"4 7" policy landing the latest summary! 7 dimensions to analyze the differences and similarities of the implementation rules of 11 cities

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In December 2018, 25 selected varieties of "4 7" band procurement were announced. According to the previous deployment of the National Health Insurance Bureau, by the end of March 2019, "4 7" band procurement should be fully implemented. Up to now, 11 cities have issued relevant documents, specifying the specific implementation time and detailed rules. Mi Intranet will analyze the detailed rules for different cities to implement "47" volume procurement from 7 dimensions.

Dimension 1: Full implementation time

Table 1: Specific implementation time in 11 cities


According to the previous deployment of the National Health Insurance Administration, by the end of March 2019, the "4 7" band procurement should be fully implemented. Judging from the time announced by the 10 cities that have clearly defined the specific implementation time, Tianjin implemented it earlier, starting on March 1, while Shanghai, Beijing, Chongqing, Shenzhen, Shenyang, Dalian, Xi 'an and Xiamen implemented it later, starting in mid-to-late March. It is reported that, the First Affiliated Hospital of Xiamen University completed the first purchase of selected drugs on March 15 at the Fujian Provincial Pharmaceutical Equipment Joint Price Limit Sunshine Procurement Hercynian Platform. Guangzhou is expected to implement it from April 1, but Chengdu has not yet announced it. Beijing, Chongqing, Shenyang and Dalian have more accurate breakdown of the execution time, and Xi 'an still has time for trial operation.

Although Fujian Province is not a pilot area, the province will take 60% of the market share to implement "4+7" volume procurement, which will be implemented on April 1. In addition, WeChat public number Sanming Medical Security recently released news that the "4+7" winning results began to land in Sanming. Fujian Province is expected to become the first province among the five provinces (Guangdong, Liaoning, Shaanxi, Sichuan and Fujian) in the "4+7" pilot cities to promote volume procurement.

Dimension 2: Ensure the admission and reasonable use of the selected varieties.

Table 2: Measures to Ensure Admission and Rational Use of Selected Varieties in 11 Cities



This purchase with quantity takes 12 months as a purchase cycle. If the medical institution completes the agreed purchase quantity in advance within the purchase cycle, the excess can still be purchased according to the selected price. Organize medical institutions, selected production enterprises and distribution enterprises to sign purchase and sale contracts, and refine and stipulate the purchase price, drug quality, purchase quantity, etc.

To ensure the smooth admission and rational use of the selected varieties is the key to determine the smooth implementation of the "4 7" band procurement, a number of provinces and cities clearly to give priority to the procurement, the use of the selected varieties, not to control the total cost, "drug proportion" and other reasons to affect the supply and use of the selected drugs.

In addition, Shanghai has made it clear that doctors whose prescription dosage has dropped significantly should strengthen doctors' interviews. Beijing encourages non-public hospitals to use the selected varieties, and will summarize and evaluate whether the pilot will continue and expand the dosage according to the drug usage during the pilot period. In addition, Beijing is the first pilot city to issue a special document on how medical institutions use the selected drugs; shanghai, Beijing, Tianjin, Shenyang, Dalian, and Xi'an have imposed greater penalties on medical institutions and medical personnel who do not purchase and use the selected varieties as required; Shenzhen will link the selected varieties with GPO, and the price will refer to the "4 7" result. This means that the price of the previous shopping in Shenzhen is invalid.

Dimension 3: Use of Unselected Varieties

Table 3: Requirements for the use of unselected varieties in 11 cities




Except for Xiamen, Xi'an and Guangzhou, which are not stated in the document, the other eight cities and cities have put forward gradient price reduction requirements for the unselected varieties. After completing the purchase volume of the selected varieties, the unselected varieties with guaranteed quality, curative effect and appropriate price can be selected.

Shanghai has proposed that the unsuccessful varieties should not be restricted by the "one product, two regulations" and will increase the proportion of individual self-payment for "high-priced drugs" by 10%-20%. In addition, it has taken the lead in carrying out the work of gradient price reduction for the unsuccessful varieties. Beijing and Shenzhen will no longer purchase the products of enterprises that have passed the "4+7" varieties that have passed the consistency evaluation.

Since Shanghai has previously carried out three batches of volume procurement, it has a "weather vane" role in this national volume procurement. Beijing, Tianjin, Shenyang, Dalian, Shenzhen, Chengdu, etc. all use Shanghai's price reduction results as a reference. Tianjin will not recognize the payment standard for varieties that have not completed the application for price reduction within the adjustment period. Beijing also requires comparison with the lowest price in the country on the basis of Shanghai. Shenzhen also embeds GPO negotiations on the basis of Shanghai. The reduction rate of the unsuccessful varieties shall not be less than 25% of the price difference between Shenzhen GPO price and the price of the selected drugs in 2018. In addition, retail prices are also introduced as a reference, chengdu sets "red line price" for non-selected drugs and conducts testing and assessment.

Dimension 4: Medicare Payment Issues

Table 4: Regulations on Medicare payments in 11 cities



In order to ensure the admission and reasonable use of the selected varieties, the combination of rewards and punishments will be implemented in this purchase with quantity. Medical institutions and medical personnel who do not purchase and select the selected varieties according to regulations will be punished accordingly. However, the medical insurance expenditure will be reduced due to the selection of the selected drugs, and the balance will be left to the medical institutions for their own use.

The implementation of medical insurance fund prepayment is one of the characteristics of this volume purchase. Tianjin will pay 50% and 50% twice, Shanghai will pay 50%,45% and 5% three times, Shenyang and Dalian will pay not less than 50% in advance, and exploration of direct medical insurance settlement will be encouraged. Beijing and Shenzhen will pay 30% in advance; tianjin, Shenyang, Dalian, Xiamen, Xi 'an, Chongqing and Guangzhou unify the medical insurance payment price, with the selected price as the medical insurance payment standard, and the original research drugs, reference preparations and consistency evaluation varieties under the same general name have the same payment standard. Xi 'an and Chongqing explore the operation mode of direct advance payment from medical insurance funds to enterprises; Guangzhou has clearly defined the medical insurance payment standards for different varieties such as selected varieties, non-selected varieties and varieties that have not passed consistency evaluation.

Dimension 5: The problem of payment collection

Table 5: Requirements for Refunds in 11 Cities



In order to ensure the timely settlement of payment for goods and reduce the transaction costs of production enterprises and operating enterprises, this volume purchase puts forward requirements for payment collection. Shanghai, Beijing, Shenzhen, Shenyang, Dalian, etc. specify that the payment collection time shall not exceed 30 days, of which Shanghai shall pay off the payment before the 15th of each month. Tianjin has strict requirements on the payment time, and it only takes 8 working days for the drug payment to be made from medical institutions to production enterprises; xi 'an has taken punitive measures such as interviews and notifications to the heads of medical institutions who do not pay back on time.

Dimension 6: Distribution Issues

Table 6: Requirements for Drug Distribution in 11 Cities


In terms of distribution of selected drugs, Shanghai and Liaoning are exclusive distribution, Beijing can have multiple distribution, Shenzhen can choose no more than 3 (including 3) enterprises to distribute, in addition, Shanghai, Liaoning and Xi 'an encourage direct distribution by production enterprises. Shenzhen and Liaoning have put forward clear requirements for distribution enterprises to ensure response within 12 hours, delivery in place within 24 hours, delivery tickets in line with each other and issue separate invoices, provide drug test report, etc.

At present, Shanghai, Beijing and Shenyang have announced the distribution enterprises of the selected varieties, and Sinopharm Holdings and China Resources Pharmaceutical, the two major pharmaceutical distribution giants, have obtained most of the distribution rights.

Dimension 7: Other Aspects

Table 7: Characteristics of 11 cities in other


Of the 11 cities, only Liaoning has explored expanding the scope of the pilot project and encouraged non-pilot cities to participate on a city-by-city basis on the premise of meeting the purchase usage, medical insurance payment policy and drug payment settlement. Guangzhou has now reached the fourth batch of GPO medical insurance negotiations. Manufacturers who failed in the "47" variety need to negotiate drug prices. In addition, Guangzhou medical insurance negotiations collect prices from Fujian Province, which means that the negotiation results will come out, the new national lowest price will be born!

Source: Gathering Southern Medicine, Medical Procurement Network of Provinces and Cities

Note: The article is summarized from various public materials, and the documents in Beijing have been withdrawn. The relevant contents above are for reference only. If there are omissions, welcome to correct!