Purchase with volume:
Terminator of the "Golden Age" of generic drugs
China News Weekly Reporter / Li Mingzi
Published on 2020.5.25, the 948th issue of China News Weekly
What products can continue to sell well after being priced dozens of times higher?
Except for the masks during the epidemic, it was the state organizations that concentrated on the purchase of the drugs before. In January of this year, when the second batch of “National Organized Centralized Purchasing of Medicines” (referred to as “purchasing by volume”) was opened for bidding, the German pharmaceutical company Bayer reported a “fracture price” of RMB 5.42 per box for the bidding session of the blood sugar-lowering drug Acarbose. Less than 1/10 of the original price. This drug originally developed by Bayer has occupied the number one position in the domestic diabetes drug market for many consecutive years since it entered China in 1995.
Not only the original research drugs, but also the equivalent generic drugs with high prices. In the first batch of procurement trials, a successful bidding company for the common hepatitis B drug entecavir lowered the selling price from the original 310.8 yuan to 17.36 yuan.
On March 18 this year, the National Medical Insurance Bureau issued a "Letter on Actively and Steady Advancement of the Second Batch of National Organizations for the Procurement of Centralized Drug Purchases." The provinces have successively issued documents to clearly implement the results of the election by the end of April. Patients across the country will be used to High-priced medicines.
According to an industry research report released by Ernst & Young, China's pharmaceutical market reached US $ 137 billion in 2018, and it has become the world's second largest pharmaceutical country market, but the price of medicine is still high. The dissolution of the abnormal combination of "big country and expensive medicines" means that the predicament that provincial-level centralized recruitment cannot be exchanged for quantity in the past ten years has been broken. At the same time, this also means that the current status of domestic innovative medicines will soon change.
"We are more maintaining order, rather than repricing." The National Medical Insurance Administration's reply to China News Weekly said, "After the state has concentrated on volume purchases, reducing drug prices is indeed very important to the people. From a long-term perspective, It is equally important to guide the industrial ecology. "
The higher the price of medicine
Zhang Ping, a hypertensive patient who lives in She County, Anhui Province, has been taking a long-term domestic amlodipine besylate tablet that was suddenly unavailable in the hospital. The medicines of this brand only cost a little more than 1 cent per tablet on average, and the price of another brand of medicines has replaced several dozen times, 2.77 yuan per tablet. This happened in early 2019, when Anhui was not in the scope of the pilot drug procurement.
The fact that commonly used cheap base drugs cannot be prescribed in hospitals also happened in Shanghai. According to Gong Bo, director of the Medical Price and Tendering and Purchasing Department of Shanghai Medical Security Bureau, when Shanghai began to study the volume procurement pilot in August 2012, it was found that the price of similar drugs that entered the hospital through tendering was extremely large, and the high price exceeded the market price. Several times, the low price is close to the production cost. The common people are afraid to use quality. There are still some brands that used to be unsuccessful. The patients have to go to the second and third level hospitals in the surrounding cities to prescribe.
The emergence of such situations is closely related to the past recruitment system. Before the trial of national drug procurement by volume, bidding was conducted through the provincial drug centralized procurement platform. The common practice is to "group bid", also called "quality level". Under normal circumstances, the original research drugs and imported drugs are divided into one group, which is called the "VIP private room" group in the industry. It has a small number and poor competitiveness, and can be shortlisted by a slight price reduction; generic drugs and domestic drugs are divided into several groups according to quality grade. Within each group, the lower the level of quality, the more intense the group competition. Dozens of companies "fight" for one or two places, and the lower the price, the lower the price. This is also the price of original drugs and imported drugs after the National Development and Reform Commission has repeatedly adjusted prices. The reason for staying high.
In some provinces, there will be 5 to 7 quality groupings of the same drug, allowing 1 to 2 companies to be selected in each group. The most extreme result is that a drug has won dozens of companies after recruitment. When the hospital actually purchases, it usually chooses one of each of the imported and domestic categories. Who chooses which one does not choose, most depends on the promotion efforts of each pharmaceutical company or pharmaceutical representative, commonly known as "sale with gold".
"The core issue of high drug prices in China is the sale of gold, which can be said to be a tumor. The medical reform has struggled against it for more than two decades." An official of the National Medical Insurance Bureau, who did not want to be named, told China News Weekly.
The formation of this "poisonous tumor" can be traced back to the mid-1980s. Prior to this, pharmaceuticals were monopolized by Chinese pharmaceutical companies, prices were fixed, and purchases were underwritten to form a three-tier wholesale station-province (autonomous region, municipality) -city (prefecture, county) wholesale station distribution mode. Hospitals, health stations and pharmacies. With the reform of the economic system and the marketization of medicines, the top-down three-tier wholesale distribution channel has been broken. All wholesale stations at all levels can purchase goods from pharmaceutical factories and sell them to hospitals. Pharmaceutical companies and wholesale stations at all levels have successively established drug sales companies. , Engaged in marketing activities, such a pharmaceutical circulation model once occupied a dominant position.
Zhu Hengpeng, deputy director of the Institute of Economics of the Chinese Academy of Social Sciences and director of the Center for Public Policy Research of the Chinese Academy of Social Sciences, recalled in the article "The Disadvantages of the Medical System and the Distortion of Drug Pricing" that by the end of the 1990s, the number of pharmaceutical distribution companies increased to more than 16,000, forming " "Small, scattered, chaotic" business characteristics of medicine.
Public hospitals are the largest customers in the domestic pharmaceutical market. The latest "National Basic Medical Insurance, Industrial Injury Insurance and Maternity Insurance Drug Catalog" contains a total of 2709 drugs, with sales accounting for 80% of the total, making it an indispensable place for sales.
After a period of decentralized procurement, in 1999, the state re-tested the centralized drug bidding for procurement, first in prefecture-city units and then in provinces, to allow winning bids to be circulated on the basis of the bid price. According to the system at the time, Zhu Hengpeng divided the revenue from selling drugs in hospitals into four parts: the purchase price difference and the discounts publicly refunded by the pharmaceutical companies as publicly recognized legal gains, or "explicit deductions"; the other two were private agreements between hospitals and pharmaceutical companies. The discount (that is, "dark deduction"), and the rebates received by individuals including doctors, are behind-the-scenes transactions that deviate from supervision, which is the main part of "sales with gold".
Driven by common interests, hospitals tend to choose medicines with high prices and large “dark deductions”. Medicines with low prices or small discounts are often not marketable. "The amount of prescriptions in the hospital determines the life and death of a variety or even a manufacturer. When the recruitment was conducted more than ten years ago, the price was lowered, but the prescription could not be prescribed, resulting in a situation of 'recruiting one and dying one'. "Gong Bo said to" China News Weekly ".
In response to the increase in the price of drugs, at the end of March 2004, 13 pharmaceutical industry associations across the country jointly drafted the "Proposal on Requesting to End the Centralized Bidding and Procurement of Drugs". The "State Council" stated that the price of successful drugs after bidding far exceeded market wholesales. The actual supplier price.
Subsequently, the central government issued a series of documents to gradually eliminate the drug markup. But these measures have not touched on the fundamental link of selling drug prices with high prices. Zhan Jifu, the former director of the Fujian Provincial Medical Security Bureau, had figured out the price of medicine before leading the Sanming medical reform. The price of provincial centralized medicine collection was several times or even tens of times the ex-factory price. On behalf of sales fees (20%), and other provinces to the ticket company's ticket reversal fee (10%).
At this time, the actual selling price of the drug is almost not proportional to the production cost. According to an internal data obtained by China News Weekly, the production cost of the anti-schizophrenia drug olanzapine is only 0.5 yuan / piece in 2020, including the main and auxiliary materials, packaging materials, personnel, quality inspection and all other costs, It is far lower than the lowest bid price of 2.48 yuan / tablet in 2019 when the first batch of tape purchases are expanded, which is less than 7% of the original research company US Eli Lilly's offer of 6.74 yuan / tablet.
Test water "purchase with volume"
"Sale with volume is a weapon to destroy sales with gold. To enable pharmaceutical companies to change their path dependence, they must provide new routes. After purchasing with volume, there is no need for sales promotion, so there is no sale with gold." The aforementioned official of the National Medical Insurance Bureau Said.
Sanming Medical Reform, which began in 2012, is called the 1.0 version of volume procurement. It is led by the largest payer of medical insurance-the Sanming City Medical Security Fund Management Center. It will be scattered in the centralized purchasing centers, hospitals and medical insurance. The drug and payment links are centrally managed and the circulation and use of drugs are monitored throughout the process. Whoever pays is more motivated to control fees. At the same time, increase the payment price of medical services, optimize salary, and decouple doctor's income from the cost of medicines and consumables.
Sanming Medical Reform has its own urgency. Before the reform, medical insurance was worn out. In 2010, the Sanming employee medical insurance co-ordination fund received more than 140 million yuan, and the medical insurance fund owed more than 17 million yuan in drug fees to 22 public hospitals in the city. After the medical reform, by the end of 2014, Sanming City had a medical insurance balance of more than 86 million yuan, and the proportion of medicines dropped from 46.77% in 2011 to 27.36% in 2014. The hospitalized medical expenses per capita in public hospitals above the county level in the city were less than half of the provincial average.
However, in Sanming Medical Reform, "exchanging prices by volume, prepayments, and winning the exclusive bid at a low price" has brought success and also raised doubts. In addition, at that time, the country did not implement the "conformity evaluation of generic drugs" and lacked supporting measures to ensure the quality, supply and use of drugs.
Since 2010, the centralized procurement of pilot drugs started in Shanghai has been referred to in the industry as "Volume Procurement Version 2.0". "The risk of talking about price aside from quality is great." Gong Bo said that Shanghai fumbled and established a set of comprehensive quality evaluation indicators. He laughed at himself as "local law consistency evaluation", a total of 7 indicators, covering production enterprises The scale, EIA situation, quality certification, internal control indicators, laboratory testing and other links stipulate that at least 5 indicators must be met to participate in the bidding. The imported original pharmaceutical companies compete with generic drugs in the same field, and the lowest price wins the bid.
According to Gong Bo, the biggest difficulty at the time was that there was no national authority's consistency evaluation as the quality threshold. If the monitoring standards could stand the test, a lot of work would have to be done, one standard for each drug. Taking internal control indicators as an example, in the early stage, they asked pharmaceutical companies through door-to-door to determine which of the dozens of national standards for a drug production process have the greatest impact on quality. Then they invited clinical and pharmaceutical experts to discuss and select three or four items to write Enter the bid.
"Drug supervision department reminded us that the quality of the drugs is produced and tested, and gave us near-infrared spectroscopy monitoring equipment." Gong Bo explained that after winning the bid, the pharmaceutical company provided 6 consecutive batch numbers to the establishment of the drug inspection institute as promised The near-infrared spectroscopy model implements batch inspections. Previously, only blood products had such inspection specifications.
If you want to carry out "purchasing with volume", you also need to accurately grasp the demand of the hospital and the actual supply of the enterprise. At that time, the provincial network recruitment platform was only responsible for registering and publishing procurement information. In fact, specific information such as how much a medical institution bought and the price level did not compulsorily require online publication. The phenomenon of under-reporting, under-reporting and over-reporting all exist. Without accurate information, it is impossible to make a correct decision. How much can “quantitative” reduce the price and ensure that the medical institution can be used up?
Shanghai has solved the “quantitative” problem with technical means and rebuilt the procurement platform based on medical insurance settlement information. Over 34 months, the "Shanghai Medical Procurement Service and Supervision Information System" was completed in July 2015 and covers the city's designated medical insurance hospitals.
In June 2015, Shanghai conducted the first batch of procurement trials, including amoxicillin, cefuroxime axetil and enalapril maleate, three oral regular-release pharmaceutical products, with an average price drop of 64%. According to the data of the Sunshine platform in Shanghai, 60% to 70% of the previous year's drug use is used as a bargaining chip. According to the data of the Shanghai Sunshine drug recruitment platform, not only all the terminals (hospitals) are used up during the implementation process, but also the planned dosage 160%.
By 2018, Shanghai has completed three batches of procurement trials involving a total of 28 drugs. "It is precisely because of the preparatory work for the past three years that allows us to take the time to study and test, and meet the key issues for a long time before we can finally hook up the quantity and price of centralized drug collection." Gong Bo recalled.
On November 14 of the same year, the Fifth Meeting of the Central Committee for Comprehensive Deepening Reform reviewed and approved the "Pilot Program for Centralized Procurement of National Organized Drugs", and began to conduct volume procurement pilots in 4 municipalities and 7 sub-provincial cities across the country, referred to as "4 +7 ". The National Drug Acquisition Office is located in Shanghai, and the Shanghai Pharmaceutical Office is responsible for daily work and centralized recruitment.
How to ensure that the price is not reduced?
According to the "Plan", the premise for pharmaceutical companies to participate in volume purchases is through drug consistency evaluation to ensure the quality of bidding drugs.
After the patent protection period of the original research drug expires, in addition to the original R & D company, other pharmaceutical companies can also produce preventive drugs, but the clinical safety and effectiveness of the generic drug are different from the original research drug due to differences in impurity content and bioavailability. . As early as in the "Twelfth Five-Year Plan for National Drug Safety" in 2012, it was required that generic drugs that have not passed the consistency evaluation of drug quality will not be re-registered and their drug approval certificates will be cancelled.
According to the relevant regulations on centralized volume procurement, if a generic drug plans to participate in centralized volume procurement, it must complete a consistency evaluation before centralized procurement, otherwise it will not be eligible to participate in centralized procurement.
However, as of November 29, 2018, according to the statistics of Clove Garden, only 44.3% of the "Basic Situation Table of the Reference Preparations of 289 Catalogue Species" have been launched for the generic drugs, and only 20 varieties and 25 product standards have passed Consistency evaluation. Most companies are still watching.
On December 6 of that year, the results of the first batch of high-volume procurements announced that the 25 selected drugs dropped by an average of 52%. The price reductions most worried about by pharmaceutical companies still occurred.
"The mentality of the enterprise has gradually been corrected. In the past, there have been many medical reforms, and the price of medicine has not dropped. After the '4 + 7' pilot, the enterprise is still looking forward to expanding its scope and approval. As volume procurement has become a reality, companies must be determined to adjust themselves for development. "Chen Qiulin, director of the Social Security Research Office of the Institute of Population and Labor Economics, Chinese Academy of Social Sciences, said in an analysis.
Chengdu Beite Pharmaceutical Group selected two drugs in the first batch of "4 + 7" procurement. Tenofovir disoproxil fumarate tablets produced by the company offer the lowest price, which is 96.14% lower than the previous market price. Another Chinese medicine cefuroxime axetil tablets, commonly used in the treatment of respiratory tract infections. According to industry analysis, the end market for cefuroxime axetil series antibiotics exceeds 3 billion yuan, and tablets account for about 17% of hospitals, and the market is about 500 million yuan. "The company's judgment on the drug reform situation is accurate, seize the market, live first, and also increase investment in research and development." Yang Ying, director of Chengdu Bet Market Access Department, told China News Weekly.
After the recruitment of "4 + 7", the number of over-rated drugs surged. As of the first half of 2019, a total of 224 varieties have passed the consistency evaluation, and 95 new over-reviewed products have been added. The speed of over-review is 2.7 times that of the same period in 2018.
Starting from April 2019, the first batch of drugs purchased in batches will land in 11 cities one after another. Five months later, the pilot area will be expanded to include 25 provinces, autonomous regions and municipalities such as Shanxi and Inner Mongolia. This is different from the fact that there is only one company that won the bid for each variety in the first round of centralized mining. This expansion has introduced new regulations for "multiple bids".
"The duration of the procurement contract for the winning drug depends on whether the competition for drug prices is sufficient." Gong Bo said that the number of selected companies does not exceed 2 varieties, and the procurement cycle is in principle one year, and the selected company is 3 varieties, in principle, 2 year.
In January of this year, the General Office of the State Council issued a notice on the "Plan for the Procurement and Use of Drugs by National Organizations", which confirmed "purchasing by volume and exchanging prices by volume." On January 17th, the second batch of nationwide procurement for procurement volume was opened in Shanghai. The second batch of procurement of 33 varieties was launched on January 17th for a total of 32 drugs, with an average decrease of 53% and a maximum decrease of 93%.
Consistency evaluation eliminated a large number of low-end generic drugs. The “Opinions of the General Office of the State Council on Carrying Out the Consistency Evaluation of the Quality and Efficacy of Generic Drugs” (2016) stipulates that if there are more than three companies that have passed the consistency evaluation of the same kind of drugs, they will no longer choose to fail in the centralized procurement of drugs Variety of consistency evaluation. On April 17 this year, Quanyao released the "Shenzhen Trading Platform Suspended Purchase List" implemented under this regulation, including 8 drugs from 7 companies.
"According to the medical insurance catalogue, the most important thing is to do a consistent evaluation of 20% of the varieties." Relevant experts said that about 180 drugs in the catalogue actually occupy more than half of the drug market, and the remaining use is small and the indication population Naturally, small varieties will be actively over-rated under the influence of the large environment, thereby controlling both quality and price.
In Chen Qiulin's view, another difference in this drug reform is the "fund linkage", which is also the internal reason for leveraging the linkage of the three doctors. Taking the Shanghai pilot as an example, after the recruitment is completed, the medical insurance fund will first replace the medical institutions to prepay 50% of the payment for the pharmaceutical companies. The medical institutions will call back within 30 days of receiving the goods, and pay the money in one hand and deliver the goods in one hand.
Half a year after the first batch of purchases with volume arrived, the on-time payment rate exceeded 90%, and selected drugs accounted for 78% of the purchases of generic drugs. "It has truly achieved the same purpose of recruiting, picking, and using, and overall achieved the purpose of purchasing by volume." Ding Yilei, deputy director of the Pharmaceutical Price and Tendering Procurement Department of the State Medical Insurance Bureau, told China News Weekly.
"The procurement with volume will be implemented to ensure that the purchased medicines are used up, and it is not possible to recruit one or die one as before. This requires the support and linkage of the health department." Gong Bo said that each public hospital in Shanghai last year's medicine There are a number of dosages, and it is possible to check how many medicines each doctor prescribed. If the actual amount of prescriptions for newly purchased medicines is significantly reduced, then the health department will conduct a "physician interview" to warn, and at the same time , "Complete the target of purchasing by volume" will also be used as one of the hospital performance evaluation indicators, directly related to individual salary, bonuses, department development and the overall evaluation of the hospital.
Regarding the next step of drug reform, Hu Jinglin, director of the National Medical Insurance Bureau, published an article in Qiushi in mid-March, saying that he will continue to promote centralized volume procurement and encourage and standardize the large amount of drugs and clinical dosage that have not passed the consistency evaluation in various regions. 1. The procurement of high-value medical consumables with high purchase amount and sufficient competition is carried out by volume procurement, and the "big cut" of centralized volume procurement is used to promote the "big reform" of the medical and health system.
Taking medicine is cheaper than drinking water
"Although the reformed object is reluctant, it has been recognized by the service target. The price reduction is what the people want to see. What the people yearn for is what the government needs most and is the easiest to do." Chen Qiulin said, "The people A good foundation is the biggest difference between this reform and the past. "
The original drug brand Luohuoxi, a commonly used drug for hypertension, amlodipine besylate tablets, averaged 4.3 yuan per tablet, and the bid price of the winning brand after purchase was 0.14 yuan per tablet, which was less than 3% of the previous imported drug price. A paragraph says that taking a pill is cheaper than drinking a sip of ordinary mineral water.
According to the results of the second batch of procurement announcements, there are a total of 32 varieties, mostly drugs for the treatment of chronic diseases such as diabetes and hypertension, with an average price drop of 53% and a maximum drop of 93%.
"All the winning bids are made by the companies themselves. The government is just the organizer. During the bidding process, the original false high pricing and distorted pricing mechanisms are returned to the original form, and then the price is exchanged for quantity on the premise of ensuring quality. Preferential is the concept of a lot of fights. "Gong Bo said.
According to media reports, before the volume purchase, the price of common antihypertensive drugs in China was 3.3 times more expensive than the United States. In October 2018, the "Circulation" magazine sponsored by the American Heart Association published the article "Accessibility of Antihypertensive Drugs in China" written by Wang Jiguang, director of the Department of Hypertension of Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, focusing on primary care in China The five common antihypertensive drugs in the service, namely amlodipine, nifedipine, metoprolol, valsartan and irbesartan, the corresponding domestic selling prices are 2.33 times, 6.25 times, 4.5 times, 1.8 times and 1.5 times.
"Actually, the prices of medicines in China and the United States are very high, but they are very expensive." The above-mentioned officials of the National Health Insurance Bureau said that the generic drugs in the United States are very cheap, and the high-priced drugs are patented drugs. Although the patented drugs only account for the prescription. 10%, but sales accounted for 80% of the market, it has a say. There are few domestic innovative drugs. The common ones are domestic generic drugs and imported original drugs. All drugs are expensive.
Many multinational corporations quoted the lowest prices in the world for the original patent medicines after the patent period. For example, when the second batch of national quantities purchased from Bayer ’s acarbose, the pre-harvest price was about 65 yuan, 30 tablets (50mg) per box, calculated according to the dosage of two tablets three times a day, Each patient's daily drug cost is 13 yuan. After purchasing by volume, the price of each tablet fell to 0.18 yuan, and the daily drug cost was reduced to 1 yuan, a drop of 91.59%.
"This also sends a signal to the original research drug companies and foreign-funded companies: how to price the patented drugs abroad, the same price should be priced in China, or even cheaper. Only if the new original research drugs come in, it will be possible to sell high prices." Gong Bo said.
Price cuts are also the best policy for patented drugs. Before the second batch of volume purchases, two generic drugs of meloxicam tablets passed the consistency evaluation. According to the recruitment rules, the original drug company Boehringer Ingelheim of Germany also automatically appeared in the bidding list. This medicine is mainly used for the symptomatic treatment of pain, swelling, soft tissue inflammation, traumatic pain, and postoperative pain in rheumatoid arthritis and osteoarthritis.
According to Zeng Chenghui, vice president and regional expansion director of Boehringer Ingelheim, Meloxicam is a relatively mature product of the company. It was listed in the Netherlands in 1996 and entered China in 2002. After the patent expires in 2006, it is still in the United States. Loxicam occupies the largest market share, reaching 45.17%, but it is not the company's main product in the next few years.
"But if you don't win or the selling price is too low, you can only withdraw from the market, which is a huge loss for the patient. Therefore, whether it is for us or for the patient, winning the bid is the best choice." Zeng Chenghui told China News Weekly said that after cost accounting, the company cut prices by about 80%, and finally chose the second lowest price. It is expected that the market supply will be about 30% higher than before. The company's production line and inventory can ensure stable production capacity.
Industry reshuffle acceleration
The industry rumored that "nearly 90% of generic drugs will be eliminated" is not groundless. The relevant wind direction can be clearly felt from the actual work of the medical insurance system in various places.
At the beginning of May, the second batch of state-level procurement of unselected product price dynamic adjustment results announced by the Jiangsu Provincial Pharmaceutical Acquisition Platform showed that 188 drugs were suspended from the Internet, involving Sinopharm Group, CSPC Group, North China Pharmaceutical, Zhengda Tianqing, Jiangsu Wu Zhong, Tasly and many other well-known pharmaceutical companies. Jiangsu Medical Insurance Bureau stipulates that if the number of enterprises that have passed the consistency evaluation for the same kind of drugs reaches more than 3, the generic drugs that failed the consistency evaluation will be suspended from the Internet.
There are also 843 medicines that have also been "temporarily removed from the Internet without comment". On the basis of requesting that three medicines that have passed the consistency evaluation and failed to pass the consistency evaluation be suspended from the Internet, Shanghai further announced that its medical insurance settlement will be invalidated simultaneously.
East China Pharmaceutical, the top ten pharmaceutical industry company in Zhejiang Province, released its 2019 annual report on the evening of April 27th, which directly disclosed the elimination of 6 including erlotinib tablets, imatinib tablets, and fidaxomicin tablets. Generic drug variety. In a letter to shareholders issued on April 28, Lu Liang, chairman of East China Pharmaceutical, stated that the golden age of China's innovative drugs has arrived, and the feast of the history of generic drugs is closing. According to East China Pharmaceutical's plan, from 2020, the company's annual R & D expenses will account for no less than 10% of the pharmaceutical industry's sales revenue.
"Market competition can actually force companies to innovate." Gong Bo explained that as far as a certain kind of generic medicine is concerned, there are hundreds of small and medium-sized domestic enterprises, the production process is not complicated, and the innovation transformation has not been completed for more than ten years of development. Some of these enterprises can get out of the comfort zone under external stimulus, and some products are inevitably eliminated as backward production capacity.
Judging from the results of the two batches of purchases by volume, the winning bidders are mainly multinational companies and domestic leading companies. There are also some companies that use the consistency assessment to return to China.
"Behind the reduction in drug prices is the unreasonable gray fee space being squeezed. No matter whether the medical insurance has money or not, it will not pay for the gray fee." Ding Yilei analogy said, "It is like a beauty contest. In the past, all makeup was applied, and now it has to Su Yan. "
At the same time, the medical insurance bureau seems to be brewing a new policy for the sale of gold. Recently, the "Guiding Opinions on Establishing a Drug Price and Recruiting Credit Evaluation System (Draft for Comment)" shows that pharmaceutical companies need to bear joint and several liability for commercial bribery and other acts of agency companies, and will establish a credit evaluation level for untrustworthy drug companies, corresponding to different Disciplinary measures, including suspension of qualifications for recruitment and inclusion in the scope of combating “fraud and fraud”, recovery of improper benefits obtained by companies infringing medical insurance funds, and so on.
"After purchasing with volume, the pharmaceutical industry will reshuffle." Ding Yilei said, "when channels are king and sales with gold are in power, which company still has the energy and motivation to control costs and engage in R & D? In the long run, guide the industry Transformation is as meaningful as reducing patient burden. "
(In order to protect patient privacy, Zhang Ping is aliased in the text)
"China News Weekly" No. 18, 2020
Statement: The publication of the "China News Weekly" manuscript is subject to written authorization