Jiangxi Province to Adjust Reimbursement Standards for 42 Special Medicines under Medical Insurance

　　【Pharmaceutical Network Policies and Regulations] According to the Jiangxi Provincial Medical Security Bureau, due to the emergence of new national lowest prices for certain drugs, and in accordance with relevant regulations on the management of special medical insurance drugs, the medical insurance payment standards for related special drugs in Jiangxi Province will be lowered effective September 1, 2019.
 

The special drugs whose medical insurance payment standards are adjusted in this instance are all generics of the drugs included in the National Medical Insurance Negotiation List and drugs included in the Jiangxi Provincial Medical Insurance Negotiation List.
 

According to the Adjustment Table for Payment Standards of Special Drugs under the Basic Medical Insurance in Jiangxi Province, the payment standards for a total of 42 drugs will be adjusted, including major varieties such as dasatinib for patients with chronic myeloid leukemia and imatinib for the treatment of gastrointestinal stromal tumors.
 

Furthermore, among the varieties with significant price reductions, Qilu Pharmaceutical’s gefitinib saw a substantial price cut of over RMB 1,000. The price reductions for pemetrexed from pharmaceutical companies such as Yangtze River Pharmaceutical Group and Dezhou Deyao Pharmaceutical were also quite notable.
 

It is reported that Qilu Pharmaceutical was the first company in China to market gefitinib tablets. In late 2017, it became the first antineoplastic drug announced by the state to pass the National Consistency Evaluation of Quality and Efficacy for Generic Drugs. At that time, the price of domestically produced gefitinib was over RMB 1,600 per box, less than one-third the price of the imported product. To promote price reductions for anticancer drugs and ensure that the public has access to affordable, high-quality medications, Qilu Pharmaceutical further reduced its prices.
 

The Jiangxi Provincial Healthcare Security Administration stated that if the actual market prices of drugs across China fall below the healthcare security payment standards in Jiangxi Province, the province will dynamically adjust the payment standards for relevant special drugs in a timely manner. If the settlement price for patients using special drugs at designated institutions is lower than the current payment standard in Jiangxi Province, reimbursement will be calculated based on the actual settlement price and the proportion stipulated by Jiangxi Province.
 

In fact, this is not the first time Jiangxi Province has adjusted the payment standards for special drugs under basic medical insurance. In October 2018, the website of the Jiangxi Provincial Department of Human Resources and Social Security released the "Administrative Measures for Special Drugs under Basic Medical Insurance in Jiangxi Province."
 

"The Measures" clarify that, to effectively alleviate the pharmaceutical cost burden for insured individuals with relevant diseases, 27 Category B drugs from the "Jiangxi Province Basic Medical Insurance, Work-Related Injury Insurance, and Maternity Insurance Drug Catalogue Codes (2017 Edition)"—which are clinically essential for the treatment of major diseases and high-priced—are included in the scope of special drug management under basic medical insurance.
 

It is also emphasized that, in accordance with the unified deployment of the national and provincial human resources and social security departments, dynamic adjustments will be made to the list of special drugs and their medical insurance settlement prices as appropriate.
 

In addition to Jiangxi, Guangxi has also included seven special drugs in the basic medical insurance reimbursement scope since September 2018, including imatinib (capsules, tablets), nilotinib capsules, dasatinib tablets, sunitinib capsules, gefitinib tablets, tenofovir disoproxil fumarate tablets, and icotinib tablets.
 

Guangxi has clarified that the aforementioned seven special drugs will be uniformly covered by medical insurance based on their generic names, without restrictions on manufacturers or brand names. Generic drugs and originator drugs will be reimbursed at the same medical insurance standard.
 

In July 2018, Hunan Province issued the "Notice on Further Strengthening and Standardizing the Use and Management of Special Drugs Covered by Medical Insurance," which included 33 special drugs in the medical insurance reimbursement scope, an increase of 17 types compared to the initial implementation of the special drug system in 2016.
 

In July, Xi’an included 43 special drugs, including Gleevec, in its medical insurance coverage. These 42 drugs comprise seven clinically essential, highly effective, high-cost medications requiring special management, and 36 negotiated drugs specified by the Ministry of Human Resources and Social Security, including anticancer agents such as liraglutide injection, ticagrelor immediate-release oral formulation, recombinant human pro-urokinase injection, and icotinib immediate-release oral formulation.
 

It is evident that many regions are closely monitoring national trends in low drug pricing and actively taking measures to adjust the medical insurance reimbursement standards for specialty drugs, thereby further reducing drug prices. In particular, the price reduction of certain high-cost medications helps alleviate the financial burden on the public when seeking treatment for serious and critical illnesses, thus improving patients’ access to and utilization of medicines.