In December 2023, the National Health Insurance Administration released a new version of the medical insurance drug catalog, and the Guangdong Provincial Medical Insurance Bureau released the unified medical insurance drug catalog of the province as soon as possible, and it will be implemented from January 1, 2024. A total of 143 off-list drugs 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%, insured patients can use these new drugs and good drugs that have been negotiated by the state and included in the medical insurance at a more affordable price.
How to make insured patients "buy, use, and report" the national medicine? On January 31, the Guangzhou Municipal Medical Insurance Bureau and the Guangzhou Development Zone Management Committee held an exchange meeting on the landing and use of national medical insurance negotiation drugs in Guangzhou in 2024. This is the first large-scale interactive exchange platform for medical insurance, medical treatment and medicine in Guangzhou, and all parties work together to promote the efficient implementation of national medicine.
At the event site, the departments of health, industry and information technology, medical insurance and other departments put forward guidance and requirements for promoting the use of negotiated drugs from the perspective of management, and representatives of designated medical institutions shared the experience and practices of negotiating drugs from the perspective of implementation, and the city's enterprises showed the characteristics and advantages of the negotiated drugs from the perspective of drugs.
The relevant person in charge of the Guangzhou Municipal Medical Insurance Bureau said that this exchange meeting will enhance the understanding of negotiated drugs by building a tripartite communication and interaction platform of "functional departments, hospitals and enterprises", jointly promote the rapid access and clinical rational use of negotiated drugs in hospitals, improve the accessibility of negotiated drugs, and better meet the reasonable drug needs of the majority of insured patients.
It should be fully matched, so that patients can enjoy the benefits of national medicine as soon as possible.
As an important part of the National Medical Insurance Drug Catalog, the National Medical Insurance Administration organizes experts in pharmacoeconomics and medical insurance management to negotiate with pharmaceutical companies, and has the characteristics of high clinical value, urgent needs of patients, and low substitution. Up to now, the National Health Insurance Administration has carried out five rounds of drug list negotiations. In the past five years, more and more new and good drugs have been included in the medical insurance catalogue in a timely manner.
In order to allow patients to use Guotan medicine as soon as possible, our hospital provides 'dual-channel' drug prescription service, which should be fully matched and used well. Zhang Zhenhui, vice president of the Second Affiliated Hospital of Guangzhou Medical University, shared a case with reporters: the hospital has a ** chronic lymphocytic leukemia drug before the national negotiation of about 30,000 yuan per month, after entering the national drug catalog, hematologists apply to add the drug to the "dual channel" external distribution catalog, patients can buy the drug in pharmacies through the "dual channel" drug prescription service. In the end, the patient's monthly drug cost was reduced from more than 30,000 yuan to more than 3,000 yuan, which was one-tenth of the original maintenance cost. "The patient sent WeChat to the attending doctor as soon as possible: Thank you Guangzhou Municipal Medical Insurance Bureau for this policy, and thank you to the doctor, so that I can enjoy the benefits of Guotan medicine for the first time. Zhang Zhenhui said.
According to reports, the Guangzhou Municipal Medical Insurance Bureau has established a normalized drug declaration and listing mechanism on the Guangzhou Pharmaceutical Group Procurement (GPO) platform to support the online procurement of innovative drugs, and the hospital will purchase them independently according to actual needs. At the same time, it is the first in the province to apply the provincial electronic prescription circulation center and the "Guangdong Medical Insurance" applet to provide the insured with dual-mode services of "online full-process drug purchase" and "offline in-store drug purchase" medical insurance settlement, so as to improve the convenience of drug purchase.
At present, there are 34 designated hospitals and 30 designated pharmacies to provide "dual-channel" drug prescription services, and from January 2024, Guangzhou medical insurance will implement the new version of the provincial "dual-channel" drug scope, and the number of "dual-channel" drugs will increase from 399 to 523.
The tripartite linkage realizes the "three-way rush" of medical insurance, hospitals and enterprises
In recent years, more and more innovative drugs have entered the national medical insurance drug list through negotiation. "As a biomedical enterprise focusing on the research and development of innovative drugs, participating in this hospital-enterprise exchange meeting can enhance the hospital's understanding of the company's newly listed products, make the hospital more confident in the quality of Guangzhou's local products, and also enable Guotan Medicine to benefit patients more quickly, and realize the 'three-way rush' of medical insurance, hospitals and enterprises", Huang Yifeng, vice president of Guangzhou BeiGene Biopharmaceutical, told reporters that the company has a total of 6 innovative drugs into the Guotan Drug Catalog.
Huang Yifeng also said that the Guangzhou Municipal Medical Insurance Bureau fully supports the innovation and development of enterprises, and actively recommends qualified innovative drugs to be included in the national medical insurance drug list. The reimbursement of innovative drugs is tilted, and the medical insurance treatment is set up separately for negotiated drugs, and the management of separate payment is implemented, and the negotiated drug costs are not included in the outpatient treatment limit, and are reimbursed according to the proportion of hospitalization payment, so as to reduce the burden of the insured and enhance the willingness of the insured to use drugs. Establish a DIP score addition mechanism for the negotiated drug costs incurred in hospitalization, and calculate the add-on value according to the actual cost of negotiated drugs, so as to dispel the hospital's drug concerns.
According to statistics, more than 630 designated hospitals in the city are equipped with negotiated drugs. In 2023, there will be a total of 505 insured people in Guangzhou90,000 people used negotiated drugs, involving drug costs 2800000000000000000000000000000000900 million yuan, the number of people, drug costs, and billing costs increased by more than 30% year-on-year, which better protected the drug needs of insured patients.