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On December 30, 2021, the State Medical Security Bureau and the State Administration of traditional Chinese Medicine issued the guiding opinions of the State Medical Security Bureau and the State Administration of traditional Chinese medicine on medical insurance supporting the inheritance, innovation and development of traditional Chinese medicine, and promoted a number of measures to ensure and support the development of traditional Chinese medicine industry at the medical insurance end.
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Some pieces of traditional Chinese medicine, Chinese patent medicine and traditional Chinese medicine preparations of medical institutions have been included in the medical insurance catalogue. At the same time, the pricing mechanism has been clarified, and the fixed-point scope of medical insurance for traditional Chinese medicine has been further defined. This is expected to increase the dosage of traditional Chinese medicine in the hospital. According to regulations, qualified pieces of traditional Chinese medicine, proprietary Chinese medicine and traditional Chinese medicine preparations of medical institutions shall be included in the catalogue of Medicare drugs. According to the document, qualified ethnic medicines, traditional Chinese medicine preparations and traditional Chinese medicine decoction pieces of medical institutions will be included in the payment scope of local medical insurance, and a dynamic adjustment mechanism will be established. The prepared pieces of traditional Chinese medicine that meet the prescription management measures and the management specifications of hospital prepared pieces of traditional Chinese medicine but exceed the common dose specified in the Pharmacopoeia of the people’s Republic of China will be included in the payment scope of medical insurance. It is expected to significantly expand the dosage of traditional Chinese medicine from the clinical and demand side. At the same time, it is clearly stipulated that public medical institutions purchase Chinese herbal pieces from formal channels and sell them in strict accordance with the actual purchase price plus no more than 25%. Non decoction pieces of traditional Chinese medicine are sold in strict accordance with the “zero difference” of the actual purchase price. The prepared pieces of traditional Chinese medicine and traditional Chinese medicine preparations prepared by medical institutions are priced independently, which ensures the fair and open price of traditional Chinese medicine in the process of promotion and is conducive to the healthy development of the market. In addition, qualified medical institutions of traditional Chinese medicine (including integrated traditional Chinese and Western medicine and minority medicine, the same below) and retail pharmacies of traditional Chinese medicine shall be included in the management of fixed-point medical insurance agreements, and qualified fixed-point medical institutions of traditional Chinese medicine shall be included in the fixed-point scope of direct settlement for medical treatment in other places. It is convenient for patients to use traditional Chinese medicine and is conducive to the further expansion of the market.
We will promote the reform of payment methods for traditional Chinese medicine medical insurance and improve payment policies suitable for the characteristics of traditional Chinese medicine. The opinion points out that the general TCM medical service items can continue to be paid according to the items. Explore the implementation of payment by disease score for TCM diseases, select TCM diseases, reasonably determine the score and implement dynamic adjustment. Priority will be given to bringing the dominant diseases of traditional Chinese Medicine issued by the state into the scope of payment by disease. Traditional Chinese medicine medical institutions may temporarily not pay by disease diagnosis related grouping (DRG). For areas that have implemented DRG and pay by disease score, appropriately improve the coefficients and scores of traditional Chinese medicine medical institutions and traditional Chinese medicine diseases, so as to fully reflect the characteristics and advantages of traditional Chinese medicine services. For the advantageous diseases of traditional Chinese medicine such as rehabilitation medicine and hospice care that need long-term hospitalization, they can be paid by bed day. Explore TCM diseases with long treatment cycle, controllable risk and continuous treatment, carry out daytime TCM medical services, implement payment by disease, reasonably determine the payment standard, and the state uniformly formulates the catalogue of diseases in daytime wards. According to the characteristics of TCM medical services, gradually standardize the payment standard and scope, and promote the promotion and penetration of medical services with clear curative effect and reflecting the advantages of TCM.
Investment advice
The guidance of the National Medical Security Bureau and the State Administration of traditional Chinese medicine on medical insurance supporting the inheritance, innovation and development of traditional Chinese Medicine issued by the National Medical Security Bureau shows the government’s attention to the traditional Chinese medicine industry and its confidence in the future development of the industry, In the future, time-honored brands and companies with strong strength in scientific and technological innovation are expected to stand out in line with the development of the industry.
It is suggested to focus on the leading target of brand traditional Chinese medicine: Zhangzhou Pientzehuang Pharmaceutical Co.Ltd(600436) etc; Target of formula granules: Chinese traditional medicine, China Resources Sanjiu Medical & Pharmaceutical Co.Ltd(000999) , Tianjin Chase Sun Pharmaceutical Co.Ltd(300026) , etc; TCM downstream service targets: gushengtang, etc.
Risk statement
Risk of policy implementation falling short of expectations; Risk of medical insurance fee control policy; The risk of drug research and development is less than expected;
