The price of 700,000 pills dropped to 33,000, but these problems are still hidden behind the health insurance
Remember that “no small group should be left behind”?On January 1, 2022, “Noxinacan sodium” injection, the world’s first treatment for spinal muscular atrophy, was successfully included in the medical insurance, with the price reduced from nearly 700,000 yuan to 33,000 yuan per injection.Recently, there was good news from Ningxia People’s Hospital that Xiaoyu (pseudonym), the first beneficiary of ningxia, received successful intrathecal injection of the gene cutting drug “Noxinasan sodium” in the hospital. Xiaoyu was in stable condition after surgery with no adverse reactions, and was safely returned to the ward 30 minutes later.Doctors at the hospital said: “After the initial injection, the injections should be continued on days 14, 28 and 63, and then maintenance injections should be given every four months for life.”What does it mean to be insured?Previously, spinal muscular atrophy is a “incurable” condition, until “Nosinasan sodium” injection came on the market, bringing new hope for the treatment of this genetic disease, but the price of nearly 700,000 yuan per injection, also makes many families back.Fortunately, “Noxinacan sodium” injection was included in the medical insurance list in 2022, with the reimbursement rate as high as 70% and the price reduced to 33,000 yuan per injection. Excluding the medical insurance reimbursement, the out-of-pocket expenses of patients’ families for this drug directly decreased from millions to less than 100,000 yuan, which relieved the burden of many families of sick children.The success of Xiaoyu’s drug use is fortunate, but it does not mean that all patients can use the drug so smoothly.In fact, many new drugs enter the medical insurance system, but cannot enter the hospital, or enter the hospital and cannot be used due to other restrictions, which is called the “last mile” in the industry.In 2021, there was a lawsuit between the family of a lung transplant patient and the hospital.It is understood that during the period of postoperative recovery, the patient has purchased fengweiling, albumin and other drugs at his own expense in kangda Pharmacy on the first floor of the hospital. Later, his family found that the drugs purchased by the patient were in the national medical insurance directory, so there was this dispute.However, the fact is that the defendant hospital did not introduce relevant drugs, nor did other hospitals in Jiangsu Province introduce these two drugs, resulting in the use of these two drugs in the hospital had to pay for themselves.Why can there be a phenomenon of “drugs into the medical insurance, but not into the hospital”?The basic reason is that hospitals have the requirements of medical insurance cost control assessment and drug proportion.At present, there are clear provisions on drug restrictions in the performance appraisal indicators of public hospitals: No more than 1500 grade-III hospitals;The number of secondary hospitals is less than or equal to 1200. If innovative drugs want to enter, they must “kick out” existing drugs.Secondly, China is now fully implementing the DGRS payment system, which is simply the basis for medical insurance to prepay to the hospital. The hospital must control the expenditure within the DGRS fee to have a surplus.Therefore, hospitals will take the initiative to reduce the purchase of drugs and consumables in order to control costs.How can you ensure that the drugs you need can be reimbursed?You can’t just rely on health insurance when it comes to cancer.After all, the scope and reimbursement of medical insurance is limited: the starting line is not reported, the top line is not reported, the part of the individual self-pay is not reported, the part of the individual self-pay is not reported, and the drug use dilemma of the above-mentioned medical insurance catalog drugs, these risks and security gaps can be considered to configure commercial insurance to make up for.Commercial medical insurance: belongs to the reimbursement type, the protection scope covers the expenses outside the medical insurance (within the starting line, beyond the ceiling line, the self-paid part and the part that needs to be self-paid in the scope of reimbursement).In case of illness, unfortunately, can reimburse the cost of seeing a doctor, hospitalization, medical treatment, so that patients do not pay or pay less money, to avoid the cost of expensive treatment, and sell a house to sell a car.Millions of medical insurance: a few hundred dollars a year can have millions of protection, the amount of insurance is generally about 1 to 3 million.It includes four aspects: inpatient medical expenses, special out-patient medical expenses, out-patient surgery medical expenses, out-patient and emergency medical expenses before and after hospitalization.Serious disease danger: belong to disease norm to pay model, for instance, you bought the serious disease danger of 500 thousand protect forehead, come to suffer from cancer unfortunately in the future, insurance company can pay 500 thousand indemnity according to the agreement of the contract, use is controlled along with you.Not every patient can wait for the day when the medicine is covered by the medical insurance. The small editor suggests that if you have medical insurance, you should also prepare a “second insurance” for yourself and your family, so that you can receive the best treatment at any time and recover your health.