Patients With Hypertension And Diabetes Can Reduce Reimbursement Rate By Over 50%.

Hundreds of millions of people with high blood pressure and diabetes have welcomed the gospel.

In October 10th, in order to further strengthen the prevention and treatment of major chronic diseases and alleviate the burden of outpatient medication for hypertension and diabetes in urban and rural residents (hereinafter referred to as "two diseases"), recently, the National Health Insurance Bureau, the Ministry of finance, the health and Health Committee and the Drug Administration jointly issued the "guidance on improving the drug safety mechanism for outpatients with hypertension and diabetes in urban and rural areas" (hereinafter referred to as "opinion").

There are four safeguards in the opinion, including two patients who take part in the residents' medical insurance and the need to take medicine. The patients with "two diseases" who have been included in the slow special disease coverage of out-patient clinic shall continue to carry out the existing policies to ensure that the treatment level of the masses is not reduced.

More importantly, the proportion of the fund within the scope of the policy is more than 50%. At the same time, it is clear that the scope of medication is the drugs for lowering blood pressure and lowering blood sugar in the scope of the national basic medical insurance drug list. Priority should be given to category a drugs, basic drugs, through the consistent evaluation of the varieties, and centralized procurement of drugs.

This extends the scope of payment to a certain extent. Jin Chunlin, director of the Shanghai health and health development research center, explained the clear meaning of the policy in an interview with the twenty-first Century economic report: "after our health care reform, many people will ask the people about their sense of acquisition. Now the medical insurance has expanded the reimbursement scope, and has increased the proportion of medical insurance reimbursement to some of those which could not be included in the coverage of Medicare reimbursement. This is the greatest sense of gain, which also reflects the greatest significance of people's livelihood.

There are four safeguards in the opinion, including two patients who take part in the residents' medical insurance and the need to take medicine. The patients with "two diseases" who have been included in the slow special disease coverage of out-patient clinic shall continue to carry out the existing policies to ensure that the treatment level of the masses is not reduced. - Song Wenhui photo

Linkage of "two diseases" policy

According to the official interpretation of the national health insurance agency, the background of the "opinion" is as follows: the proportion of hospitalization expenses within the scope of medical insurance policy for urban and rural residents has reached about 70%. On the basis of doing well the hospitalization guarantee, the general out-patient plan for multiple diseases and common diseases has been established in all localities, aiming at outpatient special chronic diseases and special diseases with some higher outpatient expenses (hereinafter referred to as "slow special disease"), and alleviating the outpatient burdens of patients including hypertension and diabetes.

Hypertension and diabetes are the most common chronic diseases. It is estimated that there are about more than 300 million "two diseases" among the insured residents in urban and rural areas. In order to further reduce the burden of outpatient medication for the "two diseases" of urban and rural residents, this year's "government work report" put forward the idea of "bringing drugs for hypertension and diabetes into medical insurance reimbursement", and the sixty-fourth executive session of the State Council devoted special efforts to deploying and improving the "two diseases" out-patient medication guarantee mechanism for urban and rural residents.

As the medical insurance for urban and rural residents and the medical insurance for workers and staff members, the support ability, especially the outpatient support ability is relatively weak. The opinion is mainly aimed at the "two diseases" patients who participate in the medical insurance for urban and rural residents.

For the introduction of the "opinion", Jin Chunlin believes that "from the perspective of protecting people's livelihood, from the perspective of big policy, the problem of poverty eradication by the state next year should be solved. The two is to solve the problem of "seeing a doctor hard and expensive". Who needs it most? It is mainly the former NCMS, which is now included in the insured population. Some rural areas can not reimburse the clinic, and the protection of this part of the population must be solved. Three, under the condition that the foundation and serious illness have already been guaranteed, this "two disease" is the most important problem affecting the health of the people. Four, our country's medical insurance has surplus funds, medical insurance and ability to pay. Finally, there are all kinds of good news. With the quantity purchase, the prices of some drugs have dropped significantly. Some drugs can also be reduced through price negotiations. The price is not as expensive as imagined, and the pressure of the medical insurance fund is not so great, which has contributed to the introduction of this policy.

According to the data disclosed by the National Health Insurance Bureau, in 2018, the total annual income of the basic medical insurance fund in China was 2 trillion and 109 billion 11 million yuan, with a total expenditure of 1 trillion and 760 billion 765 million yuan. By the end of 2018, the basic medical insurance had accumulated 2 trillion and 323 billion 374 million yuan, of which 714 billion 442 million yuan had been accumulated in the personal accounts of employees' basic medical insurance. The annual income of the new rural cooperative medical insurance fund was 85 billion 689 million yuan and the expenditure was 81 billion 822 million yuan. The accumulated balance at the end of the year was 29 billion 542 million yuan.

Benefiting from collecting varieties

China is a big country with diabetes and hypertension. Taking diabetes as an example, the 2017 data released by the International Diabetes Federation (IDF) showed that 425 million adults were diabetic in 2017, an increase of 2.41% over the previous year.

China has contributed about 1/3 of diabetic patients due to its large population base. Due to urbanization and aging, the prevalence of type 2 diabetes in China increased from 2.28% in 1994 to 11.6% in 2017.

WHO estimates that from 2005 to 2015, China's economic losses due to diabetes and related cardiovascular diseases amounted to US $557 billion 700 million. Compared with the normal blood glucose group, the number of hospitalized patients increased by 1 times, and the medical cost increased by 2.4 times.

Another major fear of diabetes is its complications, and the cost of complications accounts for the vast majority of the total cost of diabetes. IQVIA calculation results show that under the current management mode, the direct cost of diabetes in China is about 621 billion yuan per year, including 593 billion yuan for the treatment of complications and 28 billion yuan for treatment of diabetes.

At present, 33.4% of the medical expenses of diabetes in our country need to be borne by the family. The medical expenses of diabetes in China are mainly outpatient expenses, accounting for 61%, the proportion of hospitalization expenses is 39%, the proportion of drug expenses in outpatient expenses is 43.8%, and the proportion of drug expenses in hospitalization expenses for diabetes is 31.8%.

According to IQVIA data, China's county hospitals became a new growth point in 2018, with a market scale of 193 billion 100 million yuan, an increase of 4.4% over the same period last year, and the growth rate was higher than that of urban hospitals. Moreover, the market growth rate of slow drug in county hospitals was significantly higher than that in the whole, such as the growth rate of diabetes and hypertension were 14.4% and 18% respectively.

At the same time, the "opinion" issue focuses on the areas of the crowd, and the policy guidance and drug market are highly unified.

The introduction of the "opinions" specifically referred to "priority selection of drugs in centralized procurement", and the first of three supporting reform measures is "perfect payment policy". We should accelerate centralized bidding and purchase, rationally determine the standards of drug payment and make dynamic adjustments, and encourage the reform of payment methods according to diseases and capitation.

This will benefit the "4+7" purchase and its expanding varieties, and is expected to produce policy linkage effect.

On the specific reimbursement variety, Jin Chunlin said, "the reimbursement scope of the original drugs still exists, and the next place will choose to reimburse the original research drug manufacturer's medicine or the winning bid medicine, and at the specific operational level, I think there will be some rules for the place."

Take diabetes treatment medicine as an example, it can be divided into two main categories: oral hypoglycemic agents and insulin. In terms of drug use, China's social medical insurance covers almost all the treatment needs of diabetics, including 12 kinds of insulin, 8 kinds of class A and 4 kinds of class B. The GLP-1 receptor agonist, l, has entered the national health insurance directory through negotiations on high priced drugs.

Oral glucose lowering drugs are the largest varieties of the oral glucosidase inhibitors from the perspective of market competition. The market size is more than 4 billion yuan. The market share is stable in the market as a classic drug. The GLP-1 receptor agonists, DPP-4 inhibitors and SGLT-2 inhibitors have been rising overseas since 2005. Because of the good efficacy and ease of use, the market share has been increasing. However, because of the high price, it accounts for only about 5.6% of the domestic oral drug market, far less than 50% of the developed countries and regions. In the future, with the further upgrading of the structure of drug use and the expansion of medical insurance directory, the market is broad.

According to EvaluatePharma data, it is estimated that by 2024, the antidiabetic drug market will be the second largest treatment area besides cancer, with sales amounting to US $60 billion.