Volume price game war! 2019 Drug Collection Half-way Summary
As an important part of the three-medicine linkage, the drug supply guarantee chain will strengthen the "clinical rational and standardized use" in the future. As a transition, the "drug proportion" control now emphasized will gradually evolve to the precise trend of "medication guide and clinical pathway". Therefore, the change and adjustment of drug prices are also in a quiet transition period of "grasping the overall situation, grasping the key and making a decision. In the first half of 2019, diversified drug procurement "listened to thunder in a silent place". The procurement methods were differentiated, dynamic adjustment was frequent, and procurement with quantity was standardized. It seemed that there was no "thunder blow" but only a "gentle knife", which puzzled many drug companies. The author briefly shared his crude views on drug procurement during the transition period at this stage.
Key word one: strict
Recently, Hunan, Guangxi and other places of drug collection from various channels to issue a notice or draft. in the whole countryMedicineUnder the background that the industrial growth rate is not optimistic, under the background that the key monitoring drug catalogue is issued and the national medical insurance catalogue is being adjusted, the centralized bidding and procurement of drugs will undoubtedly become more "strict". With the establishment of the National Medical Insurance Bureau last year, the provincial medical insurance bureaus have basically been established one after another. Under the premise of unified functions, the medical insurance bureau will gradually eliminate the barriers of various functional departments, make decision-making and implementation more efficient, and the management link of drug access and procurement will undoubtedly be more stringent in the next step.
The new round of drug collection around the current situation shows several trends:
Keep up with the pace type: province-wide follow-up or selective follow-up 4 7
Unique type: independent innovation procurement methods (such as Guangxi GPO, Hunan 5 types of procurement);
Steady and steady: the province to carry out inter-provincial price linkage (Zhejiang, Guangdong, Anhui, Guangxi and other places);
Inmove type: continue to adhere to the original procurement method unchanged, but do a good job in new bidding preparation (Gansu, Hubei, Fujian, Heilongjiang and other places);
No longer bidding type: Chongqing (no longer bidding mode), Hebei (mainly hospital procurement, no provincial standard trend for many years).
Key word two: broken
Since the beginning of Anhui 161 in 2015, centralized procurement in all provinces across the country has evolved from "unified" to "fragmented diversity. After the official publication of document No. 7 and document No. 70, all provinces have generally changed their thinking in bidding, from the original provincial winning bid to the provincial shortlist, and from the provincial winning election to the bargaining of prefectures, cities and even counties and hospitals. The most critical turning point is the "Several Opinions on Further Reforming and Improving Drug Production, Circulation and Use Policies" (Guo Ban Fa  No. 13) issued by the General Office of the State Council on February 9, 2017. Document No. 13 clearly stated: "Improve drug procurement Mechanism. In areas where the reform of medical insurance payment methods has been fully implemented or where medical insurance drug payment standards have been established, public hospitals are allowed to jointly purchase with volume and budget on the provincial drug centralized procurement platform (provincial public resources trading platform)." And allowing hospitals to jointly band volume, with budget procurement, is equivalent to giving local medical institutions can naturally carry out drug procurement independent bargaining. The characteristics of fragmentation under the new situation are:
Different prices in the same province: 4 7 project cities (follow-up cities) and non -4 7 project cities.
Catalogue selection: 500 county medical community has the possibility of purchasing separately (unified catalogue, unified distribution, unified price, unified distribution).
Procurement methods are not uniform: provincial and municipal GPO regional alliance procurement inter-provincial linkage drug exchange consortium (hospital) independent procurement.
Key word three: union
In the first half of this year, alliance procurement in various places seemed to be silent, but many places were still "undercurrent". Among them, the changes in the past two years are worth paying attention to, and there may be new adjustments in the future.
1. the expansion of the Beijing-Tianjin-Hebei Drug Collection Alliance: In September 2018, Shandong Province issued the "Notice on Further Improving the Bargaining Procurement Mechanism and Regulating the Online Centralized Procurement Behavior of Public Medical and Health Institutions", the notice put forward the requirement of "actively docking information with the procurement consortium of drugs and medical consumables in surrounding areas to realize price information sharing", and clearly turned the implementation of the provincial bid winning results into online prices, priority reference to the Beijing-Tianjin-Hebei joint mining network price for bargaining and price linkage.
Sanming Alliance, which 2. "small fire and slow price reduction": Sanming Alliance members 6 pilot cities and 28 demonstration counties. One of the hottest trends in Sanming Alliance recently is Tongren, Guizhou. The city has recently carried out many drug negotiation purchases and solicited opinions from all walks of life on further optimizing the city's drug procurement catalogue, which is quite promising to become bigger and stronger.
3. four provinces and one city to "group together for warmth": In November 2016, Shanghai, Jiangsu, Zhejiang, Anhui, and Fujian jointly signed the "Shanghai, Jiangsu, Zhejiang, Anhui, and Fujian" Four Provinces and One City Comprehensive Medical Reform Joint Conference System Agreement ". Policy coordination is carried out in the procurement of consumables, medical insurance payment, medical service price reform, personnel compensation, and health industry development. On May 9, 2018, according to relevant media reports and policies, Anhui Province will actively participate in the joint procurement of pharmaceutical consumables in the four provinces and one city of "Shanghai, Jiangsu, Zhejiang, Anhui and Fujian" before October to further reduce the price of pharmaceutical consumables.
The emergence of the procurement alliance, on the whole, is still a way of negotiation and bargaining, that is, the joint dosage scale to pry open the strong drug price gap, so as to achieve the goal of price reduction.
Key word four: quantity
According to the spirit of documents No. 7, No. 70 and No. 13, all provinces should actively implement the purchase of drugs with quantity. Three or four years have passed. With the development of 4 7, the volume procurement under the new situation has been given a new connotation:
1, procurement volume. The shallow understanding of volume procurement is: price for volume.
2. Distribution quantity. The scope of the distributor is specified by the purchaser and selected by the pharmaceutical company or hospital.
3, the amount of return. After the pharmaceutical company wins the bid, in addition to the requirements of the purchase volume and distribution volume, the length of time the amount of payment also affects the result of the purchase with volume. Like a few years ago, some regional businesses in Northeast China took a long time to collect money from hospitals, which did not meet the requirements of volume procurement under the new situation. However, it must be noted that with the price reduction measures in various regions to further reduce the price space in the industrial chain, medical institutions in a strong position in the supply chain are still one of the measures to regulate the flow of funds due to factors such as zero price difference, reduction of inspection fees and untimely financial subsidies.
4. Amount of payment. It is closely linked to the standard price of health insurance payment. After the drug is selected, how much is the burden of medical insurance? How much is the burden of patients? It directly affects the prospects of drug market sales.
5, market sales. As hospital drug prices continue to fall, the original market play (OTC, hospital line, third terminal) between the same generic name and different product regulations is bound to be affected as a whole.