On May 20, the Guangzhou Medical Insurance Bureau printed and distributed the Measures to Support the Development of Innovative Medicine, which clearly stated that in order to promote the rapid development of innovative medicine, 21 new rules should be formulated in four aspects, namely, speeding up the use in hospital, promoting clinical application, expanding payment channels, and strengthening service support.
The Notice pointed out that no budget target for the total amount of medical insurance was assigned to designated hospitals; The state talks about implementing separate payment management for innovative drugs such as drugs, and increasing the proportion of medical insurance reimbursement, Not included in the treatment limit of general outpatient service and outpatient service for specific diseases.
In addition, Guangzhou Medical Insurance Bureau will The exchange meeting of "medical insurance hospital enterprise" was held irregularly to discuss the landing and use of drugs, Promote the use of drugs in hospitals.
As an area where high-quality medical resources are concentrated nationwide, Guangzhou is exploring the implementation of supporting policies for the development of a number of innovative drugs. Guangdong Province had previously made it clear that the limit on the number of drugs used by medical institutions was lifted, and the clinical use of innovative drugs was unblocked.
Simplify the online process and speed up the admission of innovative drugs
In the process of drug purchase in Guangzhou, the GPO purchase platform is required to establish an innovative green online purchase area for medicine and equipment to simplify the application materials of enterprises.
The Bureau of Health and Education found that different provinces have different online rules and supplement cycles for innovative drugs. There are also innovative drugs that are added monthly, while most of the national drugs are listed quarterly. The online cycle has affected the sales of innovative drugs to some extent, This time, Guangzhou requested to improve and innovate the rapid networking mechanism of medicine and equipment, The original intention of optimizing the networking process.
Pharmaceutical enterprises are most concerned about the admission after being connected to the Internet. The Guangzhou Medical Insurance Bureau has made it clear that it will urge designated medical institutions to hold drug affairs meetings and timely incorporate the state negotiated drugs and innovative drugs into the procurement scope of medical institutions. Relevant information will also be included in the assessment and evaluation of medical insurance. At the same time, the "medical insurance hospital enterprise" exchange meeting on the landing and use of state talk drugs was held irregularly to promote the use of state talk drugs in hospitals.
According to the questionnaire of the Drug Research and Development Committee (RDPAC) of the China Association of Enterprises with Foreign Investment 88% of hospitals have some concerns about the quantity limit of drug use catalogue, More conservative attitude towards the introduction of negotiated drugs.
It is widely believed in the industry that the new regulations of Guangzhou undoubtedly enable medical institutions to improve the process of innovative drug admission from the system, and the blocking points are gradually being broken through. Industry insiders hope that this kind of irregular exchange meeting can be "a little more" to avoid losing the opportunity to enter the hospital due to the time difference in the implementation of local policies.
In addition to the drugs negotiated by the state and the medicine and equipment purchased in quantity, Guangzhou also launched new measures this time: Innovative products not covered by medical insurance shall be negotiated independently between enterprises and medical institutions.
Analysts pointed out that: The independent price negotiation does not mean that the hospital can negotiate the price twice, but the online price is negotiated by the enterprise and the hospital, but the low price linkage is required.
Reduce the clinical assessment of innovative drugs and incorporate them into the medical insurance of the city in time according to regulations
In addition to the continuous optimization of the process for the admission of innovative drugs, pharmaceutical enterprises are more concerned about whether the clinical use of innovative drugs is still restricted.
This time, Guangzhou made it clear that the cost of innovative drugs, such as state talk drugs, occurred in designated hospitals, Separate settlement or inclusion of payment based on disease score shall be carried out for bonus points. At the same time, in the annual assessment of medical insurance, relevant indicators such as the growth of average cost per time, the growth of average outpatient cost per person, the growth of average hospitalization cost per time, and the self expense rate were involved, and the costs related to innovative drugs and equipment such as national drugs were excluded.
In fact, the medical insurance payment of innovative drugs has been restricted by various policies in recent years. Many enterprises are difficult to obtain expected returns and have to reduce the number of marketing teams.
The National Health Insurance Bureau has publicly stated many times that, The purpose of implementing the reform of payment mode is not simply to "control fees", but to support the application of new technologies and ensure adequate treatment of seriously ill patients. Obviously, Guangzhou has fully implemented the idea of the National Health Insurance Bureau to loosen the reform of the payment side, so that innovative drugs are no longer restricted by the hospital's various assessments, which is undoubtedly a win-win result for hospitals, patients and enterprises.
However, this does not mean that it can be used freely in clinical practice. Requirements of Guangzhou, Strengthen the monitoring of the allocation and use of state negotiated drugs in designated medical institutions, Regularly report the allocation and use of designated medical institutions quarterly.
Analysts pointed out that the policy will gradually loosen the restrictions on the clinical use of innovative drugs, but if abuse occurs, the enterprises involved will be severely hit by the regulatory authorities.
meanwhile, Guangzhou also considered the particularity of innovative medical devices. The Notice clearly states that Guangzhou will timely incorporate innovative medicine and medical technology into the medical insurance payment scope of the city. For innovative technology projects, priority should be given to launching unified pricing demonstration procedures, and simultaneous research should be included in medical insurance payment. For new medical service price items that have been approved for establishment, medical institutions can record and apply them at any time.
In addition, Guangzhou will deepen the pilot policy of "Suisuikang" commercial supplementary health insurance, include self funded drugs with unlimited disease range and unlimited drug varieties as required, and give preferential treatment to eligible national drugs and innovative drugs, Support pharmaceutical enterprises that meet the conditions for innovative drugs to apply for inclusion in the "Suisuikang" organization at any time.
Writer | Xiaomi
Editor | Jiang Yun and Jia Ting
Operation | XXIII
Illustration | Visual China
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