A New Round Of Basic Drug List Adjustment Is Imminent, And Experts Suggest To Increase The Varieties Of Ophthalmic Basic Drug List

It has been three years since the publication of the national essential drug list (hereinafter referred to as the "basic drug list") in 2018. At that time, the relevant person in charge of the National Health Commission pointed out that the essential drug list would be dynamically adjusted, and the adjustment cycle should not exceed three years in principle. This also means that the 2021 version may be officially launched soon. At the beginning of this year, new information about the list of basic drugs was spread. During the two sessions of the people's Congress of the people's Republic of China and the people's Congress of the people's Republic of China, many members of the NPC and CPPCC and experts talked about suggestions on adjusting the list of basic medicines.

In fact, there are some "partial" problems in the list of basic medicines. Li Suyan, deputy to the National People's Congress, pointed out to reporters of the 21st century economic report that the list of basic medicines is updated every three years, and there are still some areas that need to be improved. For example, some basic medicines are in the basic medicines list, but they are not produced at all, while some common diseases are not. This situation needs to be adjusted in time.

Xu Xun, director of the national eye disease clinical research center and director of the ophthalmology center of Shanghai First People's Hospital, pointed out to the 21st century economic report that the current ophthalmic basic drug list has made some departments face the dilemma of no drugs available. For example, in the past few years, the ophthalmic medication in the basic medicine list has been adjusted very little, and the mainstream treatment drugs related to blinding eye diseases have not yet entered the scope of basic drug adjustment A total of 12 ophthalmic drugs were included in the list of basic medicines (2018 Edition). Most of them are aimed at traditional ophthalmic diseases. For diseases such as dry eye and blinding eye diseases, such as vascular fundus lesions and chronic open-angle glaucoma, which are increasing in prevalence, basic drugs can no longer meet the basic needs of these common eye diseases.

The new catalogue is ready to come out

China began to implement the essential drug system in 2012, and the basic drug list was officially implemented in 2013. The reimbursement rate of drugs in the basic drug list is significantly higher than that of non essential drugs, which can effectively guide the masses to use essential drugs first.

There are 520 kinds of essential drugs in the first batch. On this basis, provinces and cities have added or deleted the national list of basic medicines according to their own conditions to form the list of basic medicines in different regions.

Five years later, the National Health Commission released the 2018 edition of the basic drug list, in which the number of drugs increased from 520 to 685. The new varieties include 12 kinds of cancer drugs and 22 kinds of drugs in urgent need of children. Since the implementation of the essential drugs system, the catalogue has been dynamically adjusted every three years in principle. Therefore, a new version of the catalogue may be published in 2021.

On March 1, the National Health Commission held a teleconference on 2021 National Drug Administration. It is understood that the meeting made clear seven key points of this year's drug administration work, namely, essential drugs, stable supply and price guarantee, centralized purchase of drugs, use monitoring, clinical comprehensive evaluation, pharmaceutical care and policy research.

In terms of the key work of basic drugs, we should give priority to the allocation and use of essential drugs, strengthen the evaluation and publicity of essential drugs system, and optimize and adjust the national essential drug list.

On December 1, 2020, the State Medical Insurance Bureau disclosed in the reply letter of "proposal on implementing the support policy of Chinese patent medicines". At present, the national health and Health Commission is speeding up the revision and improvement of the "national essential drug list management measures", further highlight the clinical value of drugs, constantly optimize the structure of the catalog, improve the dynamic adjustment of the catalog, and strengthen the implementation and management mechanism of the catalog, so as to better adapt to the basic medicine Demand for health care services.

Li Suyan pointed out that this means that the list of basic drugs will further highlight the clinical value of drugs.

As a matter of fact, the function of the basic drug catalogue in China is to "highlight the basic, prevention and treatment necessities, guarantee supply, give priority to use, ensure quality and reduce burden", and pay attention to clinical needs and highlight the clinical value of drugs.

"The incidence of diseases in China has been in constant change, and the drugs that were not covered in the past may soon become large demand products. Timely adjustment of the basic drug list is conducive to better covering the vast number of patients in China." Li Suyan further pointed out that China's basic medicine catalogue will adhere to the dynamic adjustment, and pay equal attention to the transfer in and transfer out, which will be more conducive to patients' medication.

According to the introduction, China's basic drug transfer standards mainly combine disease spectrum sequence, incidence rate, disease burden, etc., to meet the basic drug demand of common diseases, chronic diseases, diseases with heavy burden and great harm, critical and severe diseases, public health, etc., and select an appropriate number of essential drugs from the drugs that have been listed in China; at the same time, support traditional Chinese medicine and innovative drugs.

The transfer out standard includes the following situations: the drug standard is replaced; the drug approval certificate is revoked by the State Drug Administration; the adverse reaction occurs and it is not suitable to be used as a national essential drug after evaluation; according to pharmacoeconomic evaluation, it can be replaced by a variety with better risk benefit ratio or cost-effectiveness ratio; the national essential drug working committee thinks that it should Other situations when called out.

On this basis, we should follow the diagnosis and treatment norms, clinical diagnosis and treatment guidelines and expert consensus, and on this basis, we should pay equal attention to Chinese and Western medicine, select an appropriate number of essential drug varieties to meet the main clinical needs of common diseases, chronic diseases and emergency rescue, and take into account the needs of special groups such as children and public health prevention and treatment.

Transfer in new drugs with both clinical and economic benefits

Li Suyan believes that, like the national health insurance negotiation, the essential drug list is also an important means to promote the decline of drug prices. In addition to clear evidence of effectiveness and safety, the cost-benefit ratio is significant, and it is also an important standard for drugs to be included in it.

Xu Xun also described the current situation of drug use to the 21st century economic reporter: "there are specific requirements for basic drugs. For example, the tertiary hospitals require about 60% of the drugs, so the slightly better drugs will not be available until the 10th of each month, and there will be no drugs from the middle of the month to the end of the month. We can consider that we should not only include some key drugs in the basic medicine, but also specify the proportion of the basic drugs used. But now we have to specify the proportion first. Finally, we find that there is a big gap. Many places have begun to prevent the pharmacy window, which leads to the above situation of "drug withdrawal."

Xu Xun cited ophthalmic medication as an example. In the past few years, there were few adjustments in ophthalmic medication in the national list of basic medicines, and the mainstream treatment drugs related to blinding eye diseases have not yet entered the scope of basic drug adjustment. In the adjustment of essential drug list in 2018, 12 new anti-tumor drugs were added, but only 2 drugs were added to ophthalmology.

At present, 12 ophthalmic drugs have been included in the national essential drug list (2018 Edition). Most of them are aimed at traditional ophthalmic diseases and lack of drugs for blinding eye diseases, most of which have been used for decades.

"There are very few basic medicines in Ophthalmology, and many of them are not produced at all. Eye drops such as chloramphenicol can't be found everywhere in the market, but they are also listed in the list of basic medicines. They can't be purchased in hospitals, and other drugs can't be used. Therefore, patients suffer from pain." Xu Xun further pointed out.

Shi lichen, director of Beijing Dingchen medical management consulting center, analyzed to the 21st century economic report that although some cancer drugs with higher prices are included in the basic drug list, most of the basic medicine prices are relatively low, and many products are included in the basic drug list, but only less than 1 / 10 of the products have an obvious upward trend in sales, most of them are not very ideal, and when the basic drugs enter the hospital, they are still In the face of bidding, the prices of raw materials are rising constantly, and the prices of many products are even lower than the production costs. Therefore, the phenomenon of drug shortage and even supply interruption will occur.

At the same time, Xu Xun also pointed out that many drugs in the list of basic drugs can no longer adapt to the current situation of eye diseases and meet the needs of clinical diagnosis and treatment, while many drugs that have been listed in China, with better clinical effects and more cost-effective advantages, are excluded from the list. To a certain extent, it hinders the allocation and use of some ophthalmic essential therapeutic drugs in medical institutions, reduces the efficiency and treatment effect of patients, and also causes a waste of medical resources and funds.

In view of the fact that the current list of ophthalmic basic drugs has been far from meeting the basic needs of Ophthalmology, Li Suyan suggested to increase the varieties of ophthalmic basic drugs list. On the premise of full demonstration by experts, drugs with wide therapeutic uses, high drug accessibility, conforming to the changes of disease spectrum and having both clinical and economic benefits should be transferred to eliminate the drugs that are no longer produced in the market.

?