Objective To study the influencing factors in the process of national medical insurance negotiation and drug pricing from the dualistic equilibrium perspective,and to provide reference for the harmonious management of...Objective To study the influencing factors in the process of national medical insurance negotiation and drug pricing from the dualistic equilibrium perspective,and to provide reference for the harmonious management of drug pricing in China.Methods Through the literature analysis and policy review,the pricing subject,pricing basis and price control system in the pricing process of medical-accessed medicines were analyzed from the perspective of binary equilibrium and harmonious management.Results and Conclusion It is found that four balances in the drug pricing process,two balances in pricing basis and three balances in price control system need to be considered,respectively.Drug pricing is the key content of national medical insurance access,which is also the hotspot of the policy in the pharmaceutical fields in recent years.Drug pricing not only reflects the value of drugs,but also reflects a lot of top-level designs of binary equilibriums in medical insurance policy.While the rational design of drug pricing requires the joint efforts of the government,pharmaceutical companies and relevant experts to comprehensively consider many equilibriums,so as to improve the relevant systems.展开更多
Objective To analyze the reimbursement policies of innovative drugs in some developed countries,and to provide reference for future reimbursement management in China.Methods Literature research method was used to stud...Objective To analyze the reimbursement policies of innovative drugs in some developed countries,and to provide reference for future reimbursement management in China.Methods Literature research method was used to study the policies related to the reimbursement management of innovative drugs in Germany,France and Japan,and their successful experience was summarized.Results and Conclusion China should establish an open and transparent value evaluation standard to improve the medical insurance reimbursement management of innovative drugs.Besides,the value of innovative drugs should be taken as an important basis for reimbursement decisions,and an independent third-party value evaluation agency must be established.展开更多
The China Basic Medical Insurance Program was created in 1999 with three objectives:equal accessibility,affordability,and quality.Today,it has become the biggest medical insurance program in the world,covering 95%of C...The China Basic Medical Insurance Program was created in 1999 with three objectives:equal accessibility,affordability,and quality.Today,it has become the biggest medical insurance program in the world,covering 95%of China's population.Since 2015,China's healthcare ecosystem has been reshaped by increasing innovation,which has in turn been driven by regulatory reform,enhancement of research and development capability,and capital market development.There has also been improved regulatory efficiency to reduce lags in launching drugs.In 2022,nearly 20%of novel active substances launched globally were from China.China has also risen to become the second biggest contributor to innovation in terms of pipelines.Using a“fast-follow”strategy,many locally developed innovative drugs can compete with products from multinational companies in their quality and pricing.However,China's pharmaceutical and biotechnology industry will continue to face challenges in pricing and reimbursement,as well as a shortened product lifecycle with rapid price erosion.The government has already accelerated the timeline for updating the drug reimbursement list and is willing to create a high-quality medical insurance program.However,some obstacles are hard to overcome,including reimbursement for advanced therapies,limited funding and an increasing burden of disease due to an aging population.This article reviews the trajectory of medical innovation in China,including the challenges.Looking forward,balancing affordability and innovation will be critical for China to continue the trajectory of growth.The article also offers some suggestions for future policy reform,including optimizing reimbursement efficiency with a focus on highquality solutions,enhancing the value assessment framework,payer repositioning from“value buyer”to“strategic buyer”,and developing alternative market access pathways for innovative drugs.展开更多
Objective To provide reference for China’s medical insurance reimbursement plan of multi-indication drugs.Methods By referring to relevant foreign literature,the implementation process and conditions of different rei...Objective To provide reference for China’s medical insurance reimbursement plan of multi-indication drugs.Methods By referring to relevant foreign literature,the implementation process and conditions of different reimbursement management modes of multi-indication drugs were analyzed to provide suggestions for reimbursement of multi-indication drugs in China.Results and Conclusion It is suggested to further explore the suitable conditions and select the corresponding mode in China.Payment standards should be set according to value pricing and budget impact analysis.Besides,data collection and analysis mechanism must be improved.Lastly,reward and punishment mechanism can be adopted to improve management efficiency.展开更多
Under Chinese medicine and health care system, Medicine Catalogue for National Basic Medical Insurance（2009） was issued in 2009 in China to fulfill the basic drug demands of the insured Chinese and to control the me...Under Chinese medicine and health care system, Medicine Catalogue for National Basic Medical Insurance（2009） was issued in 2009 in China to fulfill the basic drug demands of the insured Chinese and to control the medical expenses. In this study, the influence of the list adjustment on drug utilization was investigated. With the comparison between inpatients＇ use of drugs before and after adjustment of Basic Medical Insurance Drug List, we classified the drugs adjusted in national list into six categories： class A to class B, class B to class A, class A to class C, class B to class C, class C to class A, and class C to class B（class A referring to overall insured drugs, class B referring to partial reimbursement drugs, class C referring to self-funded drugs in China）, and drug utilization and expenditure were analyzed with time series model. We analyzed the overall expenditure and average expenditure per 10 000 people based on the comparison before and after the adjustment of 2009 Basic Medical Insurance Drug List. The drug expenditure from class A to class B was decreased by 13.87% of overall expenditure and 16.37% of average expenditure per 10 000 people, and it was decreased by 38.74% and 48.03% from class A to class C; respectively, the drug expenditure from class B to class A was increased by 74.12% and 94.52%, while it was reduced by 19.79% and 14.52% from class B to class C; expenditure declined by 31.77% and 36.22% from class C to class A, and expenditure was increased by 12.42% and 22.05% from class C to class B, respectively, both were lower than before. The adjustment of National Basic Medical Insurance Drug List reduced the overall drug expenditure.展开更多
文摘Objective To study the influencing factors in the process of national medical insurance negotiation and drug pricing from the dualistic equilibrium perspective,and to provide reference for the harmonious management of drug pricing in China.Methods Through the literature analysis and policy review,the pricing subject,pricing basis and price control system in the pricing process of medical-accessed medicines were analyzed from the perspective of binary equilibrium and harmonious management.Results and Conclusion It is found that four balances in the drug pricing process,two balances in pricing basis and three balances in price control system need to be considered,respectively.Drug pricing is the key content of national medical insurance access,which is also the hotspot of the policy in the pharmaceutical fields in recent years.Drug pricing not only reflects the value of drugs,but also reflects a lot of top-level designs of binary equilibriums in medical insurance policy.While the rational design of drug pricing requires the joint efforts of the government,pharmaceutical companies and relevant experts to comprehensively consider many equilibriums,so as to improve the relevant systems.
文摘Objective To analyze the reimbursement policies of innovative drugs in some developed countries,and to provide reference for future reimbursement management in China.Methods Literature research method was used to study the policies related to the reimbursement management of innovative drugs in Germany,France and Japan,and their successful experience was summarized.Results and Conclusion China should establish an open and transparent value evaluation standard to improve the medical insurance reimbursement management of innovative drugs.Besides,the value of innovative drugs should be taken as an important basis for reimbursement decisions,and an independent third-party value evaluation agency must be established.
文摘The China Basic Medical Insurance Program was created in 1999 with three objectives:equal accessibility,affordability,and quality.Today,it has become the biggest medical insurance program in the world,covering 95%of China's population.Since 2015,China's healthcare ecosystem has been reshaped by increasing innovation,which has in turn been driven by regulatory reform,enhancement of research and development capability,and capital market development.There has also been improved regulatory efficiency to reduce lags in launching drugs.In 2022,nearly 20%of novel active substances launched globally were from China.China has also risen to become the second biggest contributor to innovation in terms of pipelines.Using a“fast-follow”strategy,many locally developed innovative drugs can compete with products from multinational companies in their quality and pricing.However,China's pharmaceutical and biotechnology industry will continue to face challenges in pricing and reimbursement,as well as a shortened product lifecycle with rapid price erosion.The government has already accelerated the timeline for updating the drug reimbursement list and is willing to create a high-quality medical insurance program.However,some obstacles are hard to overcome,including reimbursement for advanced therapies,limited funding and an increasing burden of disease due to an aging population.This article reviews the trajectory of medical innovation in China,including the challenges.Looking forward,balancing affordability and innovation will be critical for China to continue the trajectory of growth.The article also offers some suggestions for future policy reform,including optimizing reimbursement efficiency with a focus on highquality solutions,enhancing the value assessment framework,payer repositioning from“value buyer”to“strategic buyer”,and developing alternative market access pathways for innovative drugs.
文摘Objective To provide reference for China’s medical insurance reimbursement plan of multi-indication drugs.Methods By referring to relevant foreign literature,the implementation process and conditions of different reimbursement management modes of multi-indication drugs were analyzed to provide suggestions for reimbursement of multi-indication drugs in China.Results and Conclusion It is suggested to further explore the suitable conditions and select the corresponding mode in China.Payment standards should be set according to value pricing and budget impact analysis.Besides,data collection and analysis mechanism must be improved.Lastly,reward and punishment mechanism can be adopted to improve management efficiency.
文摘Under Chinese medicine and health care system, Medicine Catalogue for National Basic Medical Insurance（2009） was issued in 2009 in China to fulfill the basic drug demands of the insured Chinese and to control the medical expenses. In this study, the influence of the list adjustment on drug utilization was investigated. With the comparison between inpatients＇ use of drugs before and after adjustment of Basic Medical Insurance Drug List, we classified the drugs adjusted in national list into six categories： class A to class B, class B to class A, class A to class C, class B to class C, class C to class A, and class C to class B（class A referring to overall insured drugs, class B referring to partial reimbursement drugs, class C referring to self-funded drugs in China）, and drug utilization and expenditure were analyzed with time series model. We analyzed the overall expenditure and average expenditure per 10 000 people based on the comparison before and after the adjustment of 2009 Basic Medical Insurance Drug List. The drug expenditure from class A to class B was decreased by 13.87% of overall expenditure and 16.37% of average expenditure per 10 000 people, and it was decreased by 38.74% and 48.03% from class A to class C; respectively, the drug expenditure from class B to class A was increased by 74.12% and 94.52%, while it was reduced by 19.79% and 14.52% from class B to class C; expenditure declined by 31.77% and 36.22% from class C to class A, and expenditure was increased by 12.42% and 22.05% from class C to class B, respectively, both were lower than before. The adjustment of National Basic Medical Insurance Drug List reduced the overall drug expenditure.
