Three sectors: 17 anticancer drugs included in medical insurance should not be negotiated again

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 Three sectors: 17 anticancer drugs included in medical insurance should not be negotiated again


However, Pengbao News learned that according to the current policy, patients who want to successfully use and reimburse the use of 17 anti-cancer drugs in public hospitals need to enter the provincial procurement platform, implement procurement within public hospitals, determine reimbursement proportion in the health insurance co-ordinated area, adjust the health insurance information system and many other access links, involving multi-level, multi-level and different departments.

In addition, because the unit price of anticancer drugs is generally high, even after the completion of the process, the actual use of anticancer drugs is prone to conflict with the current implementation of drug proportion and other medical fee control policies.

To this end, on November 29, the State Medical Insurance Bureau, together with the State Health and Health Commission and the Ministry of Personnel Settings, issued the Notice on Implementing the Negotiation of 17 National Medical Insurance Negotiations on Anti-cancer Drugs (No. 20 of 2018 issued by the Medical Insurance Office) to speed up the process of negotiating the landing of anti-cancer drugs in an all-round way.

In this regard, Fu Hongpeng, director of the Drug Policy Department of the Health Development Research Center of the State Health and Health Commission, interpreted document 20 in detail, and directed and urged all regions to solve the problems affecting the landing and use of negotiated drugs.

Q: What links do 17 anticancer drugs need to go through to reach patients?

Fu Hongpeng: According to the current policy, negotiating the reimbursement of drugs into public hospitals requires entering the provincial procurement platform, implementing procurement in public hospitals, co-ordinating the area to determine reimbursement ratio, adjusting the medical insurance information system and other access links, involving different departments at different levels of provinces, cities and counties.

The starting point of these nodes is to promote rational drug use, effectively control prices and costs, and improve the level of patient protection. However, there are advantages and disadvantages in everything. The closely linked management measures ensure the tightness of the policy system, while the disadvantages are the lack of flexibility and the long-term coordination of work.

Document No. 20, in the form of joint issuance, made it clear that the negotiated drugs should be publicly linked on the provincial drug centralized procurement platform according to the payment standard of medical insurance, and that no renegotiation and negotiation should be allowed. It also coordinated the requirements of the regional medical insurance agencies to adjust the information system and formulate the settlement management methods for the negotiated drugs. It provided a clear working method for local governments to organize the landing of anticancer drugs and would be significantly reduced. Short landing time period of anticancer drugs.

Question: What policies are interrelated with the actual use of negotiated drugs?

Fu Hongpeng: After completing the landing process, it is the medical fee control policy that plays an obvious restrictive role in the use of anticancer drugs.

For a long time, Chinas medical expenditure has been on the high side, increasing rapidly, and there are unreasonable factors. Since the start of the new health care reform, measures such as promoting the implementation of the reform of the total payment of medical insurance, setting up the indicators of hospital fee control, and establishing an assessment and accountability mechanism have played an important role in controlling medical expenses and promoting rational drug use. However, if the measures are not used properly, they will play a restrictive role in the use of anticancer drugs.

The total amount of medical insurance and cost control indicators are generally based on the base of previous years and the normal operating conditions of hospitals. At the end of this negotiation, the number of anti-cancer drugs included in one-time will increase greatly, and the expenditure of medical insurance fund in some hospitals will increase dramatically. There is widespread concern that the fund will exceed the total amount after the use of anti-cancer drugs.

Therefore, Document 20 emphasizes that when medical institutions end-of-year cost liquidation, negotiated drug costs are not included in the total control scope, and the cost of negotiated drugs for rational use is separately accounted for and guaranteed, and when formulating the total control indicators for 2019, it is necessary to take into account the factors of reasonable use of negotiated drugs to adjust the payment limit of the fund.

Question: How to regulate and avoid the problems of inadequate, improper and excessive use of anticancer drugs?

Fu Hongpeng: Negotiated drugs are expensive life-saving drugs. Rational use is extremely important.

First, we must prevent the use of inadequate. In some areas, medical institutions lack the ability of cancer diagnosis and treatment technology, lack of understanding of the performance of innovative anticancer drugs, and will not use or dare not use them.

Second, we should prevent improper use. Eliminating the mechanism of reinforcing medicine with drugs has not yet won a fundamental victory. The average price reduction of 17 kinds of anti-cancer drugs negotiated by the state is 56.7%, which is lower than that of the surrounding countries and regions by more than 30%. The price space has been effectively reduced. From the point of view of abiding by the negotiation agreement, hospitals should not continue to negotiate. However, in the case of relatively large price space for other drugs and certain promotions, some institutions and medical personnel may not be able to strictly follow the diagnostic and therapeutic norms and the principle of rational drug use.

Third, we should prevent overuse. Negotiated anticancer drugs are mostly targeted drugs, which are suitable for patients with clear symptoms and indications, while the use of other patients has no therapeutic effect. But inevitably, there will be the phenomenon that patients who do not meet the requirements of medication. For this reason, Document 20 points out that health departments should improve the criteria of cancer diagnosis and treatment and clinical application guidelines of anti-cancer drugs, guide medical institutions to allocate drugs according to the criteria, optimize the structure of drug use, give full play to the role of clinical pharmacists, strengthen the assessment of rational drug use, and promote the rational use of anti-cancer drugs. Peoples and social sectors should comprehensively consider the negotiation of drug indications and use policies to ensure the rational use of medicines for work-related injuries.

Q: How to balance the policy of controlling medical expenses and the rational use of anti-cancer drugs in patients?

Fu Hongpeng: The State Health and Health Commission issued a special circular in March 2018, requesting that each region scientifically set annual control indicators of medical expenditure growth according to the economic and social development and the growth of medical expenditure, instead of one size fits all. In combination with the functional orientation of various public hospitals at all levels, the situation of service delivery and the requirement of establishing a hierarchical diagnosis and treatment system, the control indicators should be refined and decomposed into each hospital. No one size fits all.

The two do not carry out one-size-fits-all means that although the cost control work is extremely important, it is subordinate to the rational needs of the people for diagnosis and treatment. The relevant cost control indicators of drug proportion set by local governments in the early stage need to be adjusted according to the clinical application of anticancer drugs to prevent restrictive effects. As for the catalogue of drugs used in municipal and county public hospitals set up to strengthen drug administration, according to the Regulations on Pharmaceutical Administration of Medical Institutions, the Drug Prescription Collection and Basic Drug Supply Catalogue formulated by public hospitals and used internally are not only related to the landing of anticancer drugs, but also affect the use of doctorsprescriptions. It is objectively necessary to break the original working rhythm and start the municipal and county competent departments as soon as Door or or Hospital Pharmacy Committee related working procedures.

In response to these circumstances, Document 20 emphasizes that local health insurance, social organizations, health and other departments should put forward specific requirements for the implementation of the negotiated drugs in accordance with their responsibilities, and should not affect the supply of negotiated drugs and the demand for rational use of drugs on the grounds of total cost control, drug proportion and the basic drug catalogue of medical institutions.

Source: Pengyang News Author: Liable Editor of Liu Chu: Su Bingyong_NBJ9980