The National Health Insurance Bureau issued the Interim Measures for the Administration of Medication in Basic Medical Insurance (hereinafter referred to as the Measures), which was officially promulgated after the publication of the draft for comments on April 29th, and will be implemented on September 1 day. Subsequently, in August of 18, the supporting documents "Work Plan for the Adjustment of National Medical Insurance Drug List in 2020" (referred to as "Work Plan") and "Guide for the Application for the Adjustment of National Medical Insurance Drug List in 2020" were released. The Measures are divided into six chapters and 37 articles, including the determination and adjustment of the scope of basic medical insurance drugs, as well as the payment, management and supervision of basic medical insurance drugs, which indicates that China has taken a substantial step in establishing and improving the long-term mechanism for dynamic adjustment of medical insurance catalogues. Among them, the formulation and adjustment of the Catalogue divides drugs into four categories: new drugs, direct drugs, drugs that can be transferred out and drugs that can adjust the scope of payment restrictions. The status of the directory exit mechanism has been significantly improved compared with the past. The perfection of this mechanism will help to further optimize the drug structure in the catalogue, improve the efficiency of fund use and accelerate the transformation and upgrading of the pharmaceutical industry.
Perfecting the exit mechanism of medical insurance catalogue is in line with the practical needs of current medical insurance management.
First of all, in recent years, with the improvement of the service capacity, medical insurance coverage and security level of the medical system, the rapid growth of people's medical needs and their desire for high-quality medical products, the pressure on medical insurance fund expenditure has increased.
Second, the emerging new drugs, technologies and methods not only promote clinical treatment, but also have a potential impact on the medical insurance fund.
Third, the current catalogue structure has increased after two adjustments in recent years, and the catalogue of breakthrough innovative drugs and high-priced drugs has shown a rapid growth trend. Although the drug structure is more reasonable, there is still much room for improvement, such as the proportion of auxiliary drugs and key monitoring varieties in the catalogue is still at a high level.
Fourthly, the previous medical insurance catalogue evaluation paid more attention to the safety and effectiveness of drugs, and did not make the necessary evaluation conditions and evidence support for the economy of drugs.
Fifth, at the beginning of this century, in the era of relaxed drug approval in China, there was no perfect systematic evaluation and strict comprehensive evaluation of the admitted drugs. At present, the State Administration of Pharmaceutical Products still has more than 1.6 million registered drug numbers.
In view of this, the management measures of the National Medical Insurance Bureau and the recent medical insurance management related documents have emphasized pharmacoeconomics and pharmacoeconomics for more than ten times. In the future, the influence of medical insurance drugs on the fund budget and the evaluation of patients' health value will become more and more important.