The pilot work of centralized procurement has entered the implementation stage to eliminate the gray space of drug purchase and sale.

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Volume procurement refers to the process of centralized procurement of drugs to carry out bidding or negotiation bargaining, clear procurement quantity, so that enterprises for specific drug quantity quotation. Volume procurement can effectively reduce the purchase price of drugs, save medical expenses and reduce the burden on patients. In the long run, volume procurement is of great significance for promoting the transformation and upgrading of enterprises, improving industry concentration, and optimizing the order of drug circulation--

The national organization of drug centralized procurement and use of pilot work deployment will be held recently. At the same time, the results of the "4 7" (4 municipalities directly under the Central Government and 7 provincial capitals or cities under separate state planning) city drug centralized procurement were officially announced for a week, marking that the national organization of centralized drug procurement pilot work has entered the implementation stage.

Volume procurement is a highlight of this pilot, which has been highly concerned by all parties. The prices of the 25 proposed winning varieties fell by an average of 52%, with a maximum drop of 96%.

Will the sharp drop in drug prices dampen the innovation ability of pharmaceutical companies? Can the volume of procurement achieve the ultimate goal of giving people access to quality and low-priced drugs? In response to these questions, a reporter from the Economic Daily-China Economic Net interviewed relevant departments and experts.

  Drug prices return to reasonable

"In view of the previous characteristics of decoupling of volume and price, insufficient competition, scattered procurement and non-coordination of policies, volume procurement will effectively make up for these deficiencies, and it is clear that the shortlisted qualifications are generic drugs and original research drugs that have passed the consistency evaluation." Fu Hongpeng, a researcher at the Health Development Research Center of the National Health Commission, said that the centralized procurement organized by the state this time is mainly to improve the volume procurement method in exchange for more favorable prices. Volume procurement is proposed on the basis of centralized procurement, which refers to the process of centralized procurement of drugs to carry out bidding or negotiation, clear procurement quantity, so that enterprises can quote for specific drug quantities.

"Compared to centralized procurement without volume, this volume procurement in the announcement to clarify the volume of each variety of procurement, to the drug manufacturers clear expectations, so that more favorable prices can be given, so that patients get more benefits. At the same time, reduce the gray space in the drug purchase and sale process, to avoid 'secondary PR, 'hospitals 'secondary bargaining' and other issues." Fu Hongpeng said that the current centralized procurement of drugs lacks clear dosage requirements in the bidding stage, and winning the bid does not mean sales. The implementation of volume procurement means that through bidding can be directly signed purchase and sale contracts, to achieve the integration of recruitment and procurement, to eliminate the phenomenon of "gold sales", so it is of great significance.

"Volume procurement is a common practice in the world, which can effectively reduce the purchase price of drugs, save medical expenses and reduce the burden on patients." Wei Zining, a medical reform expert, said that practice has proved that the more centralized the procurement organization, the more obvious the transaction cost savings and the more obvious the price reduction effect of volume procurement. This practice has been used for many years in Hong Kong, and is still in its infancy in the mainland. The local procurement volume announced this time is determined by the "4+7" region according to the procurement volume of the same variety in 2017, according to the proportion of 60% to 70%, which is a great benefit for enterprises, is conducive to improving the quality of drugs, improving the concentration of the industry, and allowing people to use cheap drugs with high quality and low price.

 healthy enterprise competition

The results of the proposed selection showed that 25 of the 31 pilot generic drugs were selected for centralized procurement, with a success rate of 81%. Among them, 22 generic drugs passed the consistency evaluation, accounting for 88%, and 3 original drugs, accounting for 12%. Compared with the lowest purchase price of the same drug in the pilot cities last year, the proposed winning price fell by an average of 52% and the highest by 96%. The original research drug gefitinib tablets was reduced by 76% and fosinopril sodium tablets by 68%, which was more than 25% lower than that of neighboring countries and regions.

"The price reduction of the products to be selected is within the range of the previous estimate, which we believe is in line with expectations. In the past government procurement links, there have actually been market behaviors in which companies have drastically reduced prices and exchanged prices for volume. Before the implementation of the' 4+7 'volume procurement policy, Shanghai had already done three batches of volume procurement pilot work in the early stage, with the average drop in drug prices between 50% and 60%." National health insurance bureau medical prices and tender procurement department responsible person introduced. According to the authoritative department survey data, in the sales price of some generic drugs, the production cost accounts for only about 17 1/8 of the sales price. Therefore, such a price reduction enterprises can afford.

Take Zhengda Tianqing Company as an example. The price of entecavir, a hepatitis B drug, has been reduced by more than 90%. Due to the change of large packaging, the traditional marketing investment has been reduced, and there is still room for surplus at the ultra-low price.

"The sharp drop in the price of selected drugs is also a non-profit for pharmaceutical companies in the current period and a long-term benefit." The person in charge of the Medical Price and Bidding Procurement Department of the National Medical Insurance Administration believes that first, volume procurement has greatly reduced the cost of drugs entering hospitals. Second, the commitment to timely repayment reduces the cost of business accounts and financing. Third, alliance procurement significantly reduces its marketing costs. Fourth, the market for price, through the scale effect to reduce the unit production cost of drugs. In addition, most of the winning companies are "API preparation integration" companies. Some companies have deployed in advance and purchased a large amount of raw materials at lower prices, locking in costs in advance. "These factors can hedge the impact of drug price cuts and bring tangible benefits to the selected companies."

In response to the fact that some companies believe that the "procurement volume" promised in the volume procurement is not clear, the relevant person in charge of the National Medical Insurance Administration made it clear that the government will take various measures to ensure that the selected drugs enter the hospital and use them first, and escort the implementation of the selected results; The medical security department will incorporate the use of drugs into the management of medical insurance agreements, introduce payment standard policies, and strengthen the monitoring and monitoring of the purchase and use of selected drugs, for hospitals that reduce the expenditure of medical insurance funds due to the standardized use of selected varieties, the balance is reserved for hospitals in proportion, and a sound medical insurance assessment and evaluation index system for medical institutions is established. The health department will incorporate the selected drugs into the clinical pathway management, formulate medication guidelines, give priority to the use of selected drugs into the performance appraisal system of public medical institutions, and establish an incentive and restraint mechanism for medical institutions and medical personnel.

 Industry quality and efficiency

In the long run, volume procurement is of great significance for promoting the transformation and upgrading of enterprises, improving industry concentration, and optimizing the order of drug circulation. "On the one hand, many pharmaceutical companies have begun to reflect. In the future, they may avoid piling up generic drugs in R & D investment, reduce R & D expenditure in this area, and invest limited resources in the research and development of innovative drugs. On the other hand, there are many unreasonable phenomena in the use of medical insurance funds in the past. For a long time, medical insurance has paid too much money for expired original research drugs and high-priced generic drugs. It is an inevitable trend to optimize medical insurance funds and realize the replacement of cages." CITIC Securities senior vice president, chief analyst of the pharmaceutical industry Tian strengthened that.

Ma Ming, vice president of Beijing Jialin Pharmaceutical, the pre-winning company, said: "Through this price reduction, enterprises can be forced to transform as soon as possible and take the road of innovative drugs and generic drug branding."

The winning bid does not affect the development of the enterprise, and the price reduction does not degrade. According to the person in charge of the joint procurement office, the pilot adheres to the quality standard, and the quality qualification for centralized procurement of drugs is based on consistency evaluation as the quality support requirement, so as to improve the quality of drugs and avoid the phenomenon of "bad money driving out good money" in the competition. In the implementation of the results of the selection, the State Food and Drug Administration, the Ministry of Industry and Information Technology and other departments will strengthen the quality supervision of the production, circulation, and use of the selected drugs, increase the frequency of random inspections, increase the accountability of companies that violate laws and regulations, and ensure that the consistency evaluation is not "One-time" evaluation, so the masses do not have to worry about the quality and efficacy of drugs.

"The volume procurement model promoted by the centralized procurement of drugs organized by the state liberates pharmaceutical manufacturers from the disorderly competition of'gold saling', which is conducive to guiding them to focus on improving drug quality and promoting drug research and development, which is healthy for the health of my country's pharmaceutical industry. Development is of great and far-reaching significance." Ding Jinxi, a professor at China Pharmaceutical University and vice president of the International Pharmaceutical Business School, believes that the implementation of volume procurement will become a watershed in China's pharmaceutical industry, and this policy, together with policies such as consistency evaluation, will promote China's progress from a big pharmaceutical country to a pharmaceutical power.