After 168 negotiations and bidding for 4 days, 126 new drugs entered the medical insurance, involving rare diseases, anti-tumors, chronic diseases and other fields. What are the highlights of the new version of the National Medical Insurance Drug Catalog?What will be the impact on people's medication?"Xinhua Viewpoint" reporters interviewed relevant experts.
On November 20, the negotiation site of the 2023 National Medical Insurance Drug List. Photo by Xinhua News Agency reporter Peng Yunjia.
126 kinds of drugs are covered by medical insurance, involving many fields.
This is another comprehensive upgrade of the "medicine basket" of more than 1.3 billion insured people - 126 new drugs have entered the medical insurance, including 21 drugs for tumors, 17 drugs for new crown and anti-infectives, 15 drugs for chronic diseases such as diabetes and mental illness, and 15 drugs for rare diseasesAt the same time, 1 drug that is about to be withdrawn from the market will be withdrawn.
Huang Xinyu, director of the Department of Pharmaceutical Service Management of the National Health Insurance Administration, introduced at the press conference on the 13th that after the adjustment, the total number of drugs in the catalog will increase to 3,088, including 1,698 Western medicines and 1,390 Chinese patent medicines.
The adjustment added 15 new drugs for rare diseases out of the catalog, covering 16 rare diseases, filling the gap in drug protection for 10 diseases, such as eglastat tartrate for adult patients with type I Gaucher disease, and stuxuximab for Kastel disease.
Monogenic inherited diseases are diseases caused by abnormal function due to mutations in a single gene, accounting for 80% of rare diseases. Qiu Zhengqing, an expert in rare disease research and chief physician of Beijing *** pediatrics, said that spinal muscular atrophy (SMA) and Gaucher disease are all monogenic genetic diseases, and it is of great significance for patients to include the drugs for these diseases in medical insurance in a timely manner.
In addition, eculizumab, which can be used for three rare diseases: paroxysmal nocturnal hemoglobinuria (PNH), atypical hemolytic uremic syndrome, and refractory generalized myasthenia gravis, has also been successfully entered into the medical insurance.
PNH is a rare acquired haemolytic disease. Fu Rong, vice president of Tianjin Medical University General Hospital and director of the Blood Disease Center, said that compared with the limitations of traditional **, eculizumab has successfully entered the medical insurance, which can enable more patients to obtain effective ** and reduce the burden of patients.
Being able to enter the medical insurance means that more patients with rare diseases have hope of using drugs. "One of the leaders of the negotiation team of the medical insurance party who participated in the negotiation.
1. Jin Mei, deputy director of the Yunnan Provincial Medical Insurance Bureau, said that the value and cost of drugs for rare diseases are relatively high, and it is within the affordable range of medical insurance, and every effort should be made to include them in medical insurance.
In terms of anti-tumor drugs, the new version of the National Medical Insurance Drug List has added aclotinib for mantle cell lymphoma;For breast cancer, rebociclib, succinate, etc. Zhu Jun, Secretary of the Party Committee of Peking University Cancer Hospital and Chief Physician of the Department of Lymphomology, said that the new drugs can help patients more easily accept and adhere to long-term medical insurance, and medical insurance is also conducive to reducing the financial burden of patients.
A number of innovative drugs "pressed" into the medical insurance.
In 2023, 25 innovative drugs will participate in the negotiations, and 23 will be negotiated, with a success rate of 92%. Huang Xinyu said that through negotiations, the best innovative drugs are more reasonable, the affordability of patients has increased, and most of them have seen sales and income rise.
After nearly an hour of tug-of-war negotiations, BeiGene's self-developed anti-tumor drug zanubrutinib was successfully negotiated.
In the 2023 national health insurance negotiations, the renewal negotiation has become a new highlight. For innovative drugs that trigger the simplified renewal price reduction mechanism, enterprises are allowed to apply for renegotiation, and the price reduction can be lower than the price reduction stipulated in the simplified renewal. Many people in the industry believe that this makes the price reduction of medical insurance renewal more moderate, which is good for drug innovation.
In this way, innovative drugs with large clinical use can continue to renew their contracts with medical insurance with a relatively small reduction. Huang Xinyu introduced that according to the renewal rules adjusted and improved this year, among the 100 renewal drugs, 31 varieties need to be reduced in price, with an average reduction of 67%。
This year's negotiation rules are more scientific and can better reflect the respect for innovative drugs, which is also an encouragement for enterprises. Li Cong, the negotiator of Junshi Biosciences, said.
Hu Ying, chief physician of the Department of Medical Oncology at Beijing Chest Hospital Affiliated to Capital Medical University, said that in recent years, targeted drugs in the field of oncology have basically been included in medical insurance, and the speed is getting faster and faster. ”
This is due to the fact that in recent years, the medical insurance drug catalogue has established a dynamic adjustment mechanism of "annual adjustment", changing the access method from the expert selection system to the enterprise declaration system, and the scope of the declaration mainly focuses on newly listed drugs within 5 years. At present, the proportion of newly marketed drugs in the current year has increased from 32% in 2019 to 97% in 20236%。
Among them, in 2023, 57 varieties will be "approved in the same year and included in the catalogue in the same year", such as the myasthenia gravis drug agamod injection was approved in June 2023, and it successfully entered the medical insurance through negotiation.
As an innovative drug for rare diseases, it took less than half a year for agamod injection to be included in the medical insurance from its listing to its inclusion in the medical insurance, which reflects the country's support for innovative drugs with huge clinical needs. Zhao Chongbo, chief physician of the Department of Neurology of Huashan Hospital affiliated to Fudan University, said.
Gong Bo, a medical insurance negotiator who has participated in the negotiation for many times, said in an interview that whether it is from the optimization of the process of medical insurance negotiation in recent years or the full communication with enterprises before the negotiation, it can be clearly seen that the support of medical insurance negotiation for domestic innovative drugs is constantly strengthening.
Behind the health insurance negotiation is "life first".
On November 20, the negotiation site of the 2023 National Medical Insurance Drug List. Photo by Xinhua News Agency reporter Peng Yunjia.
The anti-tumor drug anlotinib successfully entered the medical insurance list for the first time in 2018 and participated in the renewal of the contract again this year. Compared with general targeted drugs targeting gene mutations, anlotinib covers a wider range of lung cancer types and patient populations.
A patient who participated in the medical insurance for urban employees calculated the account for the reporter: assuming that there is no medical insurance reimbursement, the annual drug cost of anlotinib is more than 70,000 yuan;After reimbursement by medical insurance, you only need to pay about 150,000 yuan.
After entering the medical insurance, the ** of anlotinib has decreased significantly, which has improved the accessibility of drugs for lung cancer patients and the clinical drug choices of doctors. Zhi Xiuyi, chief expert of the Department of Thoracic Surgery of Xuanwu Hospital of Capital Medical University, said that in recent years, with the emergence of more anti-tumor drugs independently developed in China, the situation that some drug types can only choose imported drugs has changed.
After 6 rounds of adjustments, the National Health Insurance Administration has added a total of 744 drugs to the medical insurance catalog, of which 446 have been added through negotiation, covering all 31 ** areas of the catalog. Chen Wen, a professor at Fudan University and head of the pharmacoeconomics expert group for the adjustment of the 2023 National Medical Insurance Drug Catalog, said that most of the drugs included in the catalog through negotiation are drugs that have been newly listed in recent years and have high clinical value, and a large number of drugs with new mechanisms and new targets have been included in the catalog.
Since the establishment of the National Health Insurance Administration in 2018, the annual drug negotiation has enabled the medical insurance catalogue to guide the "upgrading" of clinical drugs in China through "spitting out the old and accepting the new".
Jia Jia, the initiator of PNH Patients' Home, said that she hopes that after the official implementation of the new version of the medical insurance catalog, the medical insurance channel for rare diseases will be smoother, so that patients in need can really afford and use medicine.
In view of the problem of "getting into the medical insurance, but not entering the hospital" for negotiated drugs, China has established a "dual channel" mechanism for negotiating drug allocation and payment, and opened up the "last mile" of patients' medication through two channels: designated medical institutions and designated retail pharmacies. As of the end of October 2023, the negotiated drugs during the agreement period of the 2022 version of the drug catalogue have been negotiated in 23920,000 designated medical institutions are equipped.
Sichuan Watch (**Xinhua News Agency).