to, and focusing on meeting the basic drug needs of the majority of insured persons.

◎ Science and Technology Daily reporter Zhang Jiaxing

Source: Science and Technology Daily, National Healthcare Security Administration, CCTV News Client

Editor: Zhang Qiqi

Review: Yue Liang

Final review: Liu Haiying