People's Review: Squeeze the water out of the drug price.

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A few days ago, the General Office of the State Council issued the "Several Opinions on Further Reforming and Improving Drug Production, Circulation and Use Policies", which indicates that my country's pharmaceutical field will usher in a major reform of the entire chain and the entire process.

In deepening medical reform, drug reform is a hard nut to crack. A few years ago, the media exposed a drug called "asparagus tablets" with an ex-factory price of 15.5 yuan. After going through pharmaceutical companies, medical representatives, doctors and other links, it was finally sold to patients at a price of 213 yuan. This is a microcosm of the drug chaos in our country. The high price of medicine has become a pain in people's livelihood, and the people have responded strongly.

Due to historical reasons, my country's pharmaceutical companies are "how small and scattered", and the problems of uneven drug quality, chaotic circulation order, and inflated prices are very prominent. At the end of 2015, there were 5065 pharmaceutical manufacturers in my country, which is the world's largest producer and exporter of APIs, and also the world's largest producer of preparations. 97% of the products are generic drugs, and the homogeneity of drugs is serious, and the problem of low-level repetition is prominent. The recent announcement of excessive duplication of drugs shows that more than 100 enterprises produce 129 kinds of drugs at the same time. There are 13508 pharmaceutical wholesale enterprises and more than 453000 retail enterprises in China. The market share of the top three pharmaceutical wholesale enterprises is only 33%, which is far from the market share of more than 80% in developed countries. Industry concentration is low, with only 1.75 per cent of enterprises with modern pharmaceutical circulation conditions. There are many links in the circulation of drugs, the circulation order is chaotic, and the affiliated operation, ticket money laundering, and commercial bribery have been repeatedly banned, which have pushed up the price of drugs, corroded the team of doctors, and induced large prescriptions and prescribing expensive drugs.

Why is it difficult to curb the inflated drug prices? Because the production, circulation and use of drugs is a complex ecological chain, involving all aspects of the game of interest, neither side is willing to touch their own cheese. Only by breaking the existing interest pattern and carrying out the whole chain and whole process reform can we squeeze out the water in the price of drugs and let the drugs return to the function of curing diseases. If we do our own things and rule separately, we will inevitably get busier and busier and work to no avail. Therefore, the treatment of drugs need to learn from the water control thinking, based on the whole basin, break through the key points, up and down linkage, coordinated operations, in order to cure both the symptoms and the root causes.

Reforming and improving the policy of drug production and circulation is an important measure to promote the supply-side structural reform of the pharmaceutical industry. The "Opinions" regulate the three links of drug production, circulation, and use, and propose a series of reform measures in a targeted manner. For example, in the production process, strict drug marketing review and approval. Optimize the review and approval process, speed up the review and approval of clinically urgently needed new drugs and shortage drugs, and accelerate the evaluation of the quality and efficacy of listed generic drugs. In the circulation link, break the market segmentation of pharmaceutical products and local protection, promote the merger and reorganization of pharmaceutical circulation enterprises, and accelerate the formation of an urban and rural drug circulation network with large backbone enterprises as the main body and small and medium-sized enterprises as supporting supplements; implement the "two-invoice system" for drug purchase and sales, Reduce circulation links, eliminate irregular enterprises, and purify the circulation environment. In the use link, vigorously promote the reform of medical insurance payment methods, and fully implement a composite payment method that combines multiple payment methods such as payment by disease, payment by head, payment by bed day, etc., and reasonably determine medical insurance payment standards. Promote medical institutions to actively regulate medical behavior and reduce operating costs. This series of reform measures are of great significance for improving the quality of drug supply and standardizing drug circulation and use behavior.

"Frozen three feet, not a day's cold." The reform of drug production and circulation must persevere and fight a protracted war. All relevant departments work together, make precise efforts, formulate a timetable and roadmap for the implementation of policies and measures, and use Chinese-style methods to solve the problem of drug reform, so that the people can use higher-quality and reasonably priced drugs. (Bai Jianfeng)