The new medical insurance drug list was launched
The National List of Drugs for Basic Medical Insurance, Workers’ Compensation Insurance and Maternity Insurance (2020) was officially launched on March 1, and the new medical insurance payment standards were implemented for 221 state-negotiated drugs within the agreement period, which attracted much attention. On the first day of the implementation of the new medical insurance regulation, The Paper interviewed many hospitals in Beijing about the delivery of new drugs. It found that after many countries negotiated the delivery of biological agents to hospitals, some patients got their first prescription and found that the drug cost after the reimbursement of medical insurance was significantly lower than the original drug price, which is expected to save more than 100 thousand yuan of drug cost a year.
A number of experts also told thepaper.cn that new drugs negotiated by the state will benefit patients after entering medical insurance, but the accessibility of new drugs for grassroots patients needs to be further improved.
Biological agents bring a new therapeutic situation to the treatment of a variety of diseases
Among the new drugs negotiated by the state, a number of newly approved biological agents have entered the list of medical insurance after successfully negotiating with the state for a lower price. New drugs such as Schiuzumab, used to treat ankylosing spondylitis and psoriasis, and duprizumab, used to treat moderate to severe atopic dermatitis.
Targeted biologics treasurer, especially single resistance is the state food and drug administration issued the first batch of urgent clinical needs of foreign one of the new drug, the drug in April last year won the state food and drug administration approved for regular adult patients with ankylosing spondylitis treatment curative effect, this also is the drug after March 2019 approved for the treatment of moderately severe plaque of psoriasis after approved indications for the second in China.
Mu Rong of the director of the department of rheumatism immunology of the third hospital of Peking University that is engaged in the work of rheumatism immune disease diagnosis and treatment for a long time looks, along with the in-depth study of pathogenesis, had all sorts of targeted biological agents, whole rheumatism nearly 30 years treatment situation compares with in the past, greatly changed. Doctors still typically use traditional NSAIDs as the first line of treatment for patients with ankylosing spondylitis, but now have a new and more potent weapon in the form of targeted biologic agents for patients who have failed to respond to traditional treatments.
Current biologic agents for the treatment of ankylosing spondylitis include multiple tumor necrosis factor α(TNF-α) inhibitors and interleukin inhibitors. Three TNF-α inhibitors and one interleukin inhibitor were included in the new list through national negotiations. The only interleukin inhibitor was Schiuzumab.
Dupriuzumab, approved by the State Food and Drug Administration last June for the treatment of moderate to severe atopic dermatitis, has also changed the status of treatment in China.
Lin Zhimiao, deputy chief physician of the dermatology department at Peking University First Hospital, explained to The Paper that atopic dermatitis, especially moderate to severe atopic dermatitis, is one of the few dermatological diseases that have a high impact on quality of life. “Pruritus is the most obvious feature of this disease, and even in those patients who have been diagnosed, the effect of conventional treatment is not satisfactory, and the disease is repeatedly uncontrolled for a long time.”
“Dupriumab has significantly changed the treatment of atopic dermatitis in China.” Lin said that patients with moderate to severe atopic dermatitis now have drugs that can be used for a long time, and do not need to worry about serious adverse reactions.
It saves $160,000 a year on drug costs after reimbursement
“Biologic drugs were extremely expensive when they first came into the market. They were sky-high compared to the income of ordinary people.” ‘It’s like penicillin was also expensive in the past, but now the price has come down to a very low level,’ Mu told thepaper.cn. In the future, rheumatism will be like this, with more and more drugs available and lower prices.
At present, the way to reduce the price of “sky-high” biologics is through national negotiation for enterprises to take the initiative to reduce the price. The payment standard of the negotiated drugs is the medical insurance payment standard agreed by the drug enterprises and the National Medical Insurance Bureau, and it is also the sum of the expenses paid by the fund and the individual patients.
To this process landing have intuitive experience of non – patients. On the morning of March 1st, after receiving the first prescription form of DuPriumab after the implementation of the medical insurance from Lin Zhimiao, the patient, Xiao Hua (pseudonym), felt deeply.
“I was diagnosed with atopic dermatitis in 2017 and tried traditional treatments, but the side effects were quite severe. Itchy sleepliness is very unpleasant and the quality of life is seriously affected.” Xiao Hua said that she started using the biologic agent Dupriuzumab last year, and the cost of the health insurance is obviously reduced after it is implemented today.
“To evaluate a drug, we need to look at its effectiveness on the one hand and its accessibility on the other. “This rollout of Dupriuzumab will further benefit patients in terms of access.” Expericnce, director of the Peking University first hospital dermatological department calculated brushstroke zhang, degree of split single fight before getting into health care, especially a drug prices to more than 6000 yuan, through the national business negotiations to lower the price a lot of, combined with Beijing’s urban employee basic medical insurance fund according to the 80% pay, such self-paid part consisting of a medicine patients at this time as long as more than 600 yuan, is said to be almost 1/10 of the original drug. If according to a year of treatment to calculate, patients a year save drug costs can reach more than 160,000 yuan.
Experts called on local and municipal hospitals to buy new drugs negotiated by the state
Compared with previous years, the number of drugs transferred into the national medical insurance drug list adjustment negotiation in 2020 was the largest, benefiting a wider range of treatment fields. But most hospitals do not buy all the state-negotiated drugs in the list. What are the procedures for buying medicine at the hospital? What are the criteria for selecting drugs in the Medicare Directory?
The paper.cn has noted that the drugs listed in the new medical insurance directory still need to go through multiple procedures to reach patients. First of all, the State Administration of Medical Insurance and the Ministry of Human Resources and Social Security issued the National List of Drugs for Basic Medical Insurance, Work-related Intrial Insurance and Maternity Insurance (2020), which was purchased through the network in various provinces and cities and by various hospitals.
Wang Ping, vice president of Peking University First Hospital, told thepaper.cn on March 1 that hospitals will first compare the national medical insurance list with their own drug list, and if the price is lowered, the new price will be implemented. For the drugs that the hospital does not have before, the clinician will adjust them according to the characteristics of the disease spectrum. If there is a clinical need, the clinician will submit the demand application to the hospital pharmaceutical administration committee for evaluation by the clinical pharmacist. If the clinical application for new drugs is reasonable, the pharmaceutical administration committee will approve the purchase.
“Some hospital disciplines are at the forefront of development, such as some of our dermatology, nephrology drugs, and some anti-tumor drugs, which can be adjusted in time so that patients can use them in the first time, which can also promote the development of the discipline.” Wang Ping told thepaper.cn that hospitals have different service capacities in different disciplines. Some disciplines are stronger, so there are more drugs. Some disciplines are weak or even empty, so the drugs in such a list may not be needed for the time being.
The paper.cn previously found in an interview that many grass-roots patients could not buy direct antiviral drugs for hepatitis C, which were entered into the medical insurance directory through national negotiations. “Many hospitals, especially grass-roots hospitals, do not receive drugs, and county-level hospitals and even prefecture-level hospitals do not have these new drugs.” Wang Guiqiang, director of the department of infectious diseases at Peking University First Hospital, previously told thepaper.cn in an interview.
Because there is no good treatment drugs and treatment means at the grassroots level, many patients choose to go to big hospitals in big cities.
“We hope that these drugs can be prescribed in many hospitals across the country. We don’t expect patients to travel thousands of miles because such a drug comes to our hospital for treatment.” Lin said atopic dermatitis is a common disease and is not difficult to diagnose.
The First Hospital of Peking University, as the national clinical research center of skin and immune diseases, is responsible for the diagnosis and treatment of rare and difficult diseases.
Lin Zhimiao believes that the presence of dupriumab has changed the refractory characteristics of moderate and severe atopic dermatitis. “And the drugs are safer, so we still want patients to be treated locally.” For example, each city has a hospital that can get new drugs for treatment, Lin said. In this way, patients can truly realize hierarchical diagnosis and treatment, and there is no need to concentrate on big hospitals in big cities.
Mr. Mu Rong is of the same opinion. “Because rheumatology doctors are relatively short, discipline construction is relatively late, some cities, including prefecture-level cities have no rheumatology specialist doctors, so patients have to go to big cities to seek medical treatment.” Mu Rong said that the Chinese Association of Rheumatology now advocates a “one city, one department” plan, which means that each city should have one rheumatology department, so that patients who are not particularly difficult can be treated in regional medical centers and get reasonable treatment locally, instead of having to search for a doctor.
As for whether primary-level doctors can prescribe biologic agents such as Scuchizumab, Mu Rong believes that primary-level doctors need intensive training so that they can use drugs rationally when they have a complete understanding of the pharmacology. In addition, more clinical experience is needed to properly judge the optimal medication regimen for different patients. Rheumatism is a typical chronic disease. Grass-level doctors in community hospitals can renew prescriptions according to the prescriptions of doctors in high-level hospitals. A reasonable two-way referral system can optimize the medical process and reduce the medical expenditure.