The results of the adjustment of the 2023 National Medical Insurance Drug List have been released. A total of 126 drugs have been added to the National Medical Insurance Drug Catalogue and 1 drug has been transferred out of the catalogue. Relevant analysis pointed out that judging from the results of this year's negotiations, new drugs have occupied the main share, and some drugs that have once attracted attention have not appeared in the final medical insurance catalog, because the annual cost exceeds the bottom line of the medical insurance bureau a lot, and it is expected that these drugs will participate in the future national talks.
It is expected to reduce the burden by more than 40 billion yuan in two years.
On December 13, the National Health Insurance Administration and the Ministry of Human Resources and Social Security issued the 2023 edition of the National Medical Insurance Drug Catalog. It is reported that the National Health Insurance Administration, together with the Ministry of Human Resources and Social Security and other departments, organized the adjustment of the national basic medical insurance, work-related injury insurance and maternity insurance drug catalogue in 2023, which has been successfully concluded.
A total of 126 drugs have been added to the National Medical Insurance Drug Catalogue and 1 drug has been transferred out of the catalogue. Among the 126 new drugs, there are 21 drugs for tumors, 17 drugs for new crown and anti-infection, 15 drugs for chronic diseases such as diabetes, psychiatry, rheumatism and immunity, 15 drugs for rare diseases, and 59 drugs for other fields. After this round of adjustment, the total number of drugs in the national medical insurance drug list has reached 3,088, including 1,698 Western medicines and 1,390 Chinese patent medicinesThere are still 892 kinds of Chinese medicine decoction pieces.
At the same time, 143 drugs outside the catalogue participated in the negotiation or bidding, of which 121 drugs were successfully negotiated or bidd, with a negotiation success rate of 846%, with an average price reduction of 617%, the success rate and ** decline are basically the same as in 2022. Combined with the negotiation of price reductions and medical insurance reimbursement factors, it is expected to reduce the burden on patients by more than 40 billion yuan in the next two years.
It is understood that since the establishment of the National Health Insurance Administration, it has carried out the adjustment of the drug catalog for six consecutive years, and a total of 744 drugs have been added to the national medical insurance drug catalog, and at the same time, a number of drugs with inaccurate efficacy, clinical abuse or elimination have been transferred out of the catalog, leading to profound changes in the use of drugs.
New drugs hold the major share.
At the press conference of the National Health Insurance Administration held on December 13, Huang Xinyu, director of the Pharmaceutical Management Department of the National Health Insurance Administration, said that since the establishment of the National Health Insurance Administration, under the premise of adhering to the basics, it has vigorously supported the development of innovative drugs by including innovative drugs into the medical insurance catalog in a timely manner and supporting the acceleration of clinical application.
At the same time, according to Huang Xinyu, in 2023, 25 innovative drugs will participate in the negotiations, and 23 will be negotiated, with a success rate of 92%. The success rate is 74 percentage points, the average decline is 44 percentage points. Through negotiations, the best innovative drugs have become more reasonable, the affordability of patients has been greatly improved, and most of them have seen a sharp increase in sales and revenue.
Huang Xinyu said that in order to support innovation, relevant departments have established a dynamic adjustment mechanism for the medical insurance catalogue to adapt to the access of new drugs, and established a dynamic adjustment mechanism for the catalogue once a year, shortening the adjustment cycle from the original maximum of eight years to one year. The scope of the application mainly focuses on newly listed drugs in the past five years, and the proportion of newly listed drugs in the catalogue in the current year has increased from 32% in 2019 to 97% in 20236%。In 2023, 57 varieties will be approved and included in the catalogue in the current year, and the time from approval to entry into the catalogue of new drugs will be shortened from more than five years to more than one year now, and 80% of new drugs can enter the medical insurance drug catalogue within two years after listing.
In this regard, Zhao Heng, founder of Latitude Health, a medical strategy consulting company, told Beijing Business Daily that from the results of this year's negotiations, new drugs have occupied the main share, indicating that with the normalization of the frequency of medical insurance negotiations, the cycle of new drugs from listing to entering medical insurance has been greatly shortened.
Guarantee ** Guarantee Expectations.
The relevant statistics of the Chinese Pharmaceutical Association show that since 2018, the proportion of medical insurance drugs in the use of drugs in medical institutions has increased year by year, the dominant position has been further consolidated, and the rationality of clinical drug use has been actively improved. At the same time, the speed of innovative drugs entering the medical insurance has been significantly accelerated, the level of commonly used drugs has decreased significantly, and the level of drug protection for major diseases and special groups has been greatly improved, significantly reducing the drug burden of the masses.
At the same time, according to Huang Xinyu, the relevant departments have improved the rules for the negotiation and renewal of innovative drugs, appropriately controlled the number and decline of price reduction drugs for renewal and new indications, and gave new drug companies a stable expectation, "According to the renewal rules adjusted this year, among the 100 renewal drugs this year, 70% of the drugs were renewed at the original price, and 31 needed to be reduced because the sales exceeded expectations, and the average decline was only 6."7%。At the same time, 18 of the 100 renewed drugs have added new indications, only one has triggered the price reduction mechanism, and the others have not triggered the price reduction mechanism, and the original price has increased the indication."
Relevant data show that from 2015 to 2022, 80% of the top 20 drugs in the national clinical drug amount have changed, and the most advanced new drugs have replaced some of the original drugs with less accurate efficacy and higher efficacy, and the majority of insured people have used drugs with better effect, better quality and more suitable quality.
It is worth noting that Zhao Heng observed that some drugs that once attracted attention failed to appear in the final medical insurance catalog due to ** problems. "About CAR-T and ADC drug DS8201 trastuzumab for injection do not appear in the new version of the medical insurance catalog, in fact, this result is not surprising, the annual cost of these drugs are much more than the bottom line of the medical insurance bureau, if you don't hit the 'fracture', of course, the medical insurance catalog can only say 'no' to them. Zhao Heng said, "However, I think these first-class drugs that have failed in negotiations will still participate in the national negotiations in the future, although they can only be sold through commercial insurance and out-of-hospital markets now, but the posture still needs to be sufficient." If the sales volume is not ideal, then it will be even more necessary to enter the medical insurance, and the ** of innovative drugs will definitely decline year by year. ”
Beijing Business Daily reporter Fang Binnan Ran Lili.