Ancient Greece once said that cancer was discovered 2,000 years ago, and China also said that cancer was found in the Yin Shang periodBut the real discovery of cancer, that is, the isolation of cancer cells, was almost 1912, more than 100 years ago. For more than 100 years in modern times, scientific researchers from all over the world have been fighting against cancer and developing new methods and drugs for cancer. Until now, cancer is also one of the diseases with the highest prevalence and the highest mortality rate in China and even in the world, with 10 million people dying from cancer every year.
Early cancer can be said to be a lifeline for more affected groups, and it is simply an incurable disease. Later, there were some ** methods such as surgery, anti-chemotherapy and so on, but in general, the ** methods were not very good. The real breakthrough is the development and use of cancer-targeted drugs, which can precisely find cancer cells and kill them. There will be no bigger ***, just like the targeted drug Gleevec for leukemia patients in the movie "I Am Not the God of Medicine". Targeted drugs can turn cancer into a common chronic disease for long-term and lifelong life, so as to improve the quality of life and life expectancy, regardless of cancer, patients can achieve the same quality of life and survival life as healthy people by taking targeted drugs.
However, cancer targeted drugs are very good, the effect is good, and the effect is low, but targeted drugs have a disadvantage that is difficult to ignore, that is, expensive, unbearably expensive. There is a rule of 3 10s in international drug research and development, that is, it takes 10 years, 1 billion US dollars of investment, and a 10% success rate. In order to earn enough profits to offset the cost of R&D and maintain sufficient competitiveness in the future, drug manufacturers will price new drugs at a high enough price. Just like Gleevec in the movie, the monthly medication ** is as high as tens of thousands of yuan, which eats the house and the family collapses.
China's medical insurance is basic medical insurance, the limited amount of financing can only ensure the basic, wide coverage, for the annual cost of more than 300,000 drugs, the medical insurance catalogue is generally not included, so the early targeted drugs are generally not included in the medical insurance catalogue. Since 2017, with the negotiation of access, centralized volume procurement, the listing of domestic original targeted drugs, etc., some targeted drugs have entered the medical insurance drug list one after another, and as of this year, hundreds of targeted drugs have entered the drug list for reimbursement. However, targeted drugs that have just entered the drug list have many medical insurance reimbursement restrictions, which limit the types of diseases reimbursed, restrict second-line drugs, etc., and it is quite difficult to reimburse.
At the end of last year, a new version of the drug catalogue was released, which was implemented in March this year, and the new version of the drug catalogue in addition to adding some new drugs, its biggest change is the cancellation of many reimbursement restrictions, especially the medical insurance reimbursement restrictions for targeted drugs. The restriction on targeted drugs that were originally restricted to one type of cancer can be used for a variety of cancers, and some restrictions on second-line drugs have been removed, and they can be used directly, which can not only save money, but also make it more convenient for reimbursement. The National Health Insurance Administration has issued a document to cancel the unreasonable restrictions of medical insurance on medical institutions, returning the decision-making power that requires the judgment of doctors such as the use of drugs and the length of hospitalization to doctors, and doctors can choose to use a certain drug according to the actual condition of patients, and will not be limited to medical insurance reimbursement and dare not use or change drugs, or even let patients buy them outside at their own expense.
Hospitalization Reimbursement:After the inclusion of cancer targeted drugs in Class B drugs, if patients need to use targeted drugs when they are hospitalized, the reimbursement restrictions are now lifted, and they can be reimbursed by direct use, and they are included in the total hospitalization expenses for reimbursement, and it is very convenient to settle according to the hospitalization policy, the prescribed starting line and reimbursement ratio.
Outpatient Reimbursement:Cancer can now become chronic with long-term medication**, and chronic disease** often does not require hospitalization, as long as regular outpatient chemoradiotherapy is sufficient. In the case of outpatient radiotherapy and chemotherapy, it is necessary to apply for outpatient chronic disease, and submit the examination report, diagnosis certificate and other materials to the hospital or the medical insurance bureau to apply for chronic disease. It is very convenient to settle the reimbursement directly at the time of outpatient chemoradiotherapy. Now medical treatment outside the province can be settled directly after filing, which can save more money.
Since the current public medical institutions are implementing the zero price difference system of drugs, and the drug allocation of the hospital requires a certain amount of time and procedures, so many times the cancer targeted drugs that enter the drug list cannot be purchased in the hospital, and can only be purchased at the designated pharmacy, in this case, how to reimburse?In 2021, the National Health Commission and the National Health Insurance Bureau introduced a dual-channel medical insurance reimbursement system, which can be reimbursed through two channels: designated medical institutions and designated retail pharmacies.
When patients seek medical treatment in the hospital, if the targeted drugs that need to be used are not available in the hospital and need to go to the pharmacy to buy them, they can fill in the dual-channel drug use application approval form in the hospital, and after completing the procedure in the hospital, they can go directly to the pharmacy to buy drugs for reimbursement, which is also more convenient.