| Background:Since deepening the reform of medical system,in order to solve the problem of excessive rise in medical costs and excessive burden of personal diseases,which the people strongly resent.China has explored the establishment of a national medical insurance drug negotiation mechanism(hereinafter referred to as "national negotiation")to improve the accessibility of patented drugs and innovative drugs for insured patients by reducing drug prices and including them in the scope of medical insurance payment.The national negotiation system has only been in operation for a brief period of time,the degree of advancement of the negotiation of drug landing work is related to whether the negotiation of drugs can be effectively landed,to ensure the smooth landing of negotiated drugs is related to the level of drug protection and the vital interests of patients participating in the insurance.Therefore,focusing on the study of the current situation of the implementation of the negotiated drug policy and exploring the problems in the implementation process and their causes are important for both the implementation of the negotiated drug management model and the further improvement of the negotiated drug policy.Objective:This research aims to analyze the current status of the implementation of the national medical insurance negotiation drug policy in three cities of Shandong Province,explore the problems and reasons,and provide empirical basis and suggestions for further improving the policy of negotiated drugs and promoting the landing of negotiated drugs.Methods:This study selects 3 cities in Shandong Province as sample cities.Date was obtained mainly through collecting policy,interviews,and the medical insurance system.Relevant policy documents come from the official websites of government departments,and they were analyzed and collated using the policy analysis method to understand the current status of policy formulation in the sample cities;Each municipality’s medical insurance reimbursement database,which included information on all recognized medical insurance coordination zones,was used to extract secondary data.Analyze reimbursement of negotiated drugs at three levels:overall,reimbursement of designated medical institutions and designated retail pharmacies,and specific drugs under key indications,utilizing indicators such as the number of drug reimbursement varieties,variety availability rate,total drug costs,reimbursement visits,total use,and relative drug use visits for quantitative data analysis.Semi-structured interviews were conducted with relevant stakeholders in the form of face-to-face interviews,and finally 8 pharmaceutical organizations and 45 stakeholders were interviewed,and the interview data were analyzed using the thematic framework analysis method.Results:At the policy-making level,the differences in the policies of negotiated drugs in each city were mainly reflected in the three aspects of individual out-of-pocket ratio,special drug management mode,and "dual-channel" management mechanism.At the level of negotiated drugs reimbursed,the number of drug varieties reimbursement,the number of reimbursements,total drug costs and total drug use in the three cities all showed a significant increase after the policy,with a modest decrease in the gro wth rate in 2021.The number of reimbursements in W City was the maximum in the three cities after the policy,and the total drug costs and total drug use in R City were significantly higher than those in the other two cities.At the level of use of negotiated drugs by medical institutions and designated retail pharmacies,the number of drug varieties used by medical institutions in W City and Z City was only slightly higher than that of designated retail pharmacies,and the average annual growth rate of drug reimbursement visits,total drug costs and overall use of designated retail drug stores was noticeably higher than that of medical institutions.The average annual growth rate of reimbursement visits and total drug costs for oral normal-release dosage forms was greater than that for injectable drugs,and the percentage of reimbursement visits for injectable drugs in designated retail pharmacies in all three cities were surpass 60%in 2021;According to the use of negotiated drugs by various pharmacological action classifications,the unused drugs in 2018-2021 in W and R cities were involved in 5 pharmacological action classifications,respectively,and there were unused drugs in all categories except antineoplastic drugs and immunomodulators and cardiovascular system drugs in Z City.In terms of the use of negotiated drugs under key indications,the three cities had the highest relative use of non-small cell lung cancer drugs and the greatest increase in the relative use of drugs under retinal disease indications,and the differences across regions were negligible.The qualitative study discovered that obstacles to the adoption of negotiated drugs include shortcomings in the policy setting,the government departments did not have sufficient supporting policies and the interdepartmental coordination mechanism was not sound,the motivation of the target group of designated medical institutions to purchase the negotiated drugs needed to be improved,the management of designated retail pharmacies in the "dual channel"mechanism faced challenges,and the policy environment was not well connected with the relevant health insurance policies.Conclusion and suggestion:After the policy,the three sample cities in Shandong Province negotiated drug reimbursement varieties and the vast majority of drug reimbursement visits,total use and total cost have increased significantly,the fixed retail pharmacies negotiated drug reimbursement visits and total use rose more than the fixed medical institutions,giving full play to the complementary role of drug supply,the relative use of drugs for the treatment of major diseases significantly increased,and drug accessibility improved.At the same time,each city has combined with the current state of the medical insurance coordination area in a timely manner to protect the implementation of the negotiated drugs policy,the negotiation of drug management services to promote quality work.However,there are also problems such as inadequate supporting measures for the implementation of negotiated drug policies,the prevalence of the phenomenon of "difficulty in entering the hospital" for negotiated drugs,the challenges faced by designated retail pharmacies in implementing the "dual channel"policy,and other medical insurance policies affecting the use of negotiated drugs.Based on the above conclusions,the suggestions are as follows:(1)Consolidate the main responsibility of medical institutions for the rational use of negotiated drugs(2)Encourage the establishment of a classification management model for negotiated drugs(3)Implementing intricate and multifaceted medical insurance payment procedures and enhancing the multi-tiered medical security system(4)Improving the assessment system of negotiated drugs(5)Monitoring and assessing the use of the negotiated drugs using information(6)Optimize the management mode of fixed-point retail pharmacies... |
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