DRG payment reform was promoted to promote rational drug use in hospitals
DRG is a system that uses the idea of case combination to divide patients into several diagnosis groups for management. Under the DRG payment mode, each case enters different diagnosis related groups according to treatment methods and patient characteristics, and the medical insurance department will pay according to the payment standard of corresponding diagnosis related groups. After the DGR payment reform, the requirements for the hospital’s refinement ability have been improved, which will force the hospital to strengthen the refinement management. Combined with the drug zero plus policy, drugs will become the cost item of the hospital, promote rational drug use and optimize the clinical path.
Under the guidance of the two main management theories of evidence-based pharmacy and pharmacoeconomics, rational drug use mainly focuses on the clinical path of pharmaceutical version and the optimization of drug catalogue. Cost-effective drugs with clinical value will not be affected in the reform of DRG payment mode and are expected to really benefit. The clinical value of innovative drugs that have been on the market for many years has been verified by real-world data and has clinical recognition. At the same time, the penetration rate of these drugs is high, and their expenses have been reflected in the payment standard of DRG disease group, which is less affected and is expected to maintain the original growth. The clinical effectiveness of innovative drugs that have been on the market for a short time has been verified by clinical trials, and it is expected to obtain increment by replacing the irrational drug use.
The medical insurance bureau issued policies to ensure the landing of negotiated drugs, and the separate settlement of innovative drugs will not be affected
On September 10, 2021, the State Medical Security Administration issued the notice on adapting to the normalization of national medical insurance negotiation and continuously doing a good job in the landing of negotiated drugs. The notice indicates that the total amount of medical insurance shall be set scientifically, and the negotiated drugs that are paid separately shall not be included in the total amount of designated medical institutions. For diseases that implement DRG and other payment reform, the weight of such diseases shall be reasonably adjusted in time according to the actual use of drugs.
In addition, the National Medical Insurance Bureau has made two reasonable adjustments to the total amount of medical insurance. First, the health department should adjust and improve the drug use assessment mechanism of medical institutions, list the negotiated drugs used reasonably separately, and do not include them in the scope of assessment indicators affecting the implementation of medical institutions, such as drug proportion and average cost per time. Second, we should strengthen the guidance and management of clinical drug use behavior of designated medical institutions, mainly in urging the medical institutions under their jurisdiction to reasonably allocate and use negotiated drugs, and shall not affect the landing of negotiated drugs on the grounds of total medical insurance limit, number limit of drug use catalogue of medical institutions, drug proportion, etc. Therefore, the National Health Insurance Bureau has issued policies to ensure the implementation of guotan drugs, and the use of innovative drugs will not be affected by the reform of DRG payment method.
In the DRG payment reform, many places have begun to practice and launch relevant policies to ensure the use of negotiated drugs
At the beginning of 2021, Fujian Province established multiple charging standards for different chemotherapy schemes in the chemotherapy group, chemoradiotherapy group and malignant blood targeted treatment group, which used more innovative drugs, so as to solve the problem of high cost of chemotherapy drugs. Foshan City, Guangdong Province and Wuxi City, Jiangsu Province calculate the cost of newly included negotiated drugs separately and will not be included in the total cost of DRG group.
Investment analysis: innovative drugs with real clinical value will benefit
At present, supporting policies have been issued in some places to ensure the clinical application of innovative drugs in national talks. If the policies can be extended to the whole country, innovative drugs are expected to be paid separately or adjusted according to the actual use, and are no longer limited by the fixed expenses of DRG group. After releasing the pressure of “cost control”, the use of innovative drugs returns to clinical value. Innovative drugs that really have better efficacy, can promote patients to leave the hospital as soon as possible, reduce side effects, reduce the cost of other drugs, or reduce the risk of secondary hospitalization are expected to benefit. Main companies: Baiji Shenzhou (recommended), Xinda biology, Betta Pharmaceuticals Co.Ltd(300558) and Rongchang Biology (recommended).
Risk tip: the risk of policy change, the risk that the implementation of reform is less than expected, and the risk of insufficient response from all localities
