Why is it difficult to enter the hospital after the “soul bargaining” of innovative medical insurance drugs?

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Xinhua Media+|Why is it difficult to enter the hospital after the “soul bargaining” of innovative medical insurance drugs?

Why is it difficult to enter the hospital after the “soul bargaining” of innovative medical insurance drugs?

Xinhua News Agency, Beijing, April 8th : Why is it “difficult to enter the hospital” after the “soul bargaining” of innovative medical insurance drugs?

Xinhua News Agency reporters Peng Yunjia, Gong Wen, and Chen Xiyuan

Recently, a set of data shows that as of the third quarter of 2020, the innovative tumor drugs included in the National Medical Insurance Catalog from 2018 to 2019, Among the 1420 sample hospitals, the admission rate is about 25%. This set of data has sparked heated discussions about “difficulty of innovative drugs entering hospitals.”

How to get this set of data? Why are innovative drugs “difficult to enter the hospital”? What factors affect the provision of medicines in medical institutions? How to get through the “last mile” into the hospital? The reporter interviewed experts and industry insiders.

According to the Chinese Pharmaceutical Association, the calculation method of the data is not reasonable, and it includes all grades and types of hospitals in the statistical scope. In fact, many hospitals do not have the ability to provide medical services and therapeutic drugs for cancer patients, such as some grassroots hospitals and non-tumor specialty hospitals. Therefore, the proportion of innovative cancer drugs that they draw into hospitals is relatively low.

Hu Shanlian, a professor at the School of Public Health of Fudan University, believes that within an appropriate sample hospital, the proportion of hospital admissions of drugs can show the admission and use of drugs, but it cannot be the only way to evaluate the availability of drugs. standard.

“Different drugs will have different hospital admission rates.” Hu Shanlian said that each drug has a hospital admission rate that matches its own characteristics. Even if some drugs have been on the market for a long time, the admission rate will be different. Keep it low.

Why innovative drugs are “difficult to enter the hospital”?

“Drugs entering the hospital need to be screened by the Pharmaceutical Affairs Committee.” Fan Jia, academician of the Chinese Academy of Sciences and dean of Zhongshan Hospital of Fudan University, said that since the 2018 medical insurance catalogue began to be adjusted, many innovative drugs have been included in medical insurance. , But entering the medical insurance does not mean entering the hospital immediately.

So, what are the factors that affect the provision of medicines in medical institutions?

——The degree of clinical demand for drugs. “Whether a certain kind of medicine can be equipped by the hospital depends mainly on the hospital’s demand for the medicine in terms of clinical treatment.” Hu Shanlian believes that in general, the more extensive the hospital’s strong professional treatment fields, the more urgent the clinical needs, and the corresponding drug allocation rate Higher.

——Consideration of the hospital’s own cost. After the implementation of the drug “zero price difference” policy, objectively drug distribution, storage, and loss have become hospital costs.

——The pressure of hospital assessment. Although relevant national departments have issued policies, individual regions still include negotiated drugs into assessment indicators such as “drug proportion” in the assessment of public hospitals, which affects the enthusiasm of public hospitals to equip innovative drugs.

——The hospital has been equipped with a stock of types of medicines. “For some hospitals that have been equipped with drugs in full, new drugs mean that the same number of varieties must be transferred.” Hu Shanlian introduced that public hospitals with more than 800 beds should not be equipped with more than 1,500 drugs.

——Competition of similar drugs. In the same treatment field, there are a large number of drugs with the same treatment mechanism and different manufacturers, and the provision of drugs into the hospital is facing competition, which will ultimately affect the provision of drugs.

“In the past three years, the list of medical insurance drugs has been adjusted every year.” said Ding Jinxi, a professor at China Pharmaceutical University. It is precisely because the frequency of adjustments has accelerated and the number of drugs in the new catalog has increased, the pressure of admission to the hospital has been great. , The problem of slow progress only gradually emerged. It can be said that “difficulty in entering the hospital” is the “throttle” that has occurred after the reform of medical insurance.

Innovative drugs “entering the hospital” does not happen overnight

Experts say that compared to drugs with a long clinical time, newly-marketed innovative drugs will take more time to enter the hospital. A step-by-step process.

——It takes time to accept new drugs. “Innovative drugs in medical insurance can not only fill up the medication gap, but also increase the scope of patients’ choice.” Ding Jinxi said, but it takes time for new drugs to be accepted and used, including clinicians’ understanding of new drugs, clinical medication guidelines and norms. Factors such as formation and revision will affect the admission of new drugs to hospitals.

“Admission to the hospital is also a kind of competition.” Li Ning, general manager of Junshi Biotech, said that some medicines were collected and used by the hospital before entering the medical insurance. It is relatively easy to enter the hospital after entering the medical insurance. But if the hospital has never purchased a certain brand of medicines, it will consider more factors when entering the hospital.

——The equipment of new medicines is promoted according to the echelon. Experts said that compared with drugs not included in the medical insurance catalog, the provision of drugs included in the medical insurance catalog will be significantly faster. In terms of the scale of institutions, large hospitals with high technical level are equipped first, followed by small and medium-sized hospitals; in terms of geographic distribution, large cities with concentrated medical resources are the first to provide them, followed by the central and western regions.

“Innovative drugs are new drugs. With the improvement of clinical understanding and acceptance of new drugs, the number of hospitals purchased and the number of patients taking drugs will increase.” The relevant person in charge of the National Medical Insurance Bureau said that in 2019 Take the 70 newly-added drugs in the negotiations as an example. In the fourth quarter of 2020, the number of drug users increased by more than double the number of drugs used in the first quarter reached 61.

How to get through the “last mile” of entering the hospital?

In order to solve the problem of the insured’s difficulty in medication, many places have begun to explore feasible methods.

Sichuan Province implements single-line payment drug management for nationally negotiated drugs, and includes drugs that are expensive, specific to the user population, clear drug indications, and limited dosages into single-line payment management. In the latest version of the medical insurance drug list, Sichuan Province has included 88 drugs under single-line payment management, including Maxitentan for the treatment of rare diseases of pulmonary hypertension, and Pertuzumab for the treatment of breast cancer.

“Due to the small number of rare disease patients, the clinical use of rare disease drugs and hospital equipment will remain at a low level.” Ding Jinxi said that such drugs can be managed with special drugs to ensure that the people have channels to buy To medicine.

At the same time, make full use of the flexibility of retail pharmacies in many places, and adopt the method of co-supplying medical insurance drugs in designated hospitals and designated pharmacies to ensure the availability of medicines for participants.

Fan Jia believes that opening up the “last mile” of innovative drugs into hospitals requires the joint efforts of the government, hospitals, and pharmaceutical companies. We must further improve policies to loosen medical institutions; pharmaceutical companies must also strengthen guidance to clinicians to familiarize them with innovative drugs as soon as possible; at the same time, hospitals should also promote the optimization and upgrading of in-hospital drug structures to promote the improvement of diagnosis and treatment capabilities with the level of drug security.