The recently released new version of the medical insurance drug catalog has added 91 new drugs, bringing the total number of drugs in the catalog to 3159. The "drug basket" of insured persons has been upgraded again. How was the medical insurance catalog born? What medications are eligible for medical insurance? How to determine the "envelope bottom price" for negotiation? Interpretation by the National Healthcare Security Administration and relevant experts. How to choose the "medicine basket" for medical insurance? Supporting the adjustment of the list of new drugs and key drugs in medical insurance is divided into five stages: preparation, application, expert review, negotiation, bidding, and announcement of results. Which drugs can be declared for inclusion in the national medical insurance drug catalog? Huang Xinyu, Director of the Medical Management Department of the National Medical Insurance Administration, stated that the adjustment of the national medical insurance drug catalog is aimed at new drugs, namely new generic drugs approved for market by the national drug regulatory department within five years, or drugs approved by the national drug regulatory department with significant changes in indications or functional indications; The second is targeted towards key drugs, namely drugs included in the National Essential Medicines List (2018 edition), drugs encouraged to be copied, or drugs encouraged to be developed and applied for in the list of children's drugs, as well as drugs for the treatment of rare diseases. It is reported that a total of 249 drugs outside the catalog have passed the formal review and entered the expert review stage this year, of which 121 drugs have passed the review, with a pass rate of nearly 50%. Huang Xinyu introduced that some of the drugs that did not pass belong to the category of "brushing the edge". For example, some old drugs are declared under the pretext of "changes in indications" by reducing the indications on the instructions or making some descriptive changes to the indications; Some belong to the category of "old wine in a new bottle", such as adjusting the composition ratio of old drugs or changing the dosage form, without changing their clinical value, and then declaring them as new drugs; Some drugs are priced too high, beyond the scope of basic medical insurance payment. We support rational improved new drugs, but drugs with unchanged ingredients, indications, routes of administration, and clinical value are difficult to be favored in the review process Huang Xinyu said that the adjustment of the national medical insurance drug catalog is to support "true innovation" with clinical value. The data shows that out of the 91 new drugs added in the adjustment of the medical insurance drug catalog, 90 are newly launched within the past 5 years. Among them, 38 are "globally new" innovative drugs, both in terms of proportion and absolute quantity, reaching a record high in recent years. How to negotiate the price of medical insurance? The "envelope bottom price" is the benchmark on the medical insurance negotiation table, and the envelope in the hands of the medical insurance party often becomes the focus of attention. This envelope contains the expert's calculated drug base price, and the final quotation from the enterprise must be less than or equal to the "envelope base price" in order to negotiate successfully. How was this mysterious bottom price calculated? Chen Wen, a professor at Fudan University and the leader of the Drug Economics Expert Group for the 2024 National Medical Insurance Drug Catalog Adjustment, introduced that the experts in the Drug Economics Group determined the benchmark payment standards through various methods such as drug economics evaluation evidence, domestic online prices, international prices, and price comparisons with similar competitors. Fund estimation focuses more on the impact on fund expenditures, further strengthening the rigid constraints of fund influence. In addition, this year's calculation also specifically considered the characteristics and advantages of traditional Chinese medicine, and optimized the evaluation dimensions and measurement indicators in a targeted manner. Wu Jing, the deputy secretary of the School of Pharmaceutical Science and Technology at Tianjin University, who previously served as the deputy leader of the pharmacoeconomic calculation group, said that the cornerstone of bottom price calculation is to adhere to pricing based on value. For drugs with high innovation value and the ability to fill gaps, we will attach great importance to the pharmacoeconomic evaluation evidence submitted by enterprises and reasonably determine the premium. How to implement medical insurance drugs? Strengthening monitoring and ensuring that the supply of drugs is included in the catalog is not the end point. The ultimate goal is to truly enter hospitals and pharmacies, so that insured people can buy and be reimbursed. This year, the National Healthcare Security Administration and the Ministry of Human Resources and Social Security have put forward new requirements: designated medical institutions should, in principle, hold a pharmacy meeting before the end of February 2025 to adjust their medication list in a timely manner according to the new version of the National Healthcare Security Drug Catalog, to ensure the clinical diagnosis and treatment needs and the rational use of drugs rights of insured patients. It is not allowed to affect the admission of drugs to hospitals on the grounds of restrictions on the total amount of medical insurance, the number of drug catalogs in medical institutions, and the proportion of drugs. In addition, each province should timely update the scope of drugs included in the "dual channel" and separately paid, implement it synchronously with the new version of the catalog, and use channels such as the national medical insurance information platform, drug traceability code, and medical insurance drug cloud platform to collect, improve, and maintain information on the allocation, circulation, and use of medical insurance drugs within its administrative region, and strengthen the refined management of the allocation and use of medical insurance drugs within its jurisdiction. Landing is the 'last mile' that determines the effectiveness of directory adjustment work. Making medical insurance drugs truly benefit the masses and patients requires the joint efforts of medical insurance departments, medical institutions, and pharmaceutical companies Huang Xinyu said. (New Society)