A new round of medical insurance negotiation is on the way

 A new round of medical insurance negotiation is on the way

The balance between pricing and enterprise innovation

The adjustment of the medical insurance catalogue is equivalent to changing the cage for a bird. Some drugs with low clinical value are kicked out, and the drugs urgently needed in clinic will be included. This round of adjustment of the medical insurance catalogue highlights the policys preferential attitude towards innovative drugs, thus extending the access time limit of new drugs. The approval date of new drugs that were qualified to participate in the negotiation in the past must be before December 31 of the previous year, and this time the access time limit has been extended to the date of issuance of medical insurance (August 17, 2020). According to the latest regulations, the new generic name drugs approved for marketing from January 1, 2015 to August 17, 2020 can become the candidate drugs to be included in the medical insurance list. At the same time, the adjustment of the medical insurance catalogue also involves the negotiation of several renewal varieties and the increase of indications.

At the Fifth China Pharmaceutical Innovation and investment conference, Hu Shanlian, a professor of health economics at the school of public health of Fudan University, said that in recent years, China has accelerated the speed of drug listing review, and more and more new drugs have been listed, which has exerted great pressure on medical insurance. The latter needs to consider how to make so many innovative drugs benefit more people. Medical insurance pricing of drugs, on the one hand, needs to consider leaving profit space for enterprises and the supply of follow-up research and development capacity, but also to consider the economic burden of patients.

Wu JINZI, founder of Geli pharmaceutical, said in an interview with the first finance and economics reporter that innovation belongs to the national strategy. Although the medical insurance bureau does not have this function, it can support the innovation of pharmaceutical enterprises from other aspects. For example, the value of drugs should be determined according to the curative effect rather than the lowest price. Medicine is a special product, not mineral water, nor food. If bidding at the lowest price, it will lead to problems such as medication safety and drug supply safety. Drug prices should be reasonable, but the lowest price is not the most appropriate. At the same time, there are some good signs of innovation in domestic pharmaceutical enterprises, such as the level of research and development of some domestic pharmaceutical enterprises and the efficacy and safety of new drugs developed have reached international standards. In the case of efficacy and safety, medical insurance should also appropriately support national innovative drugs.

Fan Changsheng, Secretary General of Beijing Medical and Health Economics Research Association, said that the medical insurance negotiation should follow the principle of value orientation and respect for innovation, and the negotiation results should reflect the multi-dimensional value of drugs. The drug value can be comprehensively evaluated from the clinical, patient, innovation and social dimensions. The negotiation price should be evaluated by comprehensively considering the factors influencing the price, avoiding only selecting the lowest price; and for exclusive products, the negotiation price should be evaluated based on the comprehensive consideration of various price influencing factors Product, allow price maintenance in contract renewal negotiation, maintain stable payment standard of products.

Therefore, in the process of medical insurance negotiation, how to show the innovative value of drugs is the key.

Zhao Kun believes that innovative drugs must be able to achieve breakthroughs, fill clinical gaps, and meet the clinical needs. Otherwise, it is difficult to call them innovative.

For enterprises, is drug true innovation or fake innovation? If the drug innovation made by pharmaceutical enterprises wastes not only their own resources, but also the resources of many departments of the country, including the resources of evaluation and the resources of the medical insurance bureau, then it is necessary to evaluate whether such innovation is worth it Beijing Tiantan Hospital Pharmacy director Zhao Zhigang said.

Hu Shanlian said that pharmaceutical companies should fully display the clinical value of drugs when applying for the medical insurance catalogue, especially for drugs with multiple indications, to fully show the different values of different indications and different market scales.

Despite the difficulties, pharmaceutical companies are still very enthusiastic. In any case, we will actively participate in the national health care negotiations. At the same time, we should also fully weigh the advantages and disadvantages of medical insurance, such as whether it is possible to realize price for quantity and whether it is conducive to our sales abroad Li Ning, chief executive officer of Junshi biology, told the first financial reporter.