The dynamic adjustment of the medical insurance catalogue has received much attention from the industry. The National Medical and Health Insurance Bureau ("National Medical Insurance Bureau") issued the "2019 National Medical Insurance Drug Catalogue Adjustment Work Plan (Draft for Comment)" issued on the evening of March 13, saying that a new version of the drug list will be issued in June 2019, and the proposed negotiation will be announced. List of drugs; in August, the National Health Insurance Bureau issued a document to include drugs with successful price negotiations in the drug list.
A number of interviewees told China Securities Journal that the medical insurance catalogue was adjusted to improve medical insurance.fundThe use efficiency is the core, and the clinical value is highlighted on the basis of the fund's affordability. Therefore, companies with strong R&D capabilities and good clinical results will benefit, and adjuvant drugs with unclear clinical efficacy may face a crisis.
Optimize drug structure
Compared with the last draft (2016), this time it puts more emphasis on “improving the structure of medicines” and “higher efficiency in the use of medical insurance funds” and including the Chinese medicine decoction pieces. "Either the policy of medical insurance catalog adjustment or quantity procurement is essentially to guide the price of medicines back to a reasonable range through the force of 'medical insurance' in the largest payment of medical expenses." A pharmaceutical company said that medical insurance is being The original passive “payer” changed to the active “strategic purchaser” to give full play to the guiding role of “medical insurance” in the “three medical linkages”.
According to the above “Opinion Draft”, the drug list adjustment involves three aspects of western medicine, Chinese patent medicine and Chinese medicine decoction, including two items: drug transfer and drug transfer. Based on the drug information approved by the State Food and Drug Administration for listing, enterprises are not accepted for reporting or recommendation, and no evaluation fees and other various fees are charged.
At the same time, the western medicine and Chinese patent medicine to be transferred should be the medicines registered and listed by the State Drug Administration before December 31, 2018 (inclusive). Priority is given to the treatment of major diseases such as national essential drugs, cancer and rare diseases, chronic diseases, children's drugs, and emergency rescue drugs. According to the field of drug treatment, pharmacological effects, functional indications, etc., organize experts to review by category.
The transfer is divided into two types: regular access and negotiation access. Under the premise of satisfying the validity and safety, the price (expense) is equivalent to or lower than the existing varieties in the drug list, and can be included in the catalogue by routine means. Patent exclusive drugs that have a higher price or have a greater impact on the health care fund should be negotiated.
The drug catalogue adjustment will involve four groups of experts, including about 300 consultants, about 2,000 selection experts, about 30 people, and experts from the National Health Insurance Agency, local health insurance representatives and related experts. Expert group.
Guojin Securities pointed out that since the publication of the National Health Insurance Drug List in 2000, it has been updated irregularly in 2004, 2009 and 2017, and the interval is longer, which is not conducive to the timely inclusion of new drugs and good drugs in the scope of reimbursement. The development of new batch varieties. The medical insurance catalogue should be updated in principle in two years, and dynamic adjustments will be started in 2019.
A pharmaceutical company told China Securities Journal that medical insurance is the largest payment for medical expenses. The types of medical insurance can reduce the burden on patients, and on the other hand, they have great advantages in bidding, hospital access and marketing.
Innovative drugs or benefits
OneBrokerPharmaceutical industryAnalystThe China Securities Journal reporter said that the dynamic adjustment of the medical insurance catalogue has far-reaching significance. On the one hand, medical insurance adjustments are aligned with developed countries and regions to improve access to medicines. The medical insurance for several years will become the past tense, and the future adjustment of medical insurance will be more regular. It is expected to form a two-year-one-adjusted, one-year-old medical insurance form, which is in line with the medical insurance catalogue adjustment in developed countries such as Europe, America and Japan. The accessibility of medicines is higher and the coverage is wider; on the other hand, it stimulates the enthusiasm of pharmaceutical companies for the research and development of patented drugs. In the past, the medical insurance adjustment cycle was long, and the new drugs were slow after the market. The dynamic adjustment of the medical insurance catalogue can incorporate new special medicines in time to promote the sales of products during the patent period.
The analyst believes that the varieties that may be included in this edition include 18 varieties of basic medicines that are not covered by Chinese medicine insurance (8 kinds of western medicines, 3 kinds of traditional Chinese medicines), and 1 new types of medicines approved in 2017-2018 (11 types): treatment scope The invention relates to tumors (PD-1 such as salibizumab and treprilumab, small molecules such as pyrrolidine and furazolinib, albumin paclitaxel, etc.), antiviral drugs, diabetes drugs and the like. Among them, low-cost drugs are expected to enter medical insurance directly, and high-priced drugs (PD-1, etc.) will enter the medical insurance through negotiation. Listed companies include Hengrui Medicine, Cinda Bio, Ge Li Pharmaceutical, Junshi Bio, Shijiazhuang Group, Sansheng Pharmaceutical. “Entering medical insurance can greatly improve the accessibility of medicines and have a positive impact on company profits.”
Shen Wanhongyuan believes that from the adjustment of the medical insurance catalogue in 2017 and 2018, most of them have realized the price change, whether directly or through negotiations. The adjustment of the medical insurance catalogue is the highlight of the work of the Medical Insurance Bureau in 2019. It is necessary to pay close attention to the impact on the relevant companies that it is expected to transfer/recall the variety and follow-up medical insurance payments.
(Article source: China Securities Journal)