Recently, an internal draft of the guidance on centralized drug procurement of the health and Family Planning Commission (hereinafter referred to as the "draft") has aroused heated discussion in the public. According to the version of the document obtained by the reporter, although the content is still the "initial framework", it clearly reflects the thinking and direction of policy makers on the bidding and procurement of public hospitals in the future.
According to the draft, the public hospital drug bidding will be revised in combination with the formulation and adjustment of the list of low-priced drugs and the catalogue of basic drugs, as well as the reform of drug price management, the reform of medical insurance payment methods, the reform of hospital system and medical services. On the one hand, drug procurement is still the entry point of public medical reform, drug price management and medical insurance payment related policies will be included in the bidding policy consideration.
Drug price reform in line with centralized bidding
As a framework for discussion, the above-mentioned document points to the core of the reform and proposes to explore other ways of drug procurement. For example, in areas where conditions are met, with the advancement of the reform of medical insurance payment methods, hospitals can formulate purchase lists, reasonably determine the total amount of transactions, directly entrust or form a consortium to entrust suppliers, and package purchases according to the drug list.
Under this framework, inpatient medication is no longer charged separately, but is included in the comprehensive expenses such as single-disease payment, DRGs payment, total prepayment or bed-day payment. Outpatient medication is temporarily implemented according to the relevant provisions of the national drug price management, and fixed payment of medical insurance benchmark price can also be explored. For public hospitals that implement pharmaceutical logistics outsourcing management, outpatient pharmacies refer to enterprise management, pay taxes according to regulations, and use profit income as outpatient pharmacy development funds.
In addition, it is required to strengthen the interaction between drug bidding and clinical drug use and improve the management of drug prices. Explore the abolition of the maximum retail price limit for drugs and set a benchmark price for health insurance. The provincial price department, in conjunction with relevant units, conducts a comprehensive survey of the actual purchase and sale prices of drugs in hospitals and social retail pharmacies, publishes the average price of the drug market in the region every quarter, and guides hospitals to sell drugs reasonably.
On this basis, the draft encourages the establishment of a price negotiation mechanism. For patented drugs, exclusive varieties, separately priced varieties, imported joint venture drugs, anti-tumor auxiliary drugs, antibiotics, drugs for cardiovascular and cerebrovascular diseases and other drugs with high prices, difficult to bid and large sales, local medical insurance agencies can negotiate with suppliers to promote price reduction. Junior College drugs can also be purchased jointly across regions. Individual varieties can be negotiated at the national level on a trial basis.
A person from Guangzhou Pharmaceutical Group pointed out that the reform of medical insurance payment has been mentioned as an important part of the reform of public medicine for many years, but it is a new measure at the national level to be incorporated into the bidding and procurement system together with the reform of drug prices. This shows that the results of procurement pilot projects such as Shanghai's "group buying", Anhui hospital procurement catalogue, Guangdong electronic trading platform, and drug price negotiations in Jiangsu and Zhejiang have been recognized by senior government officials, and the intention to strengthen the promotion of pilot experience is obvious.
"However, the existing bidding mode is still the mainstream, but the future multi-form comprehensive drug procurement idea has slightly taken shape." A securities analyst in Shenzhen pointed out.
Release the signal of relaxation of grass-roots medication
Another important aspect of this document is the possibility of a limited relaxation of the many restrictions on existing primary drug use. Especially under the current low-cost drug policy, the new basic drug catalog and the medical insurance catalog to form a drug security system, starting from bidding and procurement, promoting the convergence and integration of the three catalogs has become the focus of work.
To this end, the above-mentioned catalogue proposes that provincial drug purchasing agencies formulate implementation plans for centralized drug procurement in their own provinces (autonomous regions and municipalities), summarize the clinical drug demand of hospitals, and reasonably formulate the Drug Procurement Catalogue of Public Hospitals according to the national basic drug catalogue, clinical application guidelines and formulary, national formulary, etc., specific to varieties, dosage forms and specifications. At the local level, Anhui implemented the procurement of basic drug catalogues for county-level hospitals in 2012, and the basic drug catalogues applicable to public hospitals were formulated and issued in 2014. Catalogues of basic drugs, medical insurance, new rural cooperative medical system, prescription set and commonly used clinical drugs were merged into unified bidding.
The person in charge of a large pharmaceutical factory in Shanghai pointed out that with the clarification of the three major catalogues, one of the major advantages of unified bidding is to skip the restrictions on the use of major catalogues in hospitals at all levels in the past, to purchase and use drugs from clinical needs outside the catalogues, and to de-administrate the drug use levels and demand boundaries of hospitals at all levels. For example, one of the biggest problems reflected in the implementation of the last round of basic medicine catalogue is that grass-roots hospitals are not enough. This situation may be improved in the form of a large catalogue.
According to the reporter's understanding, the liberalization of grass-roots drug use restrictions has been revealed at the Symposium on improving national drug policy held by the drug administration department of the national health and Family Planning Commission in June. The meeting proposed that the grassroots drug use policy will be further improved, and under the premise of fully equipped and prioritized the use of basic drugs, primary medical and health institutions will be allowed to choose a certain percentage of non-basic drugs within the scope of the medical insurance catalog.
However, from the perspective of the industry, the implementation of large catalogues may intensify competition. In the past, many "subdivided" markets will be put on a unified platform for PK. On the one hand, this requires more accurate positioning of relevant products, clear promotion strategies for different levels, and at the same time reminds enterprises to really make more efforts from the level of drug efficacy.