The National Medical Insurance Administration promotes high-quality development of medical insurance, supports the inclusion of innovative drugs in reimbursement and unifies the catalog of medical service items

China News Service, September 4. The State Council Information Office held a series of press conferences on the theme of "Starting the 15th Five-Year Plan" on the 4th to introduce the situation of promoting high-quality development of medical insurance and better serving China's modernization drive.

At the meeting, Li Tao, spokesperson and deputy director of the National Medical Insurance Administration, introduced that the medical insurance department attaches great importance to supporting the innovative development of the pharmaceutical industry. Since 2018, the National Medical Insurance Administration has continued to improve the dynamic adjustment mechanism of the medical insurance drug catalog, and has added a total of 949 new drugs, including 199 innovative drugs, so that more patients can use and afford more life-saving drugs. During the "15th Five-Year Plan" period, the medical insurance department, on the basis of "guaranteing the basics", supported differentiated innovation, encouraged pharmaceutical companies to develop more new and good drugs, and also developed more new equipment and new technologies, so that people can enjoy the results of medical innovation faster and more cost-effectively.

Li Tao said that the National Medical Insurance Administration will promote more new drugs to be included in the medical insurance catalog and be reimbursed. Facing the new situation of rapid development of the pharmaceutical industry during the "15th Five-Year Plan" period, we will continue to dynamically adjust the basic medical insurance drug catalog every year to include more eligible innovative drugs in key fields such as tumors, rare diseases, chronic diseases, children, and the elderly into the scope of reimbursement. At the same time, the catalog of innovative drugs for commercial health insurance will also be optimized and improved. For innovative drugs that are beyond the scope of basic medical insurance but have a high degree of innovation, great clinical value, and obvious patient benefits, commercial health insurance is recommended to pay in advance. Through the dual protection of "basic medical insurance + commercial health insurance", the financial burden on the families of seriously ill patients is reduced.

The National Medical Insurance Administration will also promote the unification and equalization of medical insurance and medical service items across the country. At present, the basic medical insurance drug list has been unified across the country, but which medical services and consumables can be reimbursed are still determined by each province. When people seek medical treatment, some medical services may be reimbursed in some provinces but not in other provinces. Therefore, during the "15th Five-Year Plan" period, the Medical Insurance Bureau will strive to promote the national unification of the reimbursement catalog for medical service items and medical consumables, and further narrow the differences in reimbursement policies between regions.

The National Medical Insurance Administration will also promote the rapid entry of medical innovation results into clinical practice and early application. During the "15th Five-Year Plan" period, on the one hand, we will speed up the establishment of medical service price projects, shorten the approval cycle for new technologies and new businesses with clinical value, and promote the early entry of innovative results into clinical use. On the other hand, the special case negotiation working mechanism of medical institutions is implemented. For some cases that are not suitable for payment by disease type such as long hospitalization time, complex illness, use of new drugs, new consumables and new technologies, medical institutions can declare according to procedures, and adjust the payment standards after expert review or pay by project. This eliminates the worries of hospitals in treating difficult and severe cases and applying innovative treatments, so that the insured people can truly enjoy the health dividends brought by the innovative development of medicine.