BEIJING, Feb. 16, CNN Client (Reporter Zhang Ni) Earlier this year, the State Office issued the Pilot Program for the Centralized Purchasing and Use of Drugs by State Organizations. Eleven cities including Beijing, Tianjin and Shanghai were selected to carry out the pilot work of centralized purchasing and use of drugs by State Organizations.
Recent years, including Tianjin, Dalian, Shenyang and other cities, drug purchasing rules with quantity have been promulgated one after another. What measures have been taken to promote drug quality and price reduction? Faced with the "waist-cutting" of drug prices, how will pharmaceutical enterprises deal with it? A series of issues have become the focus of attention.
Since the end of March, patients will be on trial purchasing drugs one after another.
According to the Plan issued by the State Office, there are 11 cities in Beijing, Tianjin, Shanghai, Chongqing, Shenyang, Dalian, Xiamen, Guangzhou, Shenzhen, Chengdu and Xi'an to carry out pilot work.
As early as December last year, the results of centralized recruitment and selection in pilot areas were announced. The average price of 25 varieties was reduced by 52% and the maximum was reduced by 96%.
Among the 15 Chinese pharmaceutical enterprises, two foreign enterprises have realized the "patent cliff" of the original research drug, namely, the price reduction of gefitinib tablets and Fosinopril Sodium Tablets by 76% and 68%, which are over 25% lower than that of the surrounding countries and regions.
The head of AstraZeneca Pharmaceutical Company had previously said that their gefitinib tablets had dropped to the lowest price in the world in order to win the bid.
According to the Program, the total purchasing volume should be estimated according to 60%-70% of the total annual drug consumption of all public medical institutions in the pilot area, and the purchasing with quantity should be carried out. In addition, in order to ensure the repayment, medical institutions should be paid in advance at a rate not less than 30% of the purchase amount, and cities with conditions can pilot the direct settlement of medical insurance.
According to the official introduction, the whole pilot work is divided into three stages, the first stage is the stage of centralized recruitment, which was carried out in December last year. The second stage is the implementation and matching of the winning bidding results. The third stage is the evaluation and summary stage.
Since late March, 11 pilot cities have begun to implement the results of the selection, and patients will continue to use the drugs purchased in the pilot.
Local rules have been promulgated to mobilize the enthusiasm of medical staff in some areas
Reporters noted that in recent years, some pilot cities have also announced the implementation of drug procurement rules with quantity.
For example, in January this year, Tianjin announced the Implementation Plan for the Pilot Work of Implementing the Centralized Procurement and Use of Drugs by State Organizations in Tianjin (draft for comments).
It is clear that the medical insurance agencies pay the medical insurance fund to the designated medical institutions twice according to the purchase amount of the contract (50% of the first advance payment is completed after the purchase and sale contract is signed, 50% of the second advance payment is completed within six months after the purchase and sale contract is signed).
In addition, when designated medical institutions standardize the use of selected drugs and complete the dosage, the total medical insurance management indicators of the cost of selected drugs are separately calculated, and the part of medical fund expenditure reduced by the price reduction of selected drugs is entirely left to medical institutions.
In some local rules, measures are also put forward to mobilize the enthusiasm of medical staff.
For example, Liaoning Province recently issued the "Opinions on the Implementation of the Pilot Work of Centralized Drug Purchase and Use by State Organizations".
According to the requirements of "two permissions" (allowing medical institutions to break through the current wage control level of public institutions, allowing medical service income to deduct costs, and drawing funds according to regulations, mainly for personnel rewards), public medical institutions can make overall use of personnel salary expenditure, mobilize the enthusiasm of medical personnel, and promote comprehensive reform of public hospitals.
In terms of execution time, the Implementation Opinion requires Shenyang and Dalian to unify the implementation of the national centralized procurement results on March 20.
Drug price reduction in the region has become a general trend
Although only 25 products of 15 pharmaceutical enterprises won the final bid, it has become the trend of the times for pharmaceutical enterprises to improve quality and reduce prices and extrude excess water.
As early as November 2018, Shanghai published the Supplementary Document of Shanghai Regional Concentrated Drug Purchase in 4+7 Cities. It is clearly pointed out that medical institutions can continue to purchase and use unselected drugs on the premise of guaranteeing the quantity of the selected varieties, but the quantity shall not exceed the selected varieties after conversion according to the proportional relationship.
In addition, according to the above-mentioned Documents, the highest-priced drugs of the same kind which meet the requirements of the centralized purchasing declaration must be purchased and used on the basis of winning the bid price (or hanging up the network price) in 2017 and gradient price reduction according to the price difference (based on the bottom of the selected price). If the price difference is large, the price reduction should be further increased. The actual purchasing price should be communicated by manufacturers and medical institutions. Open bargaining purchasing confirmation through internet.
Previously, industry insiders have analyzed that the promotion of purchasing with volume and consistency evaluation measures can promote hospitals to return to the nature of medical care and increase hospital revenue from the service level. The market share of "4 + 7" purchasing and bidding drugs in these cities accounts for about 30% of the national share, which will affect the further reduction of drug prices in other regions.
In addition, for the original research drugs whose patents have expired, if the price of drugs is lowered through purchasing in quantity, the expenditure of the medical insurance fund can be saved, and the innovative drugs can be supported by the medical insurance fund.
The impact on the industry after the price reduction? Pharmaceutical Enterprises: Pressure and Opportunity
When the pilot boots with volume purchasing landed, some voices once questioned that this would have a greater impact on the pharmaceutical industry, and enterprises would face the pressure of price war.
However, in the eyes of many enterprises, the new policy brings pressure and opportunities.
As early as December last year, when the pre-bid price and the list of enterprises flowed out, many domestic pharmaceutical enterprises said that the purchase with quantity would not be right.