DRG refers to the diagnosis-related group used to classify the patient and set up a system to ensure the care provided is necessary. The National Healthcare Security Administration will pay the hospital a predetermined amount according to a patient’s DRG.
The Beijing Municipal Medical Insurance Bureau issued the Notice on Printing and Distributing the CHS-DRG Payment Management Measures-Except for New Drugs and Technologies (Trial). It decided to carry out the declaration of CHS-DRG external payment for new drugs and technologies from July 20, 2022, to August 19, 2022.
The notice requires that the declared drugs, devices and treatment projects be innovative and can effectively improve clinical effectiveness.
The Beijing Municipal Medical Insurance Bureau will organize relevant professional clinical experts to evaluate the clinical effect, innovation and application rationality of the declared drugs, medical devices and treatment projects. According to the submitted cases and cost information, the Beijing Bureau will statistically analyze the impact of the claimed items on health insurance. Finally, determine the scope of drugs, medical devices and treatment projects excluded by CHS-DRG based on the expert demonstration and data verification.
According to the notice, innovative drugs, devices and treatment projects with clinically beneficial and significantly impact the DRG payment can be excluded by DRG payment mode. In other words, the cost restrictions on innovative products that truly have clinical value will be reduced.
The notice aims to improve the CHS-DRG payment mode further, regulate medical behavior and stimulate the innovation momentum of new drugs and technologies.
Even though this is the only policy pilot in Beijing, it at least signals that the company with actual innovation ability is supported and protected. The day after, companies such as Shanghai Hengrui Medicine and Mindray responded with a sharp rise in the secondary market.