How the Medical Insurance Treatment Affects the Pharmaceutical Market

On July 22, the State Medical Insurance Bureau issued the "Opinions on Establishing the Management System of Medical Security Treatment List" (hereinafter referred to as "Opinions"). The draft continues the original logic of the State Medical Insurance Administration at the regulatory level. First, the power will continue to be collected, but it will give local flexibility on the premise of guaranteeing the basic rules. Secondly, we should deepen and improve the level of security, which will accelerate the transformation of existing medical services and drug markets. Firstly, in terms of the items and standards of fund payment, the Opinion clearly defines the unified rules formulated by the state, which can be flexible to a certain extent.

First of all, the original provincial medical insurance catalogue will no longer be allowed on the drug catalogue. "The state unifies the formulation of the national basic medical insurance drug catalogue, and all localities strictly follow the national basic medical insurance drug catalogue. In principle, they must not make their own catalogue or increase the catalogue by flexible methods." Drugs." This means that the State Medical Insurance Bureau directly returns this power to the central government and no longer gives flexibility to the local government. Pharmaceutical enterprises can hardly hope to compensate for the lack of access to the national medical insurance catalogue through the addition of provincial medical insurance catalogue.

Secondly, in terms of medical service items, "the state unifies the formulation of basic medical insurance medical service items and facilities, and each province can adjust them appropriately within the scope prescribed by the state". Because of the great differences among different parts of China and the different emphasis of demand for medical service projects in different regions, provinces will make adjustments under the premise of unified provisions, which means that the rules for the scope of medical service projects and facilities will also be formulated entirely by the state, and all parts of China can only make adjustments within the limited scope. Finally, in terms of medical insurance payment standards, "all co-ordinated areas can formulate payment standards for medicines, medical service items and facilities and medical insurance adapted to various payment modes in accordance with national regulations. If the state unifies the formulation of payment standards, they shall be implemented in accordance with the provisions of the state." This means that the standard of medical insurance payment will be mainly formulated by the provinces themselves in the future, but if the State formulates a unified standard, it must be determined according to the national standards.

From the point of view of drug payment standard, the price determined by 4+7 collection and collection can be regarded as the national standard of medical insurance payment in the future, while the drug collection and collection currently being carried out in various provinces can be regarded as the local standard. Combining with the summary of the internal Symposium on the second round of collecting and mining circulated in the previous stage, it can be seen that the reason why the National Medical Insurance Bureau does not expand the second round of collecting and mining is mainly to promote this principle to be launched throughout the country. The second round of collecting still concentrates on the original 25 varieties, but it is implemented nationwide, which means that the national drug payment standard is promoted nationwide. At the same time, the pilot collection of other varieties in local areas can be further carried out, which is conducive to the formation of local medical insurance payment standards. It can be predicted that in the future, more drugs with large dosage in the country will be paid by the state, and more drugs with large dosage in some areas will be handed over to the local authorities. From the point of view of joint procurement in some areas, the prices generated by the linkage of several provinces may also become the common standard of medical insurance payment in some areas.

In the process, the National Medical Insurance Bureau and various regions can form a linkage to a certain extent, especially in the case of rapid release of some drugs, the centralized collection of the National Medical Insurance Bureau can enter the market at any time, which will have a great impact on drug prices. From the point of view of service payment standard, in the future, the mixed payment mode of outpatient service and DRG payment mode of inpatient service will be adjusted on the basis of national standards, and each region will form its own medical insurance payment standard.

On the one hand, it is based on the local economic level and actual capacity to pay, on the other hand, it is also based on the local medical costs to make an adjustment. As the adjustment of service standards requires the improvement of fine management ability, this process will be slower than that of drugs.