In recent years, medical insurance negotiation has provided more cost-effective drugs for patients while better meeting people’s basic drug needs, and related news has attracted more and more social attention. For example, the price of Nosinagen Sodium Injection, a special drug for the treatment of the rare disease spinal muscular atrophy, used to be as high as 700,000 yuan per injection. In the 2021 National Medical Insurance Drug List, 67 new drugs have been added through negotiation, covering the needs for drugs such as tumors, chronic diseases, anti-infection, and rare diseases, involving 21 clinical groups, with an average price reduction of 61.7%.
To reduce the burden of drug costs for the masses, not only should the negotiated drugs be “reimbursable” in medical insurance, but also “prescribed” in the hospital. Judging from the existing drugs negotiated by the national medical insurance, there are still cases where the proportion of hospital equipment is low or even patients “cannot prescribe drugs”. The reason for this is due to the consideration of specific interests and the constraints of a poor mechanism. For example, some pharmaceutical companies are less motivated to produce due to low prices and small quantities, and some medical institutions lack the motivation to promote the negotiation of drugs due to factors such as the proportion of drugs, the number of drugs used, and the sales of drugs with zero markup. In addition, medical insurance budget management has also made medical institutions “stay away” from negotiated drugs that have dropped significantly but are still not cheap. To effectively improve the availability of negotiated drugs, more efforts should be made to smooth the “last mile” of drugs entering medical institutions.
Perfect assessment and evaluation incentives. After the medical insurance negotiation, the key is to urge medical institutions to reasonably allocate and use the negotiated drugs. In September last year, the National Medical Security Administration and the National Health and Health Commission jointly issued a notice requiring the medical insurance department to strengthen the management of the agreement, including the reasonable allocation and use of negotiated drugs in designated medical institutions into the content of the agreement, and linking it with the annual assessment; the health department adjusts and improves medical treatment. In the institutional drug use assessment mechanism, the negotiated drugs that are reasonably used are listed separately, and are not included in the scope of assessment indicators such as the proportion of drugs in medical institutions and the average cost per time that affect their implementation. To implement these requirements, it is necessary to strengthen dynamic management, scientifically analyze the impact of assessment indicators on the entry of negotiated drugs into medical institutions, and timely revise unreasonable indicators.
Strengthen the traction of medical insurance policies. To give full play to the role of the baton in the strategic purchase of medical insurance, on the one hand, it is necessary to mobilize the enthusiasm of medical institutions to allocate and use them, and regions with conditions can actively explore and improve the policy of negotiating separate payment for drugs, and gradually include more negotiated drugs into the scope of separate payment. On the other hand, it is necessary to unblock channels for negotiating drugs into medical institutions. In May 2021, the National Medical Security Administration, together with the National Health Commission, issued a “dual-channel” policy to negotiate the supply of drugs through designated retail pharmacies and designated medical institutions for “dual-channel” supply. In addition, it can also open up two channels of hospital outpatient and inpatient. Online channels should not be ignored. On the basis of optimizing online review, the negotiation of “online ordering in store” or “online ordering in store delivery” should be promoted.
Promote the R&D and production of drugs. When negotiating the landing of drugs, it is necessary to introduce supporting policies to ensure the payment of drugs, so as to mobilize the enthusiasm of production enterprises. The medical and health needs of more than 1.4 billion people in my country have given the confidence to exchange sales for low prices in medical insurance negotiations. It is also a useful exploration that some places try to negotiate with volume on the basis of centralized procurement with volume. In addition, more targeted preferential policies should be adopted to support the R&D and innovation of domestic drug manufacturers, encourage the promotion of the consistency evaluation of generic drugs, speed up the review and approval of innovative products, promote the listing of new and good drugs as soon as possible, and promote the “patent cliff” through competition. The effect appeared, and the negotiation of drug supply guarantee and price reduction was promoted.
Introducing the most cost-effective drugs into medical insurance through negotiation is only the first step in reducing the burden of drug use for patients. Patients have a greater sense of gain. (The author is the vice chairman of the Jiangxi Provincial Political Consultative Conference)
(Source: People’s Daily Commentary)