"4 7" to "4 X": 2020 is the watershed in the development of the pharmaceutical industry!


Release time:

2019-11-20

Pharmaceutical Network, November 20-centralized drug procurement is to help achieve the goal of "healthy China". Centralized drug procurement is also one of the major measures to deepen medical reform and solve the problem of "expensive medical treatment", so as to return drug prices to a reasonable level. let the people use higher quality drugs at relatively low prices, which is an important starting point for medical reform. Taking the pilot project of centralized procurement and use of drugs as a breakthrough, strengthening the reform in the field of drugs and squeezing out the inflated price is also one of the important goals of medical reform.
 
The proper meaning of the three medical linkage
 
The promotion of volume procurement does not mean that medical insurance is out of money. The fundamental purpose of the government is to purify the market environment, establish a reasonable price system, and at the same time improveHospitalThe rate of return.
 
Supporting and guiding medical institutions to standardize drug use, optimize the drug use structure, and promote the deepening of public hospital reform is one of the purposes of implementing the centralized drug procurement policy. Of course, we should also make it clear that centralized procurement with volume is only one of the methods of drug procurement, because drugsTenderProcurement can not all use the volume of centralized procurement, not to mention the hospital clinical use of a large number of non-medical insurance varieties. Therefore, at present, the purchase with quantity is only for varieties with large clinical consumption and high purchase amount, which is of great significance to the control of medical insurance fees. As for the Junior College of generic drugs for women and children, emergency (rescue) drugs, etc., online purchase is adopted. Narcotic drugs and the first category of psychotropic drugs are purchased on a designated basis. For countries in short supply of drugs, fixed-point production is considered, and innovative drugs are negotiated by the government, so this may lead to targeted procurement... these must be clear.
 
The purpose of centralized drug procurement is to further promote the in-depth development of the three-medicine linkage, and the reform of public hospitals should be deepened-by squeezing out drug sales costs, changing the "gold sales" model, purifying the medical environment for medical staff, and promoting rational drug use. Through price reduction and substitution effect, reduce the cost of drugs, free up the cost space, to deepen the reform of public hospitals to create conditions. Medical security should reduce the burden and increase efficiency -- through medical and medical reform, reduce the burden of medical expenses of the masses, improve the efficiency of the use of medical insurance funds, and create conditions for expanding the scope of medical security and improving the level of public security. Drugs should be reduced in price and improved in quality-by promoting competition, promoting drug price reduction and generic drug substitution, and further reducing drug prices through volume-price linkage and timely repayment to reduce the cost of sales and financial costs of pharmaceutical enterprises. By setting the quality threshold, with the volume of procurement, expand market share, improve the overall level of mass drug use. Therefore, the price of drugs has dropped, the hospital's payment has been collected in a timely manner, the quantity and price can be linked, and the recruitment and collection can be integrated. It should be a good choice for enterprises to purchase their varieties with quantity. The hospital sales squeeze out the cost of drugs, purify the hospital environment, reduce the expenditure of drugs for the common people, reduce the burden, and also reflect the government's policy of benefiting the people.
 
The author noticed the "Notice on Further Promoting the Experience of Deepening the Reform of the Medical and Health System in Fujian Province and Sanming City" (No. 2 issued by the National Medical Reform Commission [2019]) (hereinafter referred to as No. 2) issued by the State Council's Leading Group on Deepening the Reform of the Medical and Health System on November 15. This document has a high level and a clear road map. It puts forward a total of 24 tasks in seven aspects, with emphasis on drug procurement, it will also expand varieties and intensify efforts. From this, the author thinks that the No. 34 document issued by the national health and Family Planning Commission in 2018 calls for further strengthening the construction of medical personnel team and strengthening the treatment guarantee of medical personnel. It is necessary to creatively implement the important instructions of the central government on the "two permits", allow medical and health institutions to break through the current wage control level of public institutions, and allow medical service income to deduct costs and withdraw various funds according to regulations, which are mainly used for personnel rewards. For hospitals, it is necessary to speed up the landing of these "two permits. To enable doctors to prescribe more drugs with quantity and allow provincial co-ordination, it is also necessary to clearly define and have a time point for advancement.
 
On the basis of the above, we should also consider the unified deployment of the country in 2020.
 
Expanding the scope of centralized procurement and use of drugs by state organizations is the general direction, and the provinces with comprehensive pilot projects will be the first to push forward, and the document also points out that the way of settling loans directly between medical insurance agencies and drug production and distribution enterprises will be implemented. Moreover, there will be more and more procurement methods actively adopted by various localities in separate and cross-regional alliances. It can also be understood that the national level will communicate with each other in quantity, and the local procurement with quantity is "the integration of recruitment and procurement", giving priority to quality, ensuring the usage and ensuring the collection of funds. This is the point of view of the above-mentioned latest document and is a special reminder to the industry. Of course, the state and local governments should divide the varieties purchased with quantity, and it is better to link the prices of drugs purchased with quantity according to the implementation area.
 
To sum up, the national volume procurement can be regarded as a social policy, which is conducive to the development of pharmaceutical enterprises and the in-depth implementation of the three medical linkage. The promotion of volume procurement does not mean that medical insurance is out of money. The fundamental purpose is to purify the market environment, establish a reasonable price system and promote the improvement of the payment rate. With the volume of procurement will certainly continue, when the level of drug use of the people up, but also must pay attention to the efficiency of the enterprise and how? From the performance of some listed companies, there is a downward trend, this enterprise must change the business model, reduce the low level of duplication is the key.
 
  2No. Document Releases Clear Signal
 
In the selection of the second batch of band procurement varieties, it is expected that cardiovascular disease and chronic disease drugs will be considered at the national level.
 
For the strategic adjustment of the enterprise in the future, whether the production line of the variety that did not win the bid needs to be retained? How long should it be retained? Whether to adjust the industrial structure or change to other varieties? All need to be considered.
 
In the "4 7" procurement, some enterprise products are the winning bid, but after the expansion of the enterprise's products have fallen. So, these enterprises due to the "4 7" bid and the expansion of equipment, additional input from the perspective of the bid analysis is a waste, then the enterprise must consider how to ensure the qualification to win the bid after the expansion? These equipment capacity to maximize the use of capacity, be sure to consider the fight for the remaining market outside the volume, otherwise the enterprise is really helpless. According to the "National Centralized Procurement of Drug Supply Guarantee Capacity Monitoring and Evaluation Project Questionnaire" report: Among the 25 drugs currently winning the bid, 17 pharmaceutical raw materials are self-produced and 8 pharmaceutical raw materials are purchased. Among them, there are 4 varieties of raw materials purchased from domestic and foreign countries. Among the 25 drugs, 20 drugs have known information on key excipients, of which 15 varieties use imported excipients, therefore, if the enterprise can achieve self-sufficiency in raw materials and the accessories have national products, of course, it is the best guarantee.
 
From the perspective of enterprises, we must pay attention to three major development trends: one is the industrial development trend, followed by the enterprise development trend, and the other is the national and local procurement trend, and emphasizes the local level. The No. 2 article also emphasizes it very clearly. There are also some non-centralized procurement varieties, which may still be classified procurement, negotiated procurement, or a variety of bidding modes such as GPO in Guangdong, Shanghai and other places, but we must not only take low prices, which is not good for the interests of all parties in the long run.
 
Enterprises need to pay special attention to Article 5 of Article 2: "All localities should actively adopt separate or cross-regional alliances and other methods to carry out procurement with quantity and budget for drugs that are not included in the centralized procurement and use of national organizations in accordance with the requirements of quantity procurement, integration of recruitment and procurement, priority of quality, guaranteed dosage and guaranteed payment. By the end of September 2020, the pilot provinces of comprehensive medical reform should take the lead in exploring, and other provinces should also actively explore.", This makes it clear that 2020 will be a watershed in the pharmaceutical industry-what should enterprises do? The second batch of large-scale procurement varieties will definitely be launched in 2020, whether the number of varieties launched will increase? The focus that enterprises have been paying attention.
 
Concerned about the state's intentions and policy support for the extension of prescriptions for chronic disease drugs, elderly drugs and cardiovascular disease drugs to primary hospitals, and considering that the state officials will increase the proportion of reimbursement for chronic disease drugs for urban residents, it is expected that the national level will consider increasing the number of cardiovascular disease and chronic disease drugs when considering the second batch of products purchased with quantity. In terms of enterprises, it may be necessary to consider whether the slow-release and controlled-release dosage forms of such drugs can be included. Whether the provincial-level centralized collection policy where the enterprise is located is consistent with the national thinking; How to maintain the quality of varieties with lower winning prices; How to ensure that the basic drugs of different levels of hospitals required by the National Health Commission are in harmony with the use ratio.
 
Multidimensional weighing of the interests of all parties
 
It is necessary not only to conduct a cost survey on the varieties purchased with quantity, but also to ensure the enthusiasm of enterprises that have been evaluated but have not been shortlisted for varieties, so as to ensure that the consistency evaluation does not become a one-time evaluation.
 
Finally, I would like to add a few words. First, regarding the expansion, in the future, the expansion will be expanded to "4 27" on the basis of 25 varieties (because two provinces have already started the trial before the promulgation of the document). When it goes directly to "4 27" (or called "4 N"), the winning varieties sold in the pilot cities that originally implemented "4 7" need a transitional connection on the purchase date of the expansion implementation, otherwise, the interests of some enterprises will be damaged.
 
Second, after the expansion of the band purchase, the remaining market of the same variety.DrugsThe price needs to be guided. It cannot be said that the price of the varieties that have entered the purchase with quantity has dropped, while the price of the non-winning varieties is still very high. This is obviously unreasonable. Hoping to be scaled down over three years and eventually unified
 
Third, the state needs to carry out cost investigation on the products purchased with quantity. It is very important to ensure that the consistency evaluation cannot become a one-time evaluation. As the competitive price is so low now, the national level must consider whether the enterprise has really reported the production cost truthfully, which is a great test for the government departments. In this proposal to remove the lowest price, so as to avoid the emergence of vicious competition.
 
Fourth, is it reasonable to stipulate that only three varieties after evaluation can enter the bidding competition with quantity procurement? The current fact is that there are more than 3 varieties. For example, 14 manufacturers of amlodipine besylate tablets have been evaluated, 11 manufacturers of montmorillonite powder varieties have been evaluated, and 10 manufacturers of metformin hydrochloride sustained-release tablets have been evaluated (statistics to November 17, 2019)... The evaluated enterprises still have to compete for 3 winning places, which is for the first enterprise that has been evaluated or failed to win the bid, how to achieve the output of the input of the previous consistency evaluation is an unavoidable problem, and it also involvesMedicineproblems of industrial development.
 
Fifth, over-evaluation but not winning the bidEnterpriseWhere does its variety go from here. The relevant government departments must also consider how to ensure the enthusiasm of enterprises that have passed the consistency evaluation of varieties, especially those that have not entered the scope of volume procurement, there should also be corresponding policy preferences, which is conducive to the improvement of the quality of domestic drugs. it is conducive to the common people to use more good drugs.
 
Of course, the selection of the next expanded belt procurement catalogue should also be combined with clinical use needs and local medical insurance payment capacity. After all, belt procurement is to solve the problem of expensive drugs, and it is a bidding mode that needs to be continuously improved and consolidated.