Recently, the news of National Drug Reimbursement negotiations has constantly touched the heartstrings of pharmaceutical people. With the increasing of the elderly population in China, the reduction of drug price is a major trend. But the falling prices may not be friendly to new drugs. In this paper, the author makes a brief analysis of the mode and history of competitive access to medical insurance drugs.
There are three types of access to medical insurance drugs in China.
With the continuous deepening of China's reform on medical and health system, the National Drug Reimbursement List and the essential drugs list are gradually developing towards scientific management and refined development. Hence, the access system for such drugs will be gradually scientific and rational, instead of just on the basis of price. National Healthcare Security Administration No.1 Order in July, 2020 showed that drugs outside the National Drug Reimbursement List can enter the channel through negotiation access, direct access and bidding access. Among them, the negotiation access is for exclusive products, direct access is for products that winning the bid, and bidding access is non-exclusive products beyond the above two products. At present, exclusive drugs and non-exclusive drugs in China are negotiated by one-time access bidding.
How do foreign countries adopt the medical insurance access?
In fact, cost control is also the key to foreign medical insurance access, especially for some new drugs or exclusive products. Different countries have different strategies, but they are basically the same. Generally speaking, the principle for generic drugs is cheap price. Negotiations or other preferential policies are mainly for innovative drugs.
Medical insurance negotiations are mainly for innovative drugs.
Medical insurance negotiations are mainly for innovative drugs. Some of the policies of countries in the world are based on the results of expert discussions, and some are based on the special evaluation of pharmacoeconomics... Only New Zealand is quite similar to China in adopting a healthcare access system.
The negotiation of innovative drugs in New Zealand is mainly based on reducing the burden on patients. For example, the price of some drugs may remain unchanged, but the actual payment price can be reduced by increasing the payment ratio of medical insurance, and the patent period of drugs can be extended by agreement, or they can embrace special patent protection extension. Pharmaceutical companies can get benefits in this way, the drug price is also reduced, and finally, patients get the benefits. In short, it is generally a triple-win result.
Low prices are the most advantageous for brand generic drugs.
After the ending of the agreement protection period or patent protection period of some original drugs ends, all manufacturers who imitate these drugs can participate in the bidding for access to the directory of medical insurance products. The term obtaining through this bidding way is a period of 2-3 years, instead of permanent. At the end of the current contract period, it is necessary to negotiate again and re-screen cheaper generic drugs to save medical insurance funds to the greatest extent. Therefore, for brand generic drugs, the low price is the most advantageous and there is a time limit. It is an exclusive national medical insurance supply right with a certain time limit.
National Drug Reimbursement List products based on common names is a drawback
At present, China's National Drug Reimbursement List is classified and managed according to the common names of drugs. All manufacturers under the common name can get medical insurance payment after these drugs are included in the National Drug Reimbursement List. The biggest problem here is that the same generic drug from different medical supplies manufacturers may have different pricing strategies, outer packaging, production levels and economic conditions of the site, which lead to great differences in product prices for generic drugs wit...
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