Medical Insurance Catalog Adjustment has finally begun.

 

  Just last day before the National Day holiday，The Ministry of Human Resources and Social Affairs selected this & ldquo; Liangchen Ji Ri RDQUO;，Released "2016 National Basic Medical Insurance、Work Injury Insurance and Maternity Insurance Drug Directory Adjustment Work Plan (Draft for Opinions) "publicly solicited for notification。Determine public solicitation of opinions as of October 12, 2016。

 

  According to the practice，my country's "Medical Insurance Catalog" is adjusted once every 5 years。1999，my country has established a urban employee medical insurance system，The first edition (2010 version) medical insurance directory was formulated the following year，Amended to form the 2005 version in 2004; December 2009，The Ministry of Human Resources and Social Security released the 2010 version of the medical insurance catalog，All therapeutic drugs in the basic medicine directory are included in the medical insurance directory in accordance with the "Basic Drug System"，260 drugs added at the same time。

 

  According to the practice，A new medical insurance directory should be revised in 2014，However, I never saw the Ministry of Human Resources and Social Act。In the first half of 2014，Officials of the Medical Department of the Consumer Product Department of the Ministry of Industry and Information Technology revealed at the China stake betting appPharmaceutical Industry Development Summit Forum，& ldquo; Start a modification of medical insurance directory for two years，The directory will expand & rdquo;。Although there is no real action at the national level，But all places have long been eager to move。Beijing announced this year that 224 kinds of chronic chronic species for treatment、Pharmaceuticals for elderly diseases are incorporated into Beijing Community Drug Medical Insurance Catalog，The scope of the reimbursement of community drugs increased from the original 1211 to 1435。

 

  So the Ministry of Human Resources and Society solicited comments，What information will be worthy of attention?

 

  I. What is the idea of ​​directory adjustment?

 

  Further optimize the directory structure，Appropriate expansion of the directory range，Support encouraging medical innovation，Gradually improve the level of guarantee，Effectively ensure the needs of the majority of insured personnel and the safe and smooth operation of the medical insurance fund。

 

  2、The increase in the number of western medicine and the number of Chinese medicines is basically balanced，Will Chinese medicine injection increase?

 

  Six basic principles established according to the directory adjustment，Among them (6) is & ldquo; insist on Chinese and Western medicines & rdquo;，Fully reflects the advantages of western medicine and Chinese traditional medicine，According to their own basic theory，Establish a perfect evaluation method，The increase in the number of western medicine and proprietary Chinese medicine (including national medicine) is basically balanced。

 

  But，In recent years，Adverse reactions of traditional Chinese medicine injections are high，Severely adverse reactions occur when there is a serious adverse reaction，Its abuse is also very common，and in the environment where the policy control policy is becoming stricter，A large amount of traditional Chinese medicine injections are included in & ldquo; Shen medicine & rdquo;、& ldquo; Auxiliary medication & rdquo; strict monitoring，Sentenity method，There are already a lot of three -level comprehensive hospitals that have been completely blocked by Chinese medicine injection，And this solicitation draft continues to insist stake sports betting appon & ldquo; the increase in the number of western medicine and Chinese medicines is basically balanced & rdquo;，Will there be a good life of Chinese medicine injections?

 

  3. Which medicines enter? Which medicines exit?

 

  Draft for Solicitation of Opinions，Drug directory adjustment is divided into adjustment and transfer。Consider 6 categories，new drug with high clinical value、Class B adjustment of local B and increase the treatment of major diseases for major diseases、Children's medication、Urgent rescue medicine、Special medication for occupational diseases。There are two main categories of mixed up: First, the original medicine in the directory，If the production has been prohibited by the national drug regulatory authorities、Sales and use; second, there are other that does not meet the requirements and conditions of medical insurance medication，Call out after the corresponding review process。

 

  4. What should I do if negotiated drugs?

 

  Negotiation Purchasing is one of the five procurement methods for the procurement of Chinese drug classification and procurement determined by the State Council，May 2016，The National Health and Family Planning Commission announced the five previously determined drugs involved in chronic hepatitis B front -line therapy drug for Norofovir.、Non -small cell lung cancer targeted therapy drugs such as Ekntinib and Gefeitinib and other three drug negotiation results，Compared with the purchase price of the previous public hospital，Decrease is 67%、54%、55%，However, afterwards, some places have been exposed to phenomena that have not implemented negotiation results。The consultation draft issued by the Ministry of Human Resources and Social Affairs is how to treat the negotiated drugs，attractive attention。

 

  I pay special attention to the regulations in this area，Determine the list of alternatives & rdquo;，Three medicines for determining the centralized procurement price of public hospitals in 2015 with national price negotiations，Considering clinical demand and price decline，Please ask the consulting experts to focus，And the procurement price determined by negotiations is judged as the price data。

 

  For clinical necessity、Exact effect，But the price is more expensive，Patent stake sports betting apppatents that may bring a certain risk to the fund at the directory at the existing market price、Exclusive medicine，Consultation experts determine the scope of alternatives to be negotiated for negotiations。

 

  Negotiated drugs determined by the selection procedure，Organizational Medicine、Pharmacy、Health Economics、Experts in areas in the fields of insurance management conduct negotiations，After reaching an agreement，Release the list of drugs listed in the drug directory。Specific negotiation methods will be formulated separately，Completed in the first half of 2017。

 

  5、The huge selection team determines a directory，Is it cost -effective?

 

  According to the provisions of the draft of the comments，To complete the catalog selection，To be established by the Ministry of Human Resources and Social Security、The Leading Group of the Four Divisions of the National Nine Ministry and the Ministry of Human Resources and Social Affairs，Set off office、Supervision Group and Expert Group。The expert group is divided into consulting experts and selection experts，Consultation experts about 400 people，The main task is to provide consultation with drug classification and data analysis、Main points of demonstration of drug review、The demonstration of the scope of drug scope of the drug。Selection expert: about 20,000 people，The main task is to be responsible for voting the list of alternative drugs。

 

  I feel，Use such a huge team，Do a directory that can't be controlled for a few years，Is it cost -effective? And our current medication catalog is indeed a lot，Both & ldquo; Basic drug catalog & rdquo;，There is also & ldquo; New Rural Cooperative Drug Catalog & RDQUO;、& ldquo; Medical insurance directory & rdquo;，Why can't it be integrated into a directory? Also give hospital information construction，Medical insurance reimbursement for convenience。

 

  What should I do? my suggestion is，Don't select and formulate the so -called medical insurance directory，All the drugs in the basic drug directory are included in the compliance costs in proportion; reimbursement of non -basic drugs，As long as it is & ldquo; reasonable medication & rdquo;，After a certain stake sports betting appproportion of self -self -，All included in the compliance expenses to be reimbursed proportionally。Focus on the following six points in reimbursement of drugs: First, for some special drugs to limit the use of special diseases; second, after the reimbursement of basic medical insurance，Patients pay more than a certain percentage of their own fees and directly enter the reimbursement of major illness insurance，Do not eliminate any project costs; the third is to abolish centralized drugs，What kind of medicines choose to use by medical institutions，What kind of price to purchase medicines; fourth, increase the strength control of the sub -average cost，Strict punishment for medical institutions with poor cost control in accordance with the & ldquo; agreement & rdquo; fifth is to punish commercial bribery in accordance with the law; sixth, actively explore & ldquo; medical insurance payment & rdquo; reform，Improve the price of medical services，Move the enthusiasm and initiative of mobilizing medical institutions for control。