Recently, the National Medical Insurance Bureau issued an announcement to solicit public opinions on the 2022 work plan for the adjustment of the national basic medical insurance, work injury insurance and maternity insurance drug catalogue (hereinafter referred to as the work plan) and related documents. This year, on the basis of continuing to support the therapeutic drugs and innovative drugs for COVID-19, the list of Medicare drugs fully reflects the concern for drugs for the treatment of rare diseases and drugs for children, and clearly lists "drugs for the treatment of rare diseases approved to be listed before June 30, 2022" and "drugs approved to be listed before June 30, 2022 and included in the list of children's drugs encouraged to be developed and declared" in the declaration conditions, It is expected that the drug security level of relevant populations will be further improved. The main expenditure of medical insurance fund is the treatment cost of various diseases. Drugs for common diseases with high incidence rate and a large number of cases are the first coverage of medical insurance. When this basic requirement is met, medical insurance is bound to further cover rare diseases, serious diseases and drugs for women and children. This is not only the function of medical insurance, but also an indispensable part of people's health demands. Related to this, in recent years, the National Medical Insurance Bureau has implemented the national pilot of DRGs payment in many cities across the country, explored the establishment of DRGs payment system, and vigorously promoted the implementation of DRGs in more cities. The implementation of DRGs will enable the national medical insurance bureau to continue to focus on cancer, chronic diseases, rare diseases and drug use for women and children while accurately allocating medical insurance expenditure and reducing the use of unreasonable and unscientific medical insurance funds. Rare diseases are characterized by low incidence rate and a small number of cases. The high cost of developing drugs by biomedical companies is often borne by fewer patients. In addition, there is less competition in remote areas, which makes it easier to form a monopoly. Therefore, the treatment drugs for rare diseases are often "sky high prices". In december2021, the specific drug nosinasheng sodium injection for the treatment of rare spinal muscular atrophy appeared in the negotiation of the medical insurance drug catalog. The price of the drug was 700000 yuan / needle before it was included in the medical insurance catalogue. After the negotiation, the price was sharply reduced, which has reached the range that many patients can afford. There are many such "sky high priced drugs" specially for the treatment of rare diseases. These patient groups and their diseases may not be well known to us, but their health should also be guaranteed. The National Medical Insurance Bureau issued the work plan to continue to pay attention to rare disease treatment drugs and solicit opinions from the public. I believe we can hear the voice of more groups of patients with rare diseases. The medication for children is different from that for rare diseases. The great differences between children and adults in growth and development, physiological activities, drug metabolism and important organ functions lead to the differences in drug use between them. For example, quinolone antibiotics commonly used in adults are prohibited in pediatrics in principle. Similar examples also exist in sedatives, antiepileptic drugs and other fields. The work plan issued by the national medical insurance bureau also strives to make the list of drugs included in the medical insurance catalogue more in line with the characteristics of children's medication and better protect the health of children's patients. However, in the course of treatment, there are still some cases where the demand for drugs conflicts with the existing policies. For example, in the treatment of children with neurogenic bladder caused by congenital malformation and tethered spinal cord, a class of drugs to alleviate lower urinary tract symptoms are needed, and the instructions of these drugs mostly recommend the use of patients older than 18 years old. In many medical guidelines and expert consensus in China, children are not recommended to use such drugs. This makes clinicians and children's families in a dilemma. On the one hand, clinicians prescribe drugs for children at the risk of no indication; On the other hand, in order to improve the children's quality of life, the family members of the children had to buy drugs imported from abroad. Similar situations show that more, more, more, more and more attention should be paid to rare diseases, serious diseases and drug use for women and children. We should not ignore some medicines just because they are not often used. Sometimes, the less commonly used drugs are also life-saving drugs. In the process of soliciting public opinions on the work plan, the relevant departments should listen to the voices of all social parties, and it is more necessary to go deep into the clinical front line to understand the actual needs and difficulties of patients, so as to better solve the specific problems in medical security. (outlook new era)