Research and Improvement Strategies on the Policy of National Reimbursement Negotiation Drugs' Implementation in Zhejiang Province Based on DRG Payment System

OBJECTIVE  To analyze the policy implementation of National Reimbursement Negotiation drugs in public medical institutions in Zhejiang Province under the diagnosis related groups(DRG) framework, and to explore how policy adjustments can promote the widespread application of these drugs in medical institutions to meet the treatment needs of patients.

METHODS  The study involved collecting and analyzing relevant policy documents issued by the National Healthcare Security Administration, press conference information, and the implementation status of the DRG payment reform in Zhejiang Province. It identified the challenges faced by National Reimbursement Negotiation drugs in their adoption within medical institutions. Additionally, the study compared the DRG payment policies across different provinces, with a particular focus on the compensation mechanisms for National Reimbursement Negotiation drugs.

RESULTS  Despite the introduction of multiple national policies to improve the accessibility and affordability of drugs, the implementation of National Reimbursement Negotiation drugs in medical institutions was still confronted with several challenges such as the drug ratio indicator in the performance assessment of public medical institutions, outpatient medical insurance pooling disparities, insufficient compensation for National Reimbursement Negotiation drugs within the DRG payment system, the required time for clinical recognition of new drugs and the complex process of drug admission into the pharmaceutical catalogue of medical institutions.

CONCLUSION  To address the identified challenges, the following strategic measures are recommended: Firstly, enhance the outpatient medical insurance coordination system to improve the accessibility of National Reimbursement Negotiation drugs at the outpatient level. Secondly, refine relevant policies to coordinate the implementation of National Reimbursement Negotiation and Volume-based Procurement drugs. Thirdly, leverage the "dual-channel" policy to enhance the construction of information technology systems and promote the transfer of prescriptions for National Reimbursement Negotiation drugs between outpatient and inpatient departments. Fourthly, strengthen the clinical promotion and education of national negotiation policies to alleviate concerns regarding their impact on DRG costs. Fifthly, formulate a unified and reasonable compensation policy for the use of National Reimbursement Negotiation drugs during the DRG/diagnosis-intervention packet(DIP) settlement process at the national level to ensure the timely implementation of these drugs.