Adjustment of the list of medical insurance drugs
It is about every insured person
July 1
This year's adjustment of the medical insurance drug list
Officially launched
Eligible pharmaceutical companies
You can start submitting your application materials
Which drugs are expected to be included in the list? What are the key points of this year's adjustment of the medical insurance drug list? The "answer" can be found in the "2024 Work Plan for the Adjustment of the Drug List of National Basic Medical Insurance, Work-related Injury Insurance and Maternity Insurance".
Accept new drugs and reduce drug prices
More new and good drugs are expected to enter the medical insurance
The work plan is clear, and the five categories of drugs outside the catalogue can apply to participate in the adjustment of the medical insurance catalogue in 2024, including drugs for children, drugs for rare diseases, drugs with major changes in indications or functional indications, etc.
This year's application conditions have also been slightly adjusted, and the time requirements for drug approval and modification of indications have been extended according to the rules, and drugs that have been approved for marketing or modified indications after January 1, 2019 can be declared. This means that more new drugs will be included in the National Reimbursement Drug List.
After the previous six rounds of adjustments, a total of 744 new drugs have been added to the National Medical Insurance Drug Catalogue, including 446 new drugs through negotiation, most of which are newly launched in recent years and have high clinical value, covering 31 therapeutic areas in the catalogue.
At present, the access method of the medical insurance drug list is the enterprise declaration system, and the application scope mainly focuses on the newly listed drugs within 5 years. Under this influence, the proportion of newly marketed drugs in the current year has increased from 32% in 2019 to 97.6% in 2023. Taking 2023 as an example, a total of 57 varieties will be "approved in the same year and included in the catalogue in the same year".
In addition to the application process, the follow-up review, calculation, negotiation and other processes also give "tilt" to innovative drugs. For example, in the review and calculation process, innovation is taken as an important indicator to enhance the competitive advantage of innovative drugs.
Adjust the "old medicine" and make space
Guide the drug catalogue to "upgrade the file"
After several adjustments, the National Medical Insurance Drug Catalogue has transferred a total of 395 drugs with uncertain efficacy, easy abuse, clinical elimination or about to be withdrawn.
This year's work plan clarifies the scope of the transferred varieties, and the conventional catalogue drugs that have not been supplied to the designated medical institutions of medical insurance in the past three years, as well as the negotiated drugs that have not guaranteed the market supply as agreed in the agreement, are listed as key considerations to help strengthen the management of supply security.
"Spit out the old and accept the new", more new drugs and good drugs will be included in the medical insurance drug list.
More scientific and standardized
The adjustment of the drug list will be more open and transparent
This year's work plan further strengthens the supervision and management of experts, clarifies the rules and selection criteria for expert participation, strengthens the professional training and guidance of participating experts, and improves the scientific and standardized nature of evaluation and calculation.
According to reports, in recent years, the expert review rules have stabilized, mainly in the form of expert discussion and personal scoring at the same time, and strive to convey the stable expectations of the enterprise.
This year, August and September will be the expert review stage. According to the application of the enterprise, experts in pharmacy, clinical, pharmacoeconomics, medical insurance management, etc. will jointly review and form a list of drug recommendations to be directly transferred, negotiated or tendered, and directly transferred, and at the same time, the specifications of the drugs to be negotiated or tendered, and the scope of medical insurance payment will be demonstrated.
In the negotiation session, medical insurance negotiators will conduct "face-to-face" negotiations with pharmaceutical companies on drug payment standards in groups, and decide whether drugs can be included in medical insurance and at what price according to the negotiation results.
By the end of 2023, about 1.334 billion people will be enrolled in basic medical insurance in mainland China. Rounds of adjustments to the medical insurance drug list are effectively helping the insured to use more good drugs and reduce the burden of medical expenses.
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Edit | Yao Taosheng
Proofreading | Li Xia, Wei Ding, Wang Jianjiao, Huang Ruijiao
Proofreading | Lan permanently
Executive Producer | Yu Zhiguo
Source of information | Xinhua