The new version of National Essential Medicines List (EML) to be published in August

Core Tip: China’s First Financial Daily was informed from authoritative channel yesterday that the new version of National Essential Medicines List (EML) that has been disputed for three years and has attracted lots of attention will be announced in August this year. Different from the simple classification of the first version of chemical drugs and traditional Chinese medicine (TCM) in 2009, the selection principle of the new EML will change a lot. It has confirmed that the medicines shall be selected according to the disease treatment field and the number of varieties of drugs included shall increase from the original 307 to around 500.

China’s First Financial Daily was informed from authoritative channel yesterday that the new version of National Essential Medicines List (EML) that has been disputed for three years and has attracted lots of attention will be announced in August this year. Different from the simple classification of the first version of chemical drugs and traditional Chinese medicine (TCM) in 2009, the selection principle of the new EML will change a lot. It has confirmed that the medicines shall be selected according to the disease treatment field and the number of varieties of drugs included shall increase from the original 307 to around 500.

Motives of “Big List”

Lei Haichao, deputy director of Beijing Municipal Bureau of Health said on the Essential Drug Seminar of the Ministry of Health held on April 10: “All places are asking to expand the list of essential medicines; are racking their brains to persuade the bureaus of health to do this, and trying their best to do work in all aspects. Here, the desire of relevant enterprises, especially of local governments, to expand the list is very strong.”

That day is not ordinary for the EML that has been developing in disputes for three years. On April 10 three years ago, that is, April 10, 2009, the state council started a new round of conference on deepening the reform of medical system, which was held in Beijing Jingxi Hotel. “To establish the national essential drug system” was ranked the second place among the five key reform points in medical reform.

In accordance with the medical reform plan, the national essential drug list published in 2009 includes list for basic medical and health institutions and list for other medical institutions two parts. The National Essential Medicines List (Part for Basic Medical and Health Institutions) (2009 version) published in advance contains a total of 307 varieties of chemical drugs and Chinese patent medicines and came into effect on September 21, 2009.

However, because hospital reform lags behind, the National Essential Medicines List (Big Hospital Version) that has originally taken the task of cooperating with public hospital reform pilot is still not introduced three years later till today, and the idea of “Big Hospital Version” has been officially weakened and renamed as “Other Part”.

The only launched essential medicines list (basic level version) also has become more complicated due to bidding and purchasing, distribution, use and other interest disputes.

As the level of medication and the ability to pay differ in different places, medical reform documents state allowing all places to appropriately supplement the required varieties in addition to those listed in the national list to meet the actual demand for medication.

Since then, the motives to supplement the variety of the list have been thoroughly released. In 2010, all places published the supplementary essential medicine lists in succession: Shandong supplemented 206 varieties, including 193 new varieties and 13 new formulations; Guangdong supplemented 260 varieties; Shaanxi 191; and Beijing and Shanghai supplemented 212 and 381 respectively. The final actual varieties on the list all rose to around 600.

Take Shanghai for example, among the 381 supplementary varieties, there are 236 chemical drugs supplemented and 145 TCM. And among the 236 chemical drugs, the products of over 20 foreign-owned enterprises including Pfizer, Bristol-Myers Squibb, Novartis and Sanofi as well as their joint-ventures in China are all included. The products of foreign-owned enterprises and joint ventures take up about 27% of the supplementary chemical medicine list, which directly pulls up the proportion of government payment.

“The lists of all places are too confusing. The current problem is not whether the variety of the list is enough but is there is no standard to judge whether it is enough”, said Yu Mingde, director of China Pharmaceutical (600056) Enterprise Association.

“We have calculated that the per capital GDP in Beijing is 12,000 US dollars and that in the whole China is 4,000 US dollars and that of Beijing is three times that of the whole country. Now, for Beijing, 519 varieties of essential medicines are completely enough. Then, I’m confused that what’s on earth the meaning for other places to supplement so many varieties?” according to Lei Haichao.

But the idea is not agreed by everyone. Professor Shi Luwen, director of the International Research Center of Medicinal Administration, IRCMA expressed that the structure of the current list is not reasonable, such as medications in gynecological and pediatric aspects are obviously insufficient; and drugs curing major diseases and frequently-occurring diseases are obviously short, so the list is in urgent need for supplementing and adjustment.

Shortly before, Minister of Health Chen Zhu has publicly stated that to adapt to the constant promotion of public hospital reform, the essential medicines list just suitable for basic level demands originally shall be revised. “This year, the serious illness protection policy will be gradually introduced; protection of eight serious illnesses including AIDS opportunistic infection and multi-drug resistant pulmonary tuberculosis shall be carried out throughout China; and 12 diseases including hemophilia and lung cancer will be included in the pilot scope of rural resident major disease protection. These all will expand the demand for essential medicines.”

“Now, many things we talk about on the essential medicine list may not have too much relation with this system. It has assumed too much pressure from comprehensive reform”, sighed Lei Haichao.

Dispute on Medical Insurance Payment

The entanglement focusing on essential medicines also lies in that this is not a thing that can be decided by the Ministry of Health alone.

“Another job the Ministry of Health is doing is to calculate whether medical insurance can afford the fees of the essential medicine list”, revealed by aforementioned informed sources.

Because the therapeutic drugs in the national EML are all included in the medical insurance scope and shall be fully reimbursed. The reporter also learned that the Ministry of Health intends to take some high-priced drugs like cancer drugs, diabetes drugs and cardiovascular drugs into the list. Therefore, this expansion of the essential medicines list will also test the actual payment ability of medical insurance.

Actually in 2011, it had been disclosed that Beijing medical insurance fund was in a “deficit”. Although the Beijing Municipal People’s Social Security Bureau announced the medical insurance work later, it also predicted that by the end of December that year, the medical insurance fund can achieve balance of payments that year, and there would be only a slight balance.

According to the existing medical insurance payment system, all places have initially formed a medical protection system covering the whole urban and rural residents with urban employee basic medical insurance, urban resident basic medical insurance and new rural cooperative medical care medical system as support.

With the increase in the rate of participation and the implementation of a series of urban people-benefiting policies and measures including improving the proportion of reimbursement, improving the cap line and expanding the scope of reimbursement, the proportion of medical insurance payments increases gradually and the expenditure of medical insurance fund increase significantly and rapidly.

But views on this issue are not consistent. Yang Hongwei, deputy director of the Health Development Research Center of the Ministry of Health said that calculation proves that medical insurance can definitely pay the supply of the EML. Yu Mingde, who has always advocated all essential medicines should be supplied by the government free of charge insisted: “If the government pays the bills for bidding, distribution and many other problems, everything will become very simple.”