The medical insurance fund is not enough to cause the drug to be transferred out of the medical insurance catalog?
The National Medical Insurance Administration responded: The national medical insurance fund has a balance of payments and a slight balance
Reporter Mei Mei Changsha reports
The person in charge of the Pharmaceutical Management Department of the National Medical Security Administration answered questions from reporters on the 23rd on the “transfer” of local supplementary medical insurance drugs. Talking about some netizens who said that “the local government removed some drugs from the medical insurance list because the medical insurance fund is not enough”, the National Medical Insurance Bureau responded and pointed out that “of course not”.
The medicines called out are hardly used clinically
Recently, the report that “some medicines will be transferred to the local medical insurance list by the end of the year” has aroused social concern. Why do some drugs have to be transferred out of the local medical insurance?
A set of data shows that from September last year to June this year, the Beijing Medical Insurance Fund actually paid nearly 300 million yuan for various dosage forms of amlodipine, while the drop pill dosage form was 0. Among the drugs transferred from Beijing this time, there is the drug “Amlodipine Dropping Pill” for hypertension and coronary artery disease with a payment of 0.
“Clinically the mainstream dosage form of amlodipine is tablet or capsule, which is produced by dozens of companies and has always been in the medical insurance catalogue. The transferred pills are hardly used clinically.” The relevant responsible person of the Medical Service Management Department of the National Medical Security Administration People explained that the local supplementary drugs “digested” (that is, transferred out) in all provinces across the country have lower prices and better quality alternative medicines in the existing national medical insurance catalog, and the transfer out has little impact on clinical medication.
A similar situation exists for another analgesic and anti-inflammatory drug, ibuprofen, which has raised concerns. The drug called out is only “ibuprofen gel”, while the national medical insurance drug catalog includes “ibuprofen” capsules, tablets, oral liquids, granules, ointments and other dosage forms.
Local supplementary medicines can be better replaced
According to reports, at the beginning of the establishment of the basic medical insurance system, in view of the fact that there were few varieties of the national medical insurance drug catalogue and the large differences in medication habits between regions, the state allowed provinces to supplement their own needs according to the actual situation such as the level of local economic and social development, medical needs and medication habits. Some drugs, but not more than 15% of the number of “Class B drugs” in the national catalog.
In 2018, the National Medical Insurance Bureau was established. A major reform has been implemented in the access method of the medical insurance drug catalogue. On the basis of maintaining basic insurance and sustainability, more new and good drugs have been included in the scope of medical insurance. A total of 507 new and good drugs have been included in the past 4 years, and 391 drugs with uncertain curative effects have been selected. , the current version of the medical insurance catalogue of Western medicines and proprietary Chinese medicines has increased to 2,860.
In terms of drug prices, price negotiation has been carried out by integrating the national dosage, and many “high-priced drugs” have negotiated “common people’s prices”; in terms of drug structure, the shortcomings of oncology drugs, chronic diseases, rare diseases, and children’s drugs have been gradually supplemented. The drug structure and efficacy level have been greatly optimized; in terms of drug supply guarantee, the main responsibility of medical institutions for negotiated drug preparation has been clarified, and designated retail pharmacies have been included in the scope of negotiated drug supply guarantee.
“The guarantee capability and level of the National Medical Insurance Drug Catalog have not been as good as before, and local supplementary drugs can basically be better replaced by drugs in the National Catalog.” The relevant person in charge of the National Medical Insurance Bureau explained.
Gradually transfer many new and good drugs into the medical insurance list
There is a point of view that “the local government removed some drugs from the medical insurance catalog because the medical insurance fund is not enough.” The relevant person in charge of the National Medical Insurance Bureau clearly responded: Of course not. In 2021, the national basic medical insurance fund (including maternity insurance) will have an income of 2.88 trillion yuan and an expenditure of 2.4 trillion yuan. In general, the national medical insurance fund has a balance of revenue and expenditure, with a slight surplus. The scale of revenue and expenditure is in line with the level of economic development, and the fund’s security capability is stable and sustainable. In fact, it is precisely under the strong protection of the medical insurance fund that since the establishment of the National Medical Insurance Bureau in 2018, many new and good drugs have been gradually transferred to the medical insurance catalog, which has achieved a significant expansion of the scope and level of medical insurance coverage.
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By the end of the year, the national medical insurance drug coverage will be basically unified
According to Xinhua News Agency, the relevant person in charge of the Medical Service Management Department of the National Medical Insurance Bureau introduced on the 23rd that by the end of 2022, all provinces in the country will complete the “digestion” of local supplementary drugs, and realize the basic uniformity of the national medical insurance drug coverage.
The person in charge introduced that on the basis of comprehensive consideration of factors such as the affordability of local medical insurance funds, clinical and public medication habits, and drug replacement cycle, the National Medical Insurance Bureau has researched and formulated a three-year “digestion” plan for local supplementary drugs, that is, from 2020. At the beginning, according to the ratio of 40% in the first year, 40% in the second year, and 20% in the third year, the drugs that were added according to the regulations in the original provincial drug list will be gradually transferred, and by the end of 2022, the national medical insurance drug coverage will be basically unified.
As of June 30, 2022, 15 provinces across the country and the Xinjiang Production and Construction Corps have completed the “digestion” task of supplementing drugs ahead of schedule, and the remaining 16 provinces have completed the “digestion” of drugs by the end of 2022.
According to the person in charge, in the next step, the National Medical Insurance Administration will strengthen the scheduling of the “digestion” of medicines across the country, guide all localities to do a good job in the conversion and connection of local catalogues and national catalogues, and guide medical insurance designated medical institutions to choose better alternatives in the national catalogue. Drugs to avoid impact on clinical medication.
Source: Xiaoxiang Morning News