According to the 2019 key work assignments of the National Medical Insurance Bureau, it is expected that a new round of national medical insurance catalogue adjustment will be launched in the near future. Referring to the progress of the 2017 edition of the catalogue, it is expected that the plan and basic database will be determined in March-April. Then, in May and June, the expert consultation and selection will be completed. From July to September, the medical insurance admission products will be negotiated. If all goes well, then the new medical insurance catalogue is expected to be released before the National Day and will be implemented during the year.
< p>Because this directory adjustment work time is tight, the task is heavy, and the time from the 2017 version of the catalog is not too long, so you can boldly guess: 1) the base database may use the 2017 version of the database when the directory is adjusted, and then join The 2017 version of the catalog database will be listed after the deadline for new drug data, which should focus on the innovative drug part. 2) should be a review of the province's supplementary and negotiated data as a reference. 3) expert library, due to the 2017 version of the country In the catalogue and provincial review, each province has established its own expert database, so it only needs to make a small update on the previous basis. Can be used directly.
As for the specific review program, whether the specific varieties can enter the catalogue, the general principle should be mentioned in the 2017 article "The ultimate guess, the most likely to be included in the new medical insurance catalogue" The clinical needs. Economic factors and market factors are not repeated here. There is no clear boundary between the catalogue and the negotiations mentioned in the previous paragraph. With the development of two rounds of medical insurance negotiations, it is now possible to deduce a general principle: The aspect should be an exclusive variety, and the vast majority are still in the patent period. On the other hand, it should be more expensive than the products in the same category or in the same therapeutic field. It is necessary to further negotiate to reduce the price. In addition, this catalogue The judging panel involves 11 non-medical national medicine products. Although the basic medicines and medical insurance catalogues are from two ministries, it does not mean that 100% of essential medicines should enter the medical insurance catalogue. However, there should still be a certain bonus in the judging.
According to the new drugs approved for domestic listing from 2016 to the present, from Pharmcube PharmaGo, although the overall number is still multinational The majority of innovative pharmaceutical products, but domestic companies have begun to have a lot of innovative products on the market, the number far exceeds the 2017 version of the catalog review, which is very encouraging progress. Although theoretically, medical insurance does not encourage domestic innovation. Obligations, but from the actual past experience, there will be some additional bonuses.
This article is mainly to make some analysis and prediction of some popular varieties in the 2019 national medical insurance catalogue adjustment, text According to the “Medical diseases such as cancer, chronic diseases, rare diseases and children's medications” highlighted in the key tasks of the National Medical Insurance Bureau, we have made a simple classification. Please also give us valuable comments.
There are still heavy products that are not included in the catalogue only De Gu insulin, from Degu insulin currently From the perspective of pricing strategy, it seems that it is necessary to enter the catalogue directly, so the probability will be directly entered into the catalogue without any negotiation. (
2. GLP-1 class
Considering Liraglutide has been negotiated into health care in 2017, In the second adjustment, exenatide. exenatide sustained-release microspheres. Lisinide. Durapeptide and domestic benaglutide are expected to enter the catalogue. Among them, exenatide is actually listed in China. GLP-1, but did not pass the expert selection when adjusting the catalogue in 2017. There may be problems with the transfer of domestic sales rights at that time, or it may be due to the two doses per day and relatively high from the perspective of the product itself. The price has formed a certain obstacle. The current price of exenatide will still be higher than that of liraglutide, but the sustained release microsphere dosage form is more expensive, but it wins once a week. Compliance. Domestic benaglutide is 3 times a day and the current price is the most expensive. It is estimated that the price of the drug will be greatly reduced. However, the nisin peptide and the glucosinolate can not be found at present.
< p>Anyway, no matter which GLP-1, at least the current laraglutide as a reference for payment standards, it is expected that the price after negotiation will not exceed 40 yuan / day, of which exenatide sustained release microspheres and degrees Lactopeptide is used as a long-acting once-a-week preparation. Can be slightly higher. My personal expectation of somaglutide and its oral preparations, from the review progress, certainly can not catch up with this catalogue. Also can not catch up with the possibility of major special support of polyethylene glycol Senamin.
Indications for this class of drugs should refer to liraglutide, the more expensive the product may be more restrictive.
3. SGLT-2 inhibitor
There are five DPP-4 drugs in the 2017 version of the catalogue, this time Daglipex. Engliflin. The three SGLT-2 inhibitors of Cagliflozin are very promising to enter the catalogue. The only problem is that the price of DPP-4 is less than 10 yuan per day. In contrast, the price of SGLT-2 inhibitors is still slightly higher. Maybe some products will start negotiations. Dagley’s actual daily cost is the lowest. The national base drug addition is the most likely to enter the catalogue directly. The indications for this category should refer to DPP-4, which is limited to second-line medication.
4. Compound product
Of the five DPP-4 inhibitors that entered the 2017 edition, four of them were marketed with metformin, and the SGLT-2 was also listed on the Metformin compound. This is undoubtedly because metformin is the absolute first-line drug for the treatment of diabetes. Internationally, both DPP4 and SGLT2, the sales of metformin compound products are not bad. For chronic diseases such as hypertension or diabetes, which can be used in combination, the compound products can be Improve patient compliance. But for the domestic medical insurance catalog review, how to pay for metformin in the compound product is the key.
At present, even the original research price of metformin is not too expensive, the day The cost is only about 3 yuan, not to mention that metformin is definitely the second batch of countries to purchase the variety, the time will definitely be less than 1 yuan or even 0.5 yuan. So, for these compound products, if similar to foreign The pricing strategy for the purchase of adjuvant drugs (Note: For example, the price of Englenet is only for the price of Englenet), it is the right choice to enter the product as soon as possible. In particular, several patents are about to expire. The product may also be able to delay the patent cliff brought by the national procurement through the exclusive compound product. From the current According to the data, metformin in the sitagliptin compound is the cheapest, and may be more active than other products, and the enclave compound may be more difficult due to the short time to market. Indications limit will be equivalent to the main drug.
The current domestic GLP-1.DPP-4.SGLT-2 has a lot of research products, from the current Judging from the progress of the review, it is estimated that it will not be able to catch up with the medical insurance catalogue review. Among them, it is worth mentioning that the relatively long-term DPP-4 inhibitor troglitazone has been fried in the past few days. This product is domestic. Some problems in patents, these two years are also the hottest domestic imitation declarations. But calm analysis, long-acting DPP4 including troglitazone and alogliptin, only listed in Japan worldwide, of which augretine is in In Europe and the United States, 9 phase III clinical trials were enrolled in more than 7,000 patients, and the market was finally abandoned. On the one hand, the product itself was safe. Compliance and other reasons, on the other hand, the price and medical insurance payment.
The ultimate goal of future domestic health insurance is to implement value-oriented strategic purchases. According to this established goal, regardless of the form of management of the future medical insurance drug list, the focus should be on the comprehensive consideration of real clinical value and price. Domestic companies, whether they are innovative or imitation, should carefully consider their product pipelines and profit expectations. Quglitin will be listed in the future. Medicare payments and market prospects will be a good example, but in If this space is limited, it will not be carried out too much. If you have the opportunity, you may be able to open a single article to talk about.
Shakuba Qusarsar is one of the hottest changes in the medical insurance catalogue. The only problem is the price. The domestic price of this product is slightly lower than that of the US. Some, but it is too expensive compared to other heart failure drugs. If you calculate according to the latest winning price, the daily cost is as high as 56 yuan. For reference, the 2017 version of the new heart disease new drug ivabradine The daily cost is only 17.3 yuan. Therefore, although this product is However, the probability of entering the catalogue is very large, but the probability of negotiating the price cut is also quite large. Depending on the outcome of the negotiations, this product may be subject to indications. If it is limited to second-line medication, it is limited to other heart-failure drugs. Tolerance will be more harmful.
There are only Yiluo's monoclonal antibodies currently marketed in this category, but alimizumab obtained CDE two weeks ago. The priority of review, perhaps also catch up with the last bus before the deadline. In terms of efficacy and practical clinical significance, PCSK9 is a good category, after all, the probability of clinical statin intolerance is about 15%, but with the above sand Like Kubba 缬沙沙坦, even in the case of foreign medical insurance payments relative to domestic easing, relatively high pricing has caused a lot of payment pressure on the payer. This is actually very well understood, although the innovation target is compared with the traditional The mature treatment plan is slightly improved, but the price is up to 10 times. Any payer will carefully verify whether the evidence of pharmacoeconomics is sufficient. In view of this, there is still a big doubt about whether this category can enter the catalogue this time. Even if It will also be under the premise of negotiating a large price cut, plus the indications for statin intolerance.
3. Compound products
Tilmisartan amlodipine. Mesalamine amlodipine. Perindopril amlodipine. Amlodipine folic acid... Don't be surprised, in the past two years, there have been so many amlodipine compound preparations on the market. On the one hand, amlodipine itself is good. Efficacy. Safety and half-life, there are more compound products of amlodipine in the world. On the other hand, there should be some Chinese characteristics. Different from the international use of antihypertensive drugs with ACEI and ARB, China market share The largest category is CCB, the largest of which is amlodipine.
The more distinctive of these products is perindopril amlodipine, after all, ASCOT research is the most in the past two decades. One of the classic cardiovascular clinical studies, the main drugs used are perindopril and amlodipine, which is undoubtedly the most adequate evidence from the evidence-based evidence. The olmesartan amlodipine may follow the Austrian Mesacitrate mono- and olmesartan medoxorate The same indications for thiazide are more restrictive than other ARBs. The price of amlodipine folic acid is not yet available, but because it is the same manufacturer as enalapril, the estimated price is not too low. Enalapril as a domestic innovation, the price is more expensive than the original research, but also entered the medical insurance catalog very early, so the amlodipine folic acid is even more expensive, as long as the price is too far from the price of the treatment, it should still Can enter the catalogue.
Speaking of cardiovascular compound products, there are two earlier classic products that are expected to enter the catalogue this time, one is perindopril and the other is sim Ruthatin ezetimibe, these two products have also been added to the provincial directory in most parts of the country.
This is the time for the State Council 2019 government work task, the article mentioned "doing common Prevention and treatment of chronic diseases, including hypertension, diabetes and other outpatient medications into medical insurance reimbursement.", it can be understood that the previous high blood pressure and diabetes products are expected to receive additional bonuses in this catalogue, relative quota restrictions are expected to be looser, will enter more production Product.
Central nervous system diseases
1. Psychiatric medication
Bunanlin and lurasidone, the same company Two new anti-schizophrenia drugs have been listed in one breath, and they still have certain characteristics. The price of Bunan Selin is not too expensive. Lurasidone can not find the price now, but it should not be too Expensive, these two products have great hopes to enter the catalogue. Fusulfacetin is known as a new generation of antidepressants, and the products do have some characteristics, but in fact, compared with the products in the catalogue, What is too big a advantage, and this product is too expensive to look at the price of the winning bid that can be queried now. It is estimated that the catalogue price will be greatly reduced. Although the psychiatric products seem to be relatively small, from the perspective of medical insurance catalogue There has always been an extra bonus, non-medical products are relatively few, and the restrictions are relatively small.
2. Neurology medication
The Parkinson's disease field has not been listed in the past two years. Less new drugs, first of all the second generation MAO-B inhibitor rasagiline, the biggest problem of this product is more expensive, than in the eyes The first generation of selegilan is more than 10 times. Of course, the efficacy of rasagiline is also quite good. Many patients in China are eating the Indian version before going public. If this price can be lowered into the catalogue, it is undoubtedly a patient. Gospel.
The other is the newly listed rotigotine patch. Parkinson's patients tend to have poor compliance. The transdermal patch for external use of the drug can undoubtedly improve patient compliance. It should be said that it is also very distinctive. The problem with the catalogue is the same as that of Rasagiran. If you want to use a full dose, it will be similar to the cost of Rasagiran. It is also more expensive. See if there is negotiation. Opportunity.
Entacapone Double Dopa is a three-way compound drug, unilaterally in the catalogue, the compound can improve compliance, the price is also OK, theoretically no problem, but Parkinson is a little niche in this area. It is a problem to enter the expert field of vision.
The anti-dementia field has also launched a new clearing skin sticker. The oral dosage form of this product is called rivastigmine. Is already in the catalogue, it is estimated that the future drug regulatory agencies will put the general Uniform. Anti-dementia 4 first-line drugs are actually in the catalogue, 2017 catalogue also added the Donepezil orally disintegrating tablets, so I feel that Liss's clear-cut skin is also very popular, especially now it seems pricing Not too expensive, and the imitation products are also on the market soon.
The field of epilepsy has newly added lacosamide (Lacamide). Since it has just been listed, the pricing is still unclear. If the pricing is reasonable, The probability of entering the catalogue is quite large, especially the imitation products are also on the market. Here, I feel that there are so many epilepsy drugs in the alphabet, and there will be bovistam in the future. It is easier to have children's indications. , but this time is too late.
Omalizumab is the world's first approved treatment for moderate to severe asthma. Targeted therapeutic drugs, the product is very good, but the wife is too expensive, the cost of 100,000+ treatment, not low incidence, even if you can negotiate to reduce part of the price, it is not very optimistic about the medical insurance fund can afford this product
Indigo Trogmonium Bromide. Ume Ammonium Bromide Rantero. Tiotropium bromide Odatrol. Fluticasone citrate Virantro. Odattro, most of the current price data can not be found, this category is generally not too expensive to enter the catalog, the price Dimensions can be found in the 2017 new catalogue of 茚达特罗.
Beidaquinoline. Dramani is a new anti-tuberculosis drug. These two products can be said to be currently resistant. The last line of defense for multidrug tuberculosis, but it is hard to say whether the medical insurance will cover these two products.
Tumor and major disease drugs
After 20 anticancer drug negotiations in 2018, The most popular products that are not in the catalog are undoubtedly PD-1. The current market is Navulitis Monoclonal Antibody (O Drug). Pabolizumab (K Drug). Treipril Monoclonal. Lizumab, and Carrefour and Tirizumab may also catch up with the last bus.
From the perspective of negotiating into the catalogue, it should be said that every family has the possibility of success. There is also the possibility of failure. First of all, it is basically clear that the negotiation will be based on the indications. If a product has been approved for multiple indications at the time of negotiation, the result of the negotiation is likely to be based on only one. Indications, and medical insurance payment restrictions will strictly follow the one indication, the latter indications are equivalent to non-medical insurance, that is, although the overall market potential of PD-1 is great, this medical insurance negotiation payment Only a small part of it will be involved.
In terms of the price dimension of reference, the international price is of little significance, and the domestic price of O medicine K medicine is lower than that of foreign countries, while others There is no price and no price in foreign countries. Charity prices will be referred to. The most important thing is to consider the efficacy and price, which is compared with traditional therapy, including first-line chemotherapy and the targeted drugs that are now in the catalog. It will also make horizontal comparisons between different PD-1 products. Therefore, although the final price is not as bad as a few hundred yuan, it is necessary to do a good job of sharply lowering the price relative to the existing price. In the case of medicine K, it is the lowest in the world to accept Chinese prices, and for domestic companies, it is also necessary to make a few folds of the existing “low price”.
Consultation results In contrast, I personally are more optimistic about foreign companies. After all, from the perspective of the adequacy of clinical evidence, or from the perspective of negotiation preparation and professionalism, foreign companies are obviously better. From the two rounds of historical negotiations, Basically, the products that failed to negotiate are in two cases. One is that the price negotiated by foreign companies is far lower than the international price. Especially for products with a longer patent period, the decline is unacceptable. The other is a small number of foreign companies and Domestic enterprises, due to the lack of clear pricing strategies and professional talents, are in a completely passive situation during negotiations.
In particular, since the development of medical insurance negotiations, the professionalism and experience of medical insurance companies are constantly growing, that is, "We have a stronger voice in the medical insurance negotiations." (Note: This is from Director Hu Jinglin). At this time, domestic companies will send some amateur players to play, although these amateurs may be among the other in business or sales. But suppose the negotiating table is a football field. This is basically the same as sending China Guoping to play with the French national football.
According to the information collected by Pharmcube Global New Drugstore NextPharma, PD-1/PD-L1 It can be said that it is the hottest target in the world, and the related projects have reached 173. Even if most of the products eventually die, more than 10 products will be listed in the next year, and the medical insurance can completely adopt the strategy of testing the water this year. In the next round of negotiations, the scope of the indications will be expanded and the prices will be greatly reduced. At that time, the grand occasion may be comparable to last year's 4+7 purchases. Although the outcome may be compared for enterprises. Cool, but for the medical insurance, you can achieve a true value-oriented strategic purchase, and for every insured person or ordinary people, we are all beneficiaries.
2. Her2. CDK4/6
Her2 target currently has clinically significant indications for breast cancer. Pertuzumab can be considered an upgraded product of trastuzumab. The main advantage of pyrrolidine is oral Small molecule drugs, and can alleviate the adverse reactions of diarrhea, both products can be combined with trastuzumab to further improve the survival of Her2-positive patients. Pipercilil is applied to HR+/Her2 by inhibiting CDK4/6 - Breast cancer patients are breakthrough improvements based on traditional aromatase inhibitors. From the perspective of clinical needs, these three products have sufficient reasons, as long as the price negotiation link can pass, the entry into the catalogue is not a big problem.
Olapali is currently the only listed PARP inhibitor in China. Other similar products are unable to catch up with the progress. The targeted drug for ovarian cancer is currently one. There is little problem in entering the negotiation process, and the price may be Based on the existing charity, there are some more.
Alitinib has been approved, and the second generation ALK's Enthatinib has won the CDE priority. Eligibility for review may also catch up with the last bus. Considering the generation of ALK crizotinib, the second generation of ALK sirinib has been negotiated in 17 anticancer drugs, so the price of these two products has also been referenced. Interval, entering the negotiation process is not a big problem.
Fuqualinib is a domestically-targeted drug that has been listed late, and the indication is colorectal cancer. The main competing product is bevacizumab, the price is also referenced, and the probability of negotiating access is estimated to be very high. Absolute intraocular injection reference products are ranibizumab and Compaqip, the current pricing is only The reference product is a bit more expensive, and the probability of negotiating access is very high. The current indication for rivastatinib is only liver cancer, and the reference product is probably Riggo. Nie, the current pricing is slightly more expensive, but there is charity. It is estimated that the negotiation can be entered into the catalogue around the charity price. The most similar to Lunvainib is actually the protagonist of the recent "fake medicine" incident, Cabotinib, but the original research seems to have no China's listing plan, domestic imitation certainly must not catch up with this catalog review.
5. Gnrh receptor antagonist
Gerekic This product is similar to already in the catalogue Goserelin implants or leuprolide microspheres are long-acting drugs for the treatment of hormone-dependent prostate cancer, but with slight improvements, so the problem of entering the catalogue is small, and the price may be better than Goscher Lin implants are slightly more expensive.
6. Alkylating agents
Melpentine injections are nitrogen mustards, oral dosage forms are already in the catalog, and injections are safe. In fact, there is improvement. Bendamustine injection is a bifunctional alkylating agent that combines the characteristics of nitrogen mustards and nitrosoureas, both of which are mostly in the catalog. These two products As long as the price is not too expensive, the problem of entering the catalogue is not big, but the two companies are relatively small, and the product awareness rate is
Paclitaxel liposomes, the first negotiation failed, the second negotiation rejected the invitation, this time I don’t know if there is still a chance There is also paclitaxel albumin, which has not been selected by experts before. Eighty percent is still too expensive and exclusive, but now there are two generic products on the market, and the possibility of entering the catalogue has increased greatly. From the perspective of efficacy safety These two products have undoubtedly improved significantly compared to ordinary paclitaxel, but the price will still play a decisive role in the question of whether or not to enter the catalogue.
P Leshafu is used for stem cell transplantation and is an orphan drug abroad. However, the concept of orphan drugs abroad is not the same as the concept of rare diseases in China, so it is estimated that it will not participate in the review as a rare disease. Domestic pricing is unknown, but because foreign countries are Orphan drugs are more expensive, so there is some doubt about whether you can significantly reduce the price into the catalogue.
Rucotinib is used to treat myelofibrosis, the only product that failed when 17 anticancer drugs were negotiated. Because the negotiated price is lower than the foreign price, this time is not I know if I can give another chance. Even if I can give the opportunity, the negotiation will be more difficult. The good thing is that there is no other drug for this indication, and after all, the first negotiation of cetuximab failed but the second time. Successful examples, so there will still be a small probability to talk about success.
Hepatitis C Drugs
According to China's Hepatitis C Prevention Guide 2015 Edition According to the disease data, HCV1b and 2a genotypes are more common in China, with 1b type (56.8%), followed by type 2 (24.1%) and type 3 (9.1%). No genes type 4 and type 5 were found. Type 6 is relatively small (6.3%). Mixed genotypes are rare (about 2.1%), mostly genetic type 1 mixed type 2.
So, according to the company's products to differentiate the program, Dala Veashurivir (type 1), Obi Pali desebuvir (type 1), albavir gravivir (type 1.4), domestic danoribe (type 1) can actually be assigned to the same The file, while the sophos-Pebuvir and its combination preparations can be single-segmented, sophos-brevevivistavir (full-genotype) is one of the most able to fight, not to mention the base drug addition, The probability of the catalogue is very large.
This category is highly competitive, and the first file can cover more than half of the patients, so it is possible to talk about products that use low-cost strategies. The probability is not great, the price of Sopho-Beauvirone is also the key, because it will definitely be higher than the first gear, so it also infers the price of the first gear.
The fierce competition in this category also stems from the fact that this negotiation is related to the first wave of medical insurance patients in China. Because the disease can be cured, foreign experience shows that who can get medical insurance payment at the right price and grab the first few patients. You can win most of the market, and the final market is almost close to disappearing. So, if you can't catch up with this negotiation, such as Ravi Davi, the market that will be harvested in the future will be very small. In addition, West American River Although it is approved in China, it is basically equal to delisting. In fact, it is also an option. After all, for multinational companies, although the domestic market is large, if the output is less than the investment, it is better to give up, but for a large number of domestic research products. In fact, it is really unknown whether the cost can be recovered in the future.
1. Integrase inhibitors
Dotivide and combination preparations of dobramide (Dotivide abacavir Lamivudine), ralivide, aceviride combination formulation acecoin (Ai Villeve Cobbistatin, which is a product of flunarbutamol, does not know if there are any products available. Achieving a breakthrough in the integration of integrase inhibitors in the medical insurance catalogue, most of the first-line treatment programs in the world contain integrase inhibitors, but the domestic price is limited to the short-term price is basically not expected to enter the free drug list. From the perspective of treatment costs, ralivide It has been close to the enoxopabine tenofovir in the catalogue, but AIDS treatment often uses several types of drugs. The entry of a relatively expensive drug into the catalog will impose an additional burden on the fund, so it may still be difficult.
< p>2. Long-acting fusion inhibitors
Aboweitai is a domestic innovative product, once a week, but the current price is still relatively expensive, it is estimated to be reduced to about half of the catalogue, and high-end oral drugs Quite a level. The short-acting enfuvirtide in the same species is in the catalogue, but it seems that the country is out of stock. The price of the winning bid can be found in the sky. There is no reference significance.
3. Protease inhibition Agent
Daranawei Cobbistat, the new listing of enhanced, the price is also expensive, consider the arrival of Lunawei is not in the catalog, feels awkward. The same variety of Shaku Nawei in the catalog, But the original research stopped importing, the country has There is no valid approval.
4. Nucleoside and nucleotide reverse transcriptase inhibitors
Entropitabine propofol tenofovir, said this product is connected Propofol is a single drug here. It is said that propofol is a famous TAF, which is a prodrug of tenofovir disoproxil (TDF), so the theoretical indication can be hepatitis B. And AIDS, but the domestic unilaterally approved only hepatitis B, and the combination of emtricitabine and integrase inhibitors are AIDS. The price is now unknown, foreign is not cheap, and domestic tenofovir disoproxil At 4+7, it is already a few cents of floor price, so I feel that the series of propofol forefovir is more difficult to enter this catalogue, unless the manufacturer can give a very favorable price, such as reference to the authorized imitation of India. Price.
Aidosaban can refer to rivaroxaban or dabigatran etexilate, the price is not too Expensive words should be able to go directly into the catalog, indications will also be limited to atrial fibrillation. edabetauzumab is a reversal agent of dabigatran etexilate, the price is unknown, but guess It is more expensive, and it is slightly less popular. It is hopeless to enter the catalogue.
The indication for atratropipin is primary immune thrombocytopenia (ITP), and the reference drug TPO is the new entry category of 2017. Products, medical insurance restrictions also have ITP, so as long as the pricing and TPO are close, entering the catalog should be a problem. Rossa, referring to the drug EPO, is estimated to limit renal anemia, as long as the price and EPO are close, entering the catalog should be a problem Not big.
Children with rare diseases
1. Pulmonary hypertension
Bosentan failed to negotiate in 2017 However, after entering the basic medicine last year, generic drugs are also on the market. As long as they no longer make mistakes in the negotiations, this catalogue hopes to be very big. An Lishengtan has entered many provincial catalogues through the failure of Bosentan negotiations. The effect and price are similar to Bosentan, and the hope is also great. Matthew Tentan is an upgraded version of Bosentan, but the price is too expensive, and it is a bit difficult to negotiate.
Leocarbin is different from the above three endothelin receptor drugs and can be used in combination. The daily price is probably about the same as that of Bosentan. But after all, it is a relatively new product. If it can be negotiated successfully, the price may be higher than that of Bosentan.
The frontline can be combined with the above 2 categories, the daily price is now and the Matthew Tan is almost the same, the possibility of negotiation success is not too big. This product is also listed on the market is also Iloprost, but the manufacturer plans to gradually withdraw from the Chinese market in 2015, so it is estimated that will not participate in this catalog. In addition, PDE5 international In fact, it is also a first-line drug, but there are no indications in the country, and it is impossible to participate in the review.
2. Niemann's disease type C
Considering that type C Niemann's disease is mostly In childhood, the incidence rate is extremely low, but the survival period is not long. Magmeste may have some bonuses during the negotiation. The difficulty is that the price is a bit high today, but there is still a certain probability that the negotiation will be successful.
3. Paroxysmal nocturnal hemoglobinuria atypical hemolytic uremia
Eculizumab is about $500,000 per year abroad, which is too expensive and epidemiological From the above point of view, these two indications are placed under the huge population base in China. Figures, so unless it is less than 1%, it is difficult to negotiate successfully.
4. Gaucher disease and Pompe disease
Imidonase. Aglucosidase It is two rare disease drugs of the same company. According to the price that can be found, it must exceed 1 million/year. However, many places in the country can be negotiated for entry, but the negotiated price is not open. Some places should have Financial and charitable subsidies, this national negotiation should be reduced on the basis of local low prices, the difficulty is not small.
5. Tetrahydrobiopterin deficiency
The current price of sapphire is more than 300,000/year. With the above two products, there are many places in the country with negotiation access. The national negotiations will further reduce the price, and the special medical food for hyperphenylalaninemia. It is also expected to go on the market. In the future, you can expect medical insurance to cover some special medical foods.
6. Idiopathic pulmonary fibrosis
Nidanib and pirfenidone in the catalogue The same is the international guide recommended drugs, but now the price is more than twice the price of pirfenidone, negotiated price reduction can also enter the catalog.
7. Multiple sclerosis
Rifamine and 36 products are negotiating into the catalogue of recombinant human interferon beta-1b, which is the first recommendation of the guide. It used to have recombinant human interferon beta-1a and recombinant human interferon beta-1b, but both have withdrawn from China. In the market, once the patient was once drug-free, he could only go abroad to buy medicine or choose second-line drugs. With the negotiation of 36 products, the recombinant human interferon β-1b returned to the domestic market, and now patients have new Choice. From a therapeutic point of view, the price of this product is now slightly higher than recombinant human interferon beta-1b. One point, the negotiation into the directory should not be a problem.
Emmy Safranizumab is a good product, but it is too expensive, foreign prices are high US$400,000/year, domestic pricing is unknown but it is not expected to be too low, and from a clinical necessity point of view, this product may not be as strong as many rare disease drugs, so it is less likely to enter the catalogue.
9. Aplastic anemia
Dalrosone is an oral iron chelator that is used to prevent iron accumulation during long-term blood transfusion. The same species has deferoxamine in the catalogue. The cost is calculated to be slightly more expensive, but there are also charities at present. It is not too expensive to calculate. The same kind of deferiprone is not included in the catalogue. Considering the majority of children in this category, the price is also calculated according to the daily cost. Also. The small price cuts of these two products are expected to enter the catalogue.
10. Children's medication
Lab Lihai is used for childhood leukemia. Uric acid levels in patients with lymphoma Control, the price is unknown, but the conventional estimation is not very low, so it depends on the negotiation results.
There are some rare drugs listed in China, but most of them have not approved indications for rare diseases in China, such as edaravone for the treatment of amyotrophic lateral sclerosis, or tacrolimus for the treatment of myasthenia Powerless. Considering that the smart audit system of medical insurance is relatively developed now, although these products are in the catalogue, the use of hyperindications is still not reimbursed. Unless the medical insurance catalogue has new rules for rare diseases, it can only be expected. Some manufacturers can register for rare disease indications.
Speaking for a long time, they are all talking about the directory, actually this The sub-directory also involves the recall of some products. Many people may associate with the auxiliary drugs. However, after the 2017 version of the catalogue has been streamlined and the indications are limited, there are not many auxiliary drugs in the national catalog. The supplementary medication data reported can be found that most of the supplementary medications are provincial supplements, or products that have been adjusted for indications at the provincial level. Therefore, in addition to the adjustment of a small number of supplementary medications, there should be one The old lack of evidence-based evidence. Actually has been delisted. There are no varieties produced and sold by manufacturers. Especially with the consistency evaluation and 4+7 progress, many better second-generation and third-generation drugs have already reached the floor price, so naturally There is no need to keep so many old generations of drugs in the catalogue.
In addition, regarding the issue of supplemental supplemental drugs at the provincial level, the National Health Insurance Bureau recently agreed on the boundaries and adjustments of medical insurance catalogue management. Soliciting opinions, the country may be unified into a medical insurance catalog in the future. If it is managed in this way, it will undoubtedly help to improve the fairness of patients across the country, and it will be a step closer to the future dynamic adjustment and management of negative catalogues, but at the same time Indeed, there are some shortcomings in regional epidemiological problems. There are some places where the health insurance fund and the financial sector are relatively abundant. Some rare disease products will be added or negotiated in advance, at least for these rare diseases. The market has played a positive role. If the national unified catalogue is in the future, then the negotiations will fail, but it is indeed some emergency. For life-saving rare disease products, manufacturers may choose to withdraw from the Chinese market. In the end, patients will have no medicine to use, and they will embark on the path of “medicine gods.” Therefore, how to weigh fairness and accessibility is indeed a very difficult one. Question, we look forward to the wisdom of managers and experts, and be able to formulate countermeasures as far as possible.
Let's look at the long-term. If the catalogue is managed by the state in the future, then this adjustment catalog may even be possible. It is the last large-scale medical insurance catalogue adjustment. In the future, it is very likely to adopt a regular dynamic adjustment method to manage the catalogue. For example, it will make a catalogue adjustment and negotiation for new drugs every year. You can even learn from overseas evaluation institutions such as NICE to explore access at any time. Or with the drug supervision and approval linkage access. With the completion of the two negotiations, the negotiation materials have basically achieved standardization, as long as the existing foundation can be further improved. Personnel and experts, the National Health Insurance Bureau and its subordinates The existing establishment of the public institution is more difficult. In the future, it may be considered to follow the CDE and establish a fixed set of expert advisory committee members. The system adopts the appointment system for the experts who participate in the medical insurance evaluation. After establishing a complete system process, the catalogue review or negotiation can be initiated at any time for the new drug, and the payment standard is set for the exclusive product, and the competitive category of the exclusive product can be handed over to the place. Formulate, more reference to the market price. This is also considered that after all, the current fund pooling level is still retained at the prefecture-level city level, and it is more conducive to balance the fund revenue and expenditure by local self-developing standards.
For pharmaceutical companies, under the situation of “winter in the winter”, this medical insurance catalogue adjustment has undoubtedly brought a spring breeze. This article only briefly combs the key parts of chemical and biological products. Others such as digestion, anesthesia, ophthalmology and other varieties have the same access opportunities, and the number of proprietary Chinese medicines will be slightly less than the chemical, and the final estimate of the number of varieties transferred may be slightly smaller than the 2017 version. Less, but to take into account that this is only a two-year update, and it is foreseeable that this directory access will inevitably update a large number of innovative products, this Suspect is a practical affirmation and encouragement for innovative companies.
In terms of specific amount, although the accurate figures cannot be accurately calculated, according to the officially announced fund burden of 36 kinds and 17 kinds of drugs negotiated According to the amount, the conservative estimate of the annual increase in medical insurance for new access products in this catalogue will be more than 10 billion, and compared with this figure, the industry will talk about the 4+7 volume of purchases that can save the medical insurance fund. It should not be half of this figure. Of course, this more than 10 billion is based on the negotiation price reduction, but "in terms of enterprises, the inclusion of medical insurance means a broad market prospect, and the growth of income can offset the loss of price reduction. "(Note: This is from Chen Jinyu, deputy director). From the sales data of the previous 36 kinds of products negotiated for nearly 2 years, most of the varieties have actually achieved a substantial increase in sales after they were included in the medical insurance, and they have eaten the cake shared by the medical insurance."
So, for pharmaceutical companies, how to eat more cakes in the future? Especially in the winter of the industry, some enterprises may face a situation in which they can't spend the winter when they eat less. Especially for a single start-up enterprise, the bottom of the company may not be as good as some old-fashioned companies. The first product medical insurance negotiation The success or failure may directly be a big problem that leads to the survival of the enterprise. On this question, I think the answer is "the weather is not as good as the land, the land is not as good as the people." Whether it is new drug creation or important imitation, the future enterprise is facing the medical insurance department. The more specialized access requirements. Although some factors such as the product's own attributes, time to market and other factors are important, but the establishment of a professional entry team early, accurate grasp of the policy situation is more important. Introduce and other corporate strategies, as small as medical insurance negotiations. Specific details such as bidding and bargaining, so that professional entry talents can participate more, so as not to let the investment in R&D funds or product buyouts float, and at the same time, access It is also more likely to negotiate good prices during negotiations and earn more reasonable profits for the company.
Let's talk about some last. I remember that when I wrote "The Ultimate Conjecture · The most likely to be included in the new version of the medical insurance catalogue analysis" in 2017, the entry of innovative medicine at the end of the article seems to be getting slower and slower, not wanting to be in just 2 years, whether it is From drug supervision to medical insurance, there has been such a drastic change in the access environment. At this speed, it is not a dream to be in line with international standards within a few years. From the patient's point of view, there can be more new drugs. Entering the truth is a great gospel, especially the focus of this directory review is the category that patients have long been looking forward to.
At the time of this writing, you can see past patients when searching for some varieties. The posts are mainly around two topics, one is where to buy, and the other is when to reimburse. Many patients are sharing some channels to buy drugs abroad, or telling stories about poverty caused by illness, watching It’s really sad, I hope that there will be fewer and fewer stories in the future. The medical insurance catalogue has been the 4th major adjustment since 2000, and every adjustment can be seen in the medical insurance management department. The various aspects of the progress from macro to detail, especially the adjustment in the last two years, have accelerated the pace of reform, and the goal of purchasing a value-oriented medical insurance strategy has become faster and faster. This is after the establishment of the Medical Insurance Bureau. The first adjustment will inevitably bear the heavy responsibility of the new department reform and the pressure to come along with it. The request put forward at the National Medical Security Work Conference held before the year “Respond to the social solution to the people and dare to take the reform”. We can expect more from this adjustment, and I wish this adjustment a complete success.