Zhejiang Province Issues Latest Medical Insurance Documents Affects All Hospitals, Pharmaceutical Companies, Pharmacies

Release date: 2020-01-10 Views: 0

Source: Cypress Blue  

On January 8th, Zhejiang Medical Insurance Bureau issued the “Notice on Publicly Soliciting Opinions on“ Improving the Function of Centralized Drug Procurement and Promoting the Full Coverage of Medical Insurance Drug Payment Reform Plan (Consultation Draft) ”(hereinafter referred to as“ Opinion Draft ”).

The content of the "Opinion Draft" involves adjusting online trading products and improving the medical insurance drug payment standard system, etc. The following are some points worthy of everyone's attention.

▍ Breeding in and out

The scope of Zhejiang's dynamic adjustment of online trading products this time includes transfer in and out.

The transfer scope includes:

( 1) It belongs to the scope of centralized drug procurement and has been included in the "National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug Catalogue" (including those that have not been deleted from the original provincial supplementary catalog) and the generic name dosage form and the "National Essential Medicine Catalogue (2018 Edition)" Drugs that do not have online trading products under the generic name (hereinafter referred to as transfer range 1).

Online trading products include volume-buying, tight supply, low-cost medicines, national negotiations and negotiations for critical illness medical insurance products and online products, as well as record-purchasing products.

(2) Compared with products that have already been traded online with the same product specifications, products with obvious price advantages (hereinafter referred to as “transfer range 2”).

Online trading products with the same product specifications do not include drugs with generic names and low-price drugs, tight supply medicines, original cheap drugs, ordinary large infusions, and record-purchased drugs.

(3) There is already a generic drug that can be traded online through a consistency evaluation of quality and efficacy. The original drug or reference product corresponding to the generic drug (hereinafter referred to as the scope 3).

The recall range includes:

(1) There are products that can be replaced by other drugs due to industry supervision, production line adjustment, and the company has been unable to supply at the current price and there is no transaction record for more than 2 years (hereinafter referred to as the scope of call out 1).

(2) Online trading of higher-priced products (hereinafter referred to as “range 2”).

(3) Independent filing

For clinical needs and no online trading products on the platform or unable to purchase at a predetermined price, after being applied by a public medical institution and reviewed by the provincial medical equipment procurement center, it will be included in the self-documenting catalogue, allowing public medical institutions to record and purchase on their own, but the purchase amount must not exceed that. 1% of the annual drug settlement amount of medical institutions.

(4) other

If the country or Zhejiang Province has relevant regulations, those regulations shall prevail.

The scope of the transfer includes the varieties that have not been deleted in the supplementary catalog of the original province, which also meets the requirements of the National Medical Insurance Bureau for the gradual clearance of local supplementary varieties within three years. Although this part of the species is still included in the full coverage of medical insurance payments, if the proportion of the species that has been cleaned up in the past 3 years is 40%, 40%, 20%, this part of the species will also face out of the medical insurance catalog. Call out the full coverage of medical insurance payments.

In addition, the transfer of products with obvious price advantages for products that have already been traded under the same product standard will encourage lower-priced products to enter the Zhejiang market, which will further change the competitive landscape of the market and promote the decline in drug prices.

The scope of the transfer includes online trading of higher-priced products. This is complementary to the product with a clear advantage in the previous point. This will avoid the situation of excessively high drug prices. The prices of medicines traded on the market are more reasonable.

In addition, as mentioned in the Opinion Draft, for products that are clinically needed and there are no online trading products on the platform or products that cannot be purchased at a predetermined price, you can opt out of the platform transaction and choose to file for procurement. Recorded procurement is to directly discuss the price with the medical institution. According to the requirements of the Opinion Draft, as long as the purchase amount does not exceed 1% of the annual medical settlement amount of the medical institution. Therefore, if the price system of the company's products is well maintained, it will be a good road for many exclusive varieties, shortages, and emergency medicines.

如何 How to ask for price

According to the Opinion Draft, Zhejiang Province dynamically adjusted the online trading products of the pharmaceutical equipment procurement platform to achieve full coverage of online trading products under the general name of medical insurance drugs and enhance the platform's price discovery function; the introduction of a dynamic competition mechanism to improve product effectiveness and reduce procurement price.

According to the "Opinion Draft", the price requirements for different products on the platform are different.

(1) Transfer range 1 and transfer range 3 products

For provinces with centralized procurement (winning bids) and actual online transactions in provinces (excluding Guangdong, Fujian, Chongqing, and military regions, hereinafter the same) that reach 10 or more, purchase at no higher than the lowest national price; For less than 10, on the premise that it is not higher than its national minimum price, after negotiating with our province including at least 10 tertiary hospitals, it is purchased online at the minimum price that is not higher than the negotiated minimum price. The products that participated in our province's centralized drug procurement in 2014 must not be higher than the reference price at that time.

(2) Transferred into range 2 products

Take the low value not higher than 70% of the lowest price of the same product and 49% of the original research imported products as the control price, and not higher than the national lowest price.

(3) Self-registered products

The self-documented products shall be negotiated and determined by the medical institution and the distribution company in accordance with the principle of fairness. Provincial Medicine and Machinery Procurement Center shall regularly publicize the status of self-registered transactions, and shall focus on monitoring products with high unit prices, large purchase amounts, and purchase of medical institutions.

Judging from the requirements of the "Opinion Draft", Zhejiang's regulations on prices are still relatively strict in this respect, basically it is in line with the lowest price in the country.

15% bonus on pharmacy medical insurance

In addition, it is worthy of everyone's attention that according to the "Opinion Draft", all designated medical institutions (including private medical institutions) in Zhejiang Province uniformly implement the zero-plus drug policy and implement uniform medical insurance drug payment standards. The designated private medical institutions refer to the medical service price reform policies of public medical institutions of the same level and raise the medical insurance payment standards for medical services.

In other words, the products covered by the medical insurance payment on the platform can be purchased on the platform's online transactions and enjoy the corresponding medical insurance payment standards, including in medical insurance designated pharmacies and private hospitals.

All the designated retail pharmacies in the province implement uniform medical insurance drug payment standards, which is 15% higher than the established medical institution payment standards (excluding national and provincial negotiated drugs), up to a maximum of 200 yuan (based on the smallest package).

Some analysts told Cypress Blue that although it can be said that Medicare designated pharmacies can participate in centralized procurement and enjoy medical insurance payments, it also means that retail prices of medical insurance drugs in pharmacies cannot be increased at will. For example, the collective purchase price of a medical insurance drug is 20 yuan, so its retail price must not exceed 23 yuan. If the limit is exceeded, the medical insurance will not be settled and can only be settled at their own expense.

This regulation has advantages and disadvantages for medical insurance designated pharmacies.

As we all know, medical insurance payment is especially important for pharmacies designated by medical insurance. Once there is no medical insurance payment function, pharmacies will face a large loss of customers. However, pharmacies also have to pay a price for fixed health insurance.

As early as October 24, Zhejiang Medical Insurance Bureau issued the "Interim Measures for the Administration of Designated Pharmacies in Zhejiang Province Basic Medical Insurance (Draft for Soliciting Opinions)". Which mentioned:

1. The province's medicinal equipment procurement platform equipped by pharmacies can not only trade less than 50% of online medicines;

2. The sales scope of medical supplies is limited to medical supplies such as medicines, Chinese medicinal materials, medical equipment (products with "mechanical name"), disinfection supplies (products with "weixiao" name), daily necessities, cosmetics, health products, etc. are not allowed to enter Designated pharmacy;

3. The designated pharmacies sell medicines other than the provincial procurement platform for medicines and drugs, and the medical insurance fund will not pay. Medicines paid for medical insurance must be uniformly purchased through the provincial medical equipment procurement platform;

4. The sales price of drugs at designated pharmacies shall be appropriately increased in accordance with the medical insurance payment standards of public hospitals, and the increase ratio shall be separately stipulated.

At present, the sale of medical insurance drugs at pharmacies is determined at a 15% markup. Under the requirement that the number of online drug transactions is not less than 50%, the profits of a large number of pharmacies will be limited to 15%. For some varieties with a profit of more than 15%, if a pharmacy uses the platform to collect and participate in medical insurance settlement, it is equivalent to actively giving up the part of the profit other than 15%.

In addition, daily necessities, cosmetics, health products, etc. are not allowed to enter designated pharmacies. Under this requirement, the profits of pharmacies will also be greatly reduced.

In the future, with the full coverage of medical insurance drug payment standards, pharmaceutical companies, pharmacies, and hospitals will all face huge opportunities and challenges.

Attachment: The catalogue of the supplementary medical insurance in Zhejiang Province has not been deleted.

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