2023-12-13 13:47:00
Xinhua News Agency, Beijing, December 13 Topic: 126 new drugs are included in the medical insurance covering rare diseases and other fields – scanning of the new version of the National Medical Insurance Drug Catalog
Xinhua News Agency’s “Xinhua Viewpoint” reporters Peng Yunjia, Wen Jinghua, and Lin Miaomiao
After 168 rounds of negotiations and bidding over four days, 126 new drugs entered the medical insurance market, covering multiple treatment areas such as rare diseases, anti-tumor, and chronic diseases. What are the highlights of the new version of the National Medical Insurance Drug Catalog? What impact will it have on people’s use of medicine? “Xinhua Viewpoint” reporters interviewed relevant experts.
On November 20, the negotiation site for the 2023 National Medical Insurance Drug List was held.Photo by Xinhua News Agency reporter Peng Yunjia
126 kinds of drugs are included in medical insurance covering multiple treatment fields
This is another comprehensive upgrade of the “drug basket” for more than 1.3 billion insured people – 126 new drugs have entered the medical insurance, including 21 cancer drugs, 17 new coronavirus and anti-infective drugs, and 15 rare drugs for chronic diseases such as diabetes and mental illness. 15 kinds of medicines for diseases, etc.; at the same time, one kind of medicine that is regarding to be withdrawn from the market was transferred.
Huang Xinyu, director of the Pharmaceutical Service Management Department of the National Medical Insurance Administration, introduced at a press conference on the 13th that following this adjustment, the total number of drugs in the catalog will increase to 3,088, including 1,698 Western medicines, 1,390 Chinese patent medicines, and medicines for chronic diseases, rare diseases, and children. The level of security in other areas has been further improved.
This adjustment adds 15 rare disease drugs outside the catalog, covering 16 rare disease categories, and fills the gaps in drug protection for 10 diseases, such as egrestat tartrate, which is used to treat adult patients with type I Gaucher disease. Stuximab for the treatment of Castleman’s disease, etc.
“Single-gene genetic diseases are diseases caused by functional abnormalities caused by mutations in a single gene, accounting for 80% of rare diseases.” Qiu Zhengqing, a rare disease research expert and chief physician of pediatrics at Peking Union Medical College Hospital, said that spinal muscular atrophy (SMA), Gaucher disease and other diseases are all single-gene genetic diseases, and it is of great significance to patients to include the medications for these diseases in medical insurance in a timely manner.
In addition, eculizumab, which can be used to treat three rare diseases: paroxysmal nocturnal hemoglobinuria (PNH), atypical hemolytic uremic syndrome, and refractory systemic myasthenia gravis, has also been successfully included in medical insurance.
“PNH is a rare acquired hemolytic disease.” Fu Rong, vice president of Tianjin Medical University General Hospital and director of the Hematology Center, said that compared with the limitations of traditional therapies, eculizumab has successfully entered the medical insurance. It can enable more patients to receive effective treatment and reduce the burden on patients.
“Being able to enter medical insurance means that more patients with rare diseases have hope of taking medicines.” Jin Mei, one of the leaders of the medical insurance negotiation team and deputy director of the Yunnan Provincial Medical Insurance Bureau who participated in the negotiation, said that the value and cost of rare disease drugs are relatively high. If it is relatively high, within the range that the medical insurance fund can bear, every effort should be made to include it in medical insurance.
In terms of anti-tumor drugs, the new version of the National Medical Insurance Drug Catalog has added acotinib for the treatment of adult mantle cell lymphoma; reboxilide succinate for the treatment of breast cancer, etc. Zhu Jun, secretary of the Party Committee of Peking University Cancer Hospital and chief physician of the Department of Lymphoma Medicine, said that the newly added drugs can help patients more easily accept and adhere to long-term treatment, and their inclusion in medical insurance will also help reduce patients’ financial burden.
A batch of innovative drugs enter medical insurance at the “whistleblower”
“In 2023, 25 innovative drugs participated in the negotiations, and 23 were negotiated, with a success rate of 92%.” Huang Xinyu said that through negotiations, the prices of innovative drugs have become more reasonable, patients’ affordability has improved, and most of them have experienced increases in sales and income. Condition.
After nearly an hour of tug-of-war negotiations, the contract renewal negotiations for BeiGene’s independently developed anti-tumor drug zanubrutinib were successful.
In the 2023 national medical insurance negotiations, contract renewal negotiations have become a new aspect. For innovative drugs that trigger the simple renewal price reduction mechanism, companies are allowed to apply for renegotiation, and the price reduction range can be lower than the price reduction range stipulated in the simple renewal contract. Many people in the industry believe that this makes medical insurance renewal price reductions more moderate and is beneficial to drug innovation.
“This allows innovative drugs with large clinical use to continue to renew their contracts with medical insurance at a relatively small price reduction.” Huang Xinyu said that according to the renewal rules adjusted and improved this year, among the 100 renewed drugs, 31 varieties require Price reductions averaged 6.7%.
“This year’s negotiation rules are more scientific and better reflect respect for innovative drugs, which is also an encouragement to companies.” Li Cong, negotiator of Junshi Biotech, said.
Hu Ying, chief physician of the Department of Medical Oncology, Beijing Chest Hospital Affiliated to Capital Medical University, said that in recent years, targeted drugs in the field of cancer have basically been included in medical insurance, and the speed is getting faster and faster. “In the past, new drugs often had to wait for many years following they were released, but now they are on the market. In one or two years, medical insurance will cover it.”
This is due to the fact that in recent years, the medical insurance drug catalog has established an “annual adjustment” dynamic adjustment mechanism, changing the access method from an expert selection system to an enterprise application system. The application scope mainly focuses on newly launched drugs within 5 years. Currently, the proportion of newly launched drugs within five years among the new varieties that year has increased from 32% in 2019 to 97.6% in 2023.
Among them, 57 varieties will be “approved and included in the catalog that year” in 2023. For example, the myasthenia gravis drug Igamod α injection was approved in June 2023 and successfully entered into medical insurance through negotiation.
“As an innovative drug for rare diseases, it took less than half a year for Igamod α injection to be included in medical insurance from its launch, which reflects the country’s support for innovative drugs with huge clinical needs.” Neurosurgery, Huashan Hospital Affiliated to Fudan University Zhao Chongbo, chief physician of the Department of Internal Medicine, said.
Gong Bo, a medical insurance negotiation expert who has participated in many negotiations, said in an interview that whether it is from the optimization of the medical insurance negotiation process in recent years or the full communication with enterprises before negotiations, it can be clearly seen that medical insurance negotiations have an impact on domestic innovative drugs. Support continues to grow.
Behind the medical insurance negotiations is “life first”
On November 20, the negotiation site for the 2023 National Medical Insurance Drug List was held.Photo by Xinhua News Agency reporter Peng Yunjia
The anti-tumor drug anlotinib was successfully negotiated to enter the medical insurance directory for the first time in 2018, and it will be renewed once more this year. Compared with general targeted drugs targeting genetic mutations, anlotinib covers a wider range of lung cancer types and patient populations.
A patient who participated in the urban employee medical insurance calculated an account for the reporter: assuming there is no medical insurance reimbursement, the annual medication cost of anlotinib is more than 70,000 yuan; following medical insurance reimbursement, he only needs to bear regarding 15,000 yuan a year.
“The price of anlotinib has dropped significantly following being included in the medical insurance, which has improved the accessibility of the drug for lung cancer patients and the clinical drug selection of doctors.” Zhi Xiuyi, chief expert of the thoracic surgery department at Xuanwu Hospital of Capital Medical University, said that in recent years, with the change of With the emergence of more independently developed anti-tumor drugs in my country, the situation in the past that only imported drugs might be selected for some drug types has changed.
“After 6 rounds of adjustments, the National Medical Insurance Administration has added a total of 744 new drugs to the medical insurance catalog, of which 446 have been added through negotiation, covering all 31 therapeutic areas in the catalog.” Professor of Fudan University, Drug Economics for Adjustment of the National Medical Insurance Drug Catalog in 2023 Chen Wen, leader of the scientific expert group, said that most of the drugs included in the catalog through negotiation are drugs that have been newly launched in recent years and have high clinical value. A large number of drugs with new mechanisms and new targets have been included in the catalog.
Since the establishment of the National Medical Insurance Administration in 2018, annual drug negotiations have enabled the medical insurance catalog to guide the “upgrading” of clinical drugs in my country by “removing the old and incorporating the new”.
Jiajia, the founder of PNH Patient Home, expressed the hope that following the new version of the medical insurance catalog is officially implemented, the medical insurance channel for rare diseases will be smoother, so that patients in need can truly afford and use medicines.
In response to the problem of negotiating for drugs that “can be admitted to medical insurance but not to hospitals”, my country has established a “dual-channel” mechanism for negotiating drug allocation and payment, opening up the “last mile” of patients’ medication through two channels: designated medical institutions and designated retail pharmacies. As of the end of October 2023, the drugs negotiated during the agreement period of the 2022 version of the drug catalog have been deployed in 239,200 designated medical institutions across the country.
[Editor in charge: Wu Jiang]
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