Tender fierce pressure: patent drug market will shrink more than 10 billion!

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Core Reading: In the past, I have not heard much about drug purchases, high-priced drugs and high-rebate drugs, and even added the bribery costs of drug companies to the drug prices, which ultimately led to the patients' losses.
Recently, the State Health Planning Commission issued a notice on drug procurement in public hospitals, proposing requirements such as classified procurement, control of procurement budget at 25%-30% of hospital business expenditure, negotiation of group purchase of patented drugs, and bidding of "double envelope" system, which are conducive to breaking the mechanism of supplementing medicine with drugs, reducing the inflated price of drugs and reducing the burden of drug use on the common people.
The National Health and Family Planning Commission issued the "Notice on the Implementation of the Guidance on Improving the Centralized Procurement of Drugs in Public Hospitals", the full moon.
The notice provides operational guidelines for drug procurement in public hospitals. What is the classification of drug procurement? The hospital budget can be controlled? Patent drug prices are high, the government group purchase can be cheap? Bidding will not blindly lower prices to ignore the quality of drugs? On the issue of common people's concern, the reporter interviewed the National Health and Family Planning Commission Department of drug administration responsible person and relevant experts.
One question: reduce the budget for buying drugs, public hospitals poor money?
The classified procurement of drugs is a highlight of the notice, and it also gives the specific scope and methods of centralized procurement. Zheng Hong, Director of the Drug Administration Department of the State Health and Family Planning Commission, said that the specific method is that the hospital shall formulate a procurement plan according to not less than 80% of the actual drug usage in the previous year, specific to the generic name, dosage form and specification. Each product specification shall specify the specific procurement quantity. In principle, there shall be no more than 3 dosage forms for each drug to be purchased, and in principle, there shall be no more than 2 specifications corresponding to each dosage forms. Priority should be given to drugs that meet the clinical pathway, include major disease protection, major new drug creation projects, and major public health projects, take into account the drug needs of special groups such as women, the elderly and children, and do a good job in linking up with medical insurance and new rural cooperative reimbursement policies.
The reporter noticed that the notice clearly requires that hospital drug expenditures are generally not higher than 25%-30% of hospital business expenditures. In fact, most public hospitals account for more than 40% of drugs, and the compensation mechanism for public hospitals has not been fully established. Under such circumstances, can such a low procurement budget be implemented?
Zheng Hong introduced that controlling drug costs from the hospital budget link is conducive to reducing the false high prices of drugs and reducing the burden of drug costs on the masses. In order to achieve the goal, it is necessary to adhere to the linkage of the three medical services (medical insurance, medical care, and medicine), and study and formulate specific methods for public hospital reform pilot cities to purchase by themselves in accordance with local conditions, and to cooperate with medical insurance payment methods, medical service prices, and salary systems. Comprehensive reforms are matched to form a policy synergy.
Jiang Yu, an associate researcher at the Development Research Center of the State Council, believes that hospital drug expenditures are generally not higher than 25%-30% of business expenditures. This is to implement hard constraints from the source of hospital budgets. "There are several bases for this proportion: first, the current proportion of hospital drugs in China is about 43%, and there is still a lot of room for decline considering excessive drug use and inflated drug prices; second, the state proposes to reduce the proportion of drugs in public hospitals in pilot cities to 30% by 2017; third, the proportion of drugs in developed countries is usually between 10% and 20%. After the successful implementation of comprehensive reform of public hospitals in Sanming, Fujian and other places, the proportion of drugs has also dropped to between 25% and 30%."
Jiang Yu pointed out that, on the other hand, reducing drug costs is equivalent to reducing part of the income of medical staff. In order to make the income of medical staff reach a reasonable level, it is necessary to further improve the compensation mechanism of public hospitals, through financial investment, reform the payment method of medical insurance, adjust the price of medical services, and use more financial and medical insurance funds to directly compensate the labor of medical staff. Fundamentally cut off the interest relationship between medical staff's income and drug costs, so that medical staff have the motivation to use drugs rationally.
Li Ling, a professor at Peking University, said that the reform of drug procurement requires the cooperation of medical insurance and medical treatment. The compensation mechanism of public hospitals has not changed, and the mechanism of supplementing medicine with medicine still exists. The method of medical insurance payment according to the project is still encouraging hospitals and doctors to prescribe more expensive drugs. The phenomenon of vicious competition among pharmaceutical enterprises has not been improved. It is impossible to completely reverse the situation of falsely high drug prices by simply implementing the method of centralized drug procurement. It needs the linkage of the three doctors to achieve the policy effect.
Second question: group purchase patent medicine, can you cut the price?
The price of patented drugs and exclusive drugs is high, and many patients shout that the price is too high to bear. The notice proposes to implement five ways of classified procurement of drugs, including negotiated procurement of patented drugs and exclusively produced drugs. It is the first time in our country to purchase drugs through negotiation to reduce the excessive price.
It is estimated that there are more than 60 kinds of imported patented drugs on sale in China, 150-160 kinds of exclusive varieties of western medicine that have passed the patent period but have no generic drugs in China, and more than 400 kinds of exclusive varieties of proprietary Chinese medicines in the medical insurance catalogue. According to this rough calculation, the sales of the entire patented drugs and exclusive varieties should be between more than 60 billion yuan and more than 70 billion yuan in the market. After the implementation of the policy, this part of the drug can reduce spending more than 10 billion yuan.
Zheng Hong introduced that the National Health and Family Planning Commission will launch a pilot negotiation in the near future, establish a joint meeting system for drug negotiations among various ministries and commissions, and establish a database of negotiation experts and supervision experts. On the basis of summing up experience in pilot projects, the scope of negotiations will be gradually expanded. For patented drugs or exclusive varieties that have not yet been included in the negotiation pilot, provinces can organize procurement according to the existing model, but all medical institutions must implement zero-margin sales. Encourage inter-provincial cross-regional joint negotiations, combined with the national regional economic development strategy, to explore the formation of regional procurement prices adapted to the medical insurance payment policy.
Jiang Yu said that negotiated procurement is an internationally accepted procurement method for patented drugs and exclusive drugs. The main reason is that the government takes advantage of the "group buyers" and uses the market scale of a region or even a country to negotiate with monopolistic patented drug manufacturers., Give full play to the advantage of large quantity and preferential, and control the price at a reasonable level.
Shi Lu Wen, director of the International Research Center for Pharmaceutical Management at Peking University, said that the most important thing in negotiating pricing is to implement the combination of volume procurement and volume and price. "The main body of the negotiation and the mode of operation can be constrained by the system, and the key is to really implement it after the negotiation. As long as the implementation is in place, the prices of most drugs should show a downward trend." He said.
Three questions: how to prevent the only low price is to take, cheap not good goods?
The notice proposed that centralized procurement should follow the "double envelope" and the method of linking quantity and price in the bidding of essential drugs. Previously, there was a phenomenon of low prices and quality problems of essential drugs, which was called "only low price is taken". How to avoid such phenomena?
Jiang Yu said that the emergence of "only low prices are taken" is generally caused by two situations. One is that due to the imperfect drug quality evaluation and supervision system, although different companies produce drugs with the same ingredients, although there are legal production approvals, there are certain differences in the quality effects of the drugs produced. In this case, if "the only low price is to take", it will affect the effect of medication, and even exclude good quality drugs. To solve this problem, it is necessary to improve the drug evaluation system, strengthen the comprehensive evaluation and monitoring of drug quality and price. Another situation is that some pharmaceutical companies fail to produce and distribute drugs on time and in quantity after winning the bid at a malicious low price. In this case, it is necessary to strengthen comprehensive evaluation in the bidding process, guide enterprises to bid rationally, and at the same time increase penalties for defaulting enterprises.
"But judging from the procurement of essential drugs in my country, the statement that'only low prices are the only ones to take 'is not very accurate." Jiang Yu said that from the beginning of the bidding procurement of essential drugs in 2011 to the centralized procurement of drugs in public hospitals, the quality and price were evaluated successively through the "double envelope" system. "For drugs of similar quality, of course, choose the lower price. This is the common sense of buying things, and it is only natural. It cannot be said that'only low price is taken '."
Shi Lu Wen believes that the purpose of drug bidding and procurement is not to directly pursue price reduction. The key to determining the quality of drugs lies in production, and bidding and procurement is a selection on the premise that the products meet the standards. Bidding is only a market mechanism to promote the rational formation of drug prices. Under the premise of respecting market laws and encouraging full competition, drug prices should return to rationality.
"At present, with a large number of enterprises and a wide gap in production efficiency, the bidding price formed by the competition mechanism will indeed be close to or even break down the cost of some enterprises." However, the elimination of inefficient enterprises is a normal phenomenon in the market economy, which is conducive to ending the chaotic state of China's pharmaceutical industry for many years and conducive to the long-term development of the whole industry.