CCTV News:Pay attention to the adjustment of medical insurance catalogue. Everyone goes to the hospital to see a doctor and prescribe drugs. Generally, doctors and patients will give priority to drugs listed in the medical insurance catalogue. Because only drugs that enter the medical insurance catalogue can be reimbursed by medical insurance. Therefore, which drugs are in the catalogue and which drugs are not in the catalogue are very important for patients, hospitals and pharmaceutical companies. Not long ago, the National Health Insurance Bureau and Ministry of Human Resources and Social Security officially published the latest version of the list of drugs in the routine access part of the national basic medical insurance, industrial injury insurance and maternity insurance. Compared with the old list, some drugs were included and some drugs were transferred out. Then, how is the list of drugs adjusted this time, and what changes will it bring to drug use?
The adjustment of the national medical insurance drug list is the first comprehensive adjustment of the drug list after the establishment of the National Medical Insurance Bureau in 2018. After the adjustment, there are 2,643 drugs in the routine access part, including 1,322 western medicines and 1,321 Chinese patent medicines.
China established the medical security system for urban workers in 1998. In 2000, the first edition of the National Basic Medical Insurance Drug List was published. This adjustment this year is the fourth comprehensive adjustment for the list. Different from the previous adjustment of "more in and less out", this adjustment has significantly increased the intensity of transfer, and 150 varieties have been transferred.
Xiong Xianjun, Director of Medical Service Management Department of National Health Insurance Bureau:Except that 71 of them are some medicines whose numbers have been revoked in National Medical Products Administration, 79 varieties, 53 western medicines and 26 Chinese patent medicines have been transferred.
What principle is the adjustment based on when the medicines in the medical insurance catalogue are transferred out? What kind of drugs have been transferred?
Fu Hongpeng, researcher of Health Development Research Center of National Health and Wellness Commission:There are mainly three kinds of drugs transferred out. One kind is that National Medical Products Administration has cancelled the approval number. The other kind is easy to be used irrationally, such as the auxiliary drugs monitored in clinic. The phenomenon of irrational use of these drugs in clinic is obvious, and it is transferred accordingly. There is another category, which has been replaced by new and better alternative drugs, mainly these three categories.
It is worth noting that the drugs transferred from this medical insurance catalogue adjustment include the drugs in the first batch of national key drug list for rational drug use released by National Health Commission. In the list of key monitoring drugs, most of them are adjuvant drugs.
Professor Shi Luwen of Peking University College of Pharmacy:Indications are broad, or its clinical evidence is not so sufficient. It is easy to expand clinical use and cause unreasonable use.
These drugs are used by many departments because of their wide indications. Although the dosage is huge, the clinical effect is not obvious. Such drugs occupy a lot of medical insurance funds.
Xiong Xianjun, Director of Medical Service Management Department of National Health Insurance Bureau:The key drugs monitored by the Health and Health Commission were originally listed in the 2017 edition of the National Drug List. Experts suggested that they be transferred out, so many of these drugs are varieties with sales exceeding 100 million yuan.
A large amount of medical insurance funds are used to pay for some drugs with low clinical treatment value. This problem is a hot spot of social concern and a pain point that needs to be solved urgently. This catalogue adjustment has identified this pain point.
The structure of drugs in the medical insurance catalogue has changed greatly through the transfer of drugs and drugs, thus adjusting the use structure of medical insurance funds. In and out, optimize the structure.
Xiong Xianjun, Director of Medical Service Management Department of National Health Insurance Bureau:After the transfer, the medical insurance fund and the people will pay less. This will save some funds for the protection of new drugs, or for the purpose of changing birds in cages.
If you spend less money on unnecessary drugs, you will have more money to spend on truly effective drugs. In this adjustment, the newly added drugs cover the national essential drugs, drugs for the treatment of major diseases such as cancer and rare diseases, drugs for chronic diseases and drugs for children, among which 5 drugs for the treatment of major diseases, 36 drugs for chronic diseases such as diabetes and 38 drugs for children were added through routine access.
Jiang Ling, Chief Pharmacist of the First Affiliated Hospital of University of Science and Technology of China:For example, chronic diseases, such as diabetes and hypertension, have been transferred to many compound preparations produced and marketed in recent years, such as some compound preparations of type 2 diabetes, such as some schemes of metformin combination. From our professional point of view, compliance is better, because compliance is very important in the treatment of chronic diseases, and he should adhere to it for a long time. The curative effect will be better, and the blood sugar will be better maintained.
On the one hand, increasing dosage forms makes the treatment effect better, and at the same time, some innovative new drugs are included in the regular access catalogue of this medical insurance catalogue. This time, a total of 148 varieties were added to the routine access part of the drug list adjustment, including 47 western medicines and 101 Chinese patent medicines. No matter whether it is transferred in or out, what principle is this adjustment based on?
Xiong Xianjun, Director of Medical Service Management Department of National Health Insurance Bureau:The first standard is clinical necessity, and the second is drugs with better pharmacoeconomic evaluation, which are actually these two standards. The first goal is to meet the basic needs of the insured for clinical medication, and the second point is that the medical insurance fund and the insured spend less money to buy better drugs and improve the efficiency of the use of funds.