To reduce the burden of people's drug expenses, we should not only make the negotiated drugs "reimbursed" into the medical insurance, but also "prescribe drugs" in the hospital. To effectively improve the accessibility of negotiated drugs, more efforts need to be made to smooth the "last mile" of drugs into medical institutions In recent years, medical insurance negotiations have better met people's basic drug needs and provided patients with more cost-effective drugs. Relevant news has attracted more and more social attention. For example, the price of nosinasheng sodium injection, a specific drug for the treatment of spinal muscular atrophy, a rare disease, was as high as 700000 yuan per injection. After two rounds of nine negotiations, it entered the medical insurance catalogue at the price of 33000 yuan last year. In the national medical insurance drug catalogue in 2021, 67 new drugs were added through negotiation, covering the drug needs of tumors, chronic diseases, anti infection and rare diseases, involving 21 clinical groups, with an average price reduction of 61.7%. To reduce the burden of people's drug expenses, we should not only make the negotiated drugs "reimbursed" into the medical insurance, but also "prescribe drugs" in the hospital. Judging from the existing national medical insurance negotiation drugs, there is still a situation that the proportion of hospital equipment and use is low, and even patients "can't get drugs". The reason is not only the consideration of specific interests, but also the restriction of poor mechanism. For example, some pharmaceutical enterprises' production enthusiasm is affected by low prices and small quantities. Some medical institutions lack motivation to promote the implementation of negotiated drugs due to factors such as the proportion of drugs, the number of drugs used and other assessment indicators, as well as zero difference sales of drugs. In addition, medical insurance budget management also allows medical institutions to "stay away" from negotiated drugs whose prices have fallen sharply but are still not cheap. To effectively improve the accessibility of negotiated drugs, more efforts need to be made to smooth the "last mile" of drugs into medical institutions. Improve assessment, evaluation and incentive. After the medical insurance negotiation, the key is to urge medical institutions to reasonably allocate and use drugs. In September last year, the state medical security administration and the State Health Commission jointly issued a notice requiring the medical insurance department to strengthen the management of the agreement, include the rational allocation and use of negotiated drugs by designated medical institutions in the content of the agreement, and link it with the annual assessment; The health department adjusted and improved the drug use assessment mechanism of medical institutions, listed the negotiated drugs used reasonably separately, and did not include them in the assessment indicators affecting their implementation, such as the proportion of drugs in medical institutions and the average cost per time. To implement these requirements, we need to strengthen dynamic management, scientifically analyze the impact of assessment indicators on the entry of negotiated drugs into medical institutions, and timely revise unreasonable indicators. Strengthen the traction of medical insurance policy. To play the role of the baton of strategic purchase of medical insurance, on the one hand, we should mobilize the enthusiasm of medical institutions in the allocation and use of medical institutions. Regions with conditions can actively explore and improve the policy of separate payment for negotiated drugs, and gradually include more negotiated drugs into the scope of separate payment. On the other hand, we should smooth the channels for negotiating drugs to enter medical institutions. In May 2021, the national medical security administration and the National Health Commission issued a "dual channel" policy to negotiate the supply guarantee of drugs through the "dual channel" of designated retail pharmacies and designated medical institutions. In addition, it can also open up two channels: outpatient and inpatient. Online channels should not be ignored. On the basis of optimizing online audit, we should promote the "online order store pick-up" or "online order store delivery" of negotiation drugs. Promote drug R & D and production. To negotiate the landing of drugs, we should also introduce supporting policies in ensuring the payment collection of drugs, so as to mobilize the enthusiasm of production enterprises. The medical and health needs of more than 1.4 billion people in China have given the confidence to trade sales for low prices in medical insurance negotiations. It is also a useful exploration for some places to try out volume negotiation on the basis of centralized volume procurement. In addition, more targeted preferential policies should be adopted to support the R & D and innovation of domestic drug manufacturers, encourage the promotion of generic drug conformity evaluation, accelerate the review and approval of innovative products, promote the listing of new and good drugs as soon as possible, promote the emergence of the "patent cliff" effect through competition, and promote the negotiation of drug supply and price reduction. Making the best cost-effective drugs into medical insurance through negotiation is only the first step to reduce the drug burden of patients. Only by adhering to the problem orientation, improving targeted measures and jointly creating a good environment for the landing of negotiated drugs, can the majority of patients have more sense of access. (outlook new era)