At 11:30 a.m. on November 8, the third floor of the Crowne Plaza Tianjin Meijiang Center Hotel gathered many representatives of pharmaceutical companies waiting to enter. They hold a bag of documents containing materials, line up to fill out the registration form, and submit the corresponding application materials. Some of the delegates looked relaxed and chatted and laughed loudly with their partners; There are also representatives with solemn expressions, staring at the materials in their hands silently.
The state organizes the centralized procurement of high-value medical consumables, which is called the "group purchase" at the national level in the field of medical consumables by netizens. This is the fourth batch of high-value medical consumables organized by the state in Tianjin, covering high-value medical consumables related to intraocular lenses and sports medicine. At the site of the opening of the bid, the reporter of China Youth Daily and China Youth Network learned that a total of 128 companies participated in the centralized procurement, and the market size of the centralized procurement products was about 155.<> billion yuan according to the price before the centralized procurement.
In the end, a total of 126 pharmaceutical companies planned to be selected in this round of centralized procurement, with a selection rate of 98%, and the average price of the selected products was reduced by about 70%. What are the characteristics of this centralized procurement? What will be the impact on domestic and foreign companies? What are the positive signals?
The coverage of consumables has been further expanded, benefiting more patients
Prior to this, the state has organized 3 batches of centralized procurement of medical consumables, of which coronary stents can save 109.160 billion yuan per year, artificial joints can save 260 billion yuan per year, and orthopedic spine can save 39 billion yuan per year. The centralized procurement of intraocular lens consumables is expected to save 67.<> billion yuan per year, and sports medicine consumables are expected to save <>.<> billion yuan per year.
The consumables collection is divided into 31 product categories and 40 bidding units. Intraocular lenses cover a total of 8 categories of products, in addition to 3 types of viscoelastic products, including monofocal, bifocal, trifocal, depth-of-field extended crystals (including boosters), as well as cohesive, diffuse, and hybrid viscoelastic agents; In the sports medicine category, there are 7 product categories in 20 categories, including threaded anchors, knotless anchors, fixing nails, fixation plates, prosthetic sutures, soft tissue reconstructions, and bone reconstructions. The leading enterprises at home and abroad with high market share have all selected their products, maintaining the stability of clinical use, and the product supply is rich and diversified.
Gao Xue, deputy director of the National Organization of High-value Medical Consumables Joint Procurement Office, said that the centralized procurement of high-value medical consumables is mainly to select products with large consumption, high amount, and demand from the masses. For example, the base of cataract patients is large and the demand is large, so intraocular lenses are included in the scope of this mass collection; Meniscus and artificial ligaments are also commonly used consumables for patients when they need to repair sports injuries and labor injuries.
It is understood that the centralized procurement covers a full range of products in all categories of intraocular lenses, and the average price of intraocular lens consumables is reduced by 60%. The average price of sports medicine consumables was reduced by 74%. Previously, artificial joints, orthopedic spine and other products have been carried out by the national centralized procurement, and trauma consumables are carried out by the inter-provincial alliance. The addition of sports medicine consumables means that the four categories of high-value medical consumables in orthopedics have basically achieved full coverage of centralized procurement.
The participation of foreign-funded enterprises is increasing
In the on-site quotation link, the reporter found that the quotations of enterprises are more rational, and the enthusiasm of foreign companies to participate is also higher, which is closer to the quotations of domestic enterprises.
Jiang Changsong, assistant to the dean of the National Medical Insurance Research Institute of Capital Medical University and director of the price procurement office, believes that from the first batch of centralized procurement to the fourth batch of centralized procurement, the biggest change for foreign-funded enterprises is that the degree of participation is getting higher and higher.
"When the first batch of cardiac stents were procured, mainstream foreign-funded companies such as Abbott did not win the bid. At the time of the fourth batch of centralized procurement, the products of several mainstream foreign-funded enterprises, such as Shi Lehui, which has the largest market share in China in sports medicine, and Alcon and Zeiss in intraocular lenses, are basically selected across the board. Jiang Changsong said, "This shows that foreign-funded enterprises also attach great importance to the Chinese market, and want to meet the clinical needs of the Chinese people, and also take what they need and benefit each other." ”
Compared with centralized drug procurement, why are foreign-funded enterprises more involved and enthusiastic about medical consumables?
Lu Yun, a professor at the International Pharmaceutical Business School of China Pharmaceutical University, believes that first of all, for the centralized procurement of drugs, it is difficult for foreign-funded enterprises to change their production methods and achieve the cost input of domestic enterprises in a short period of time, and it is difficult to reach an agreement with domestic enterprises in a short period of time. "Now domestic high-quality generic drugs have been done very well, if the cost of the original drug cannot be reduced, there is no way to use it in centralized procurement." Medical consumables are "one product and one policy", which can give more space to foreign-funded enterprises.
Secondly, there is also the factor of quantity. Lu Yun pointed out that the proportion of centralized drug procurement is mostly 50%-80%, and there is room for unselected drugs to be used in hospitals. The proportion of medical consumables is 90%, which means that if you don't win, your market share will be compressed. "With the increase in the proportion of volume, we are also guiding more companies to win."
At the same time, a variety of rules have been set up for different types of enterprises and products to be selected, so as to ensure that hospitals can use different types of products in surgery. Lu Yun summarized the highlights of the rules as "smart rules, stable clinical, and innovative promotion". "A variety of rules to be selected increase the chances of enterprises to be selected, and at the same time, more room for choice is given to medical institutions with large volumes, and innovative products that have improved clinical efficacy and function are also given certain bonuses."
The more price reductions, the better? Not necessarily
"The biggest change for domestic companies is that the quotation is more rational. When the first batch of centralized procurement, the quotations were very low, and everyone was generally more than 400 yuan or 500 yuan. Judging from this centralized procurement, everyone is more rational, and most of the quotations are more than 1000,<> yuan. Jiang Changsong said.
However, there are also individual companies that have quoted "floor prices". For example, in the product quotation of titanium alloy strip anchor (1 suture), in the case that the quotations of other companies are about 1000,300 yuan/piece, Changchun Shengboma Biomaterials Co., Ltd. quoted a price of <> yuan/piece, which caused heated discussions on the spot. A medical representative at the scene said that the excessively low price may be unfamiliar with the rules of centralized procurement, or it may be malicious bidding.
The proposed selection rules for this centralized procurement set the minimum selection reduction rate for different groups. In intraocular lens products, if the quotation of the enterprise is less than or equal to 60% of the highest effective declaration price, it can obtain the qualification to be selected; Among sports medicine products, if the quotation of the enterprise is less than or equal to 40% of the maximum effective declaration price, it can obtain the qualification to be selected, and is not limited by the number of participating and selected enterprises. The rules are in line with the previously announced purpose of "promoting more enterprises to be selected and enhancing the expected stability under the premise of ensuring fair competition, maintaining competition intensity, and removing inflated price space".
Jiang Changsong explained that the "selected reduction" set by the centralized procurement of medical consumables was determined according to the market price analysis. Taking intraocular lenses as an example, the price of some products is still very high, while some products have fallen to the "floor price", and the price difference between products is very large. The "continuation" rule of this centralized procurement is actually to continue to lower the price of high-priced products, and pull back the products that are too low-priced, which is a process of making the market price more "stable". "Stabilize the clinic, stabilize the expectations of the enterprise, and stabilize the market."
Previously, some companies experienced a decline in performance after participating in the centralized procurement of medical consumables. In Jiang Changsong's view, it is a normal process for corporate performance to be affected in the short term. In addition to reducing the burden of patients' costs and saving medical insurance funds, it is also one of the goals of centralized procurement to promote the development of industries and enterprises through centralized procurement. Jiang Changsong pointed out that at present, the compression of centralized procurement is the inflated price between the consumables after leaving the factory and being used in the hospital.
"It has not pressed the reasonable profits of the production enterprises, nor the sunshine income that doctors should get, and the centralized procurement compresses the unreasonable and non-sunny part. If this part exists in large quantities, everyone may have to passively accept those particularly expensive consumables when they go to the doctor, and the manufacturers actually do not get the money we pay them, and the development of the industry may not be good. Jiang Changsong pointed out that not the higher the price, the better the development of the industry, "a reasonable price may be able to promote the development of the industry."
"In layman's terms, a company's market share is very important, and sometimes it would rather make less money and capture the market. Because if someone else preempts it, it will be difficult for you to take it back in the future. Therefore, enterprises often have a good balance before participating in centralized procurement. Gu Hai, director of the Health Policy and Management Research Center of Nanjing University, said that unlike drugs, medical consumables will remain in the human body, so more emphasis is placed on clinical stability. This centralized procurement is mainly to adjust in the existing market, rather than vicious competition in price. ”
Will centralized procurement affect the enthusiasm of medical consumables enterprises to innovate?
After the announcement of the results of the centralized procurement, the reporter saw at the scene that the chairman of a high-value medical device company shouted at the front desk of the venue: "We have spent 17 years doing such an innovation, how can we continue like this?" Anyway, if we talk about this fact now, the company will be closed, and there will be no more decades of innovation. ”
It is understood that the caller is the chairman of Chongqing Runze Pharmaceutical Co., Ltd. (hereinafter referred to as "Chongqing Runze"). The product declared by Chongqing Runze is synthetic bone, and the quotation is 0,25 yuan for 6600.2 cubic centimeters, equivalent to 64,<> yuan per cubic centimeter.
According to the "Announcement on the Centralized Procurement of Intraocular Lens and Sports Medicine Medical Consumables (No. 11)" issued by the National Organization of High-value Medical Consumables Joint Procurement Office on November 10, the highest effective declared price of synthetic bone is 2 yuan/cubic centimeter. The results of the proposed selection announced on the evening of November 856 show that the unit price of synthetic bone of the selected enterprises is generally 11 yuan-30 yuan/cubic centimeter. This means that the quotation of Chongqing Runze is more than 200 times that of the selected enterprises of synthetic bone, and it is far beyond the highest effective declared price of synthetic bone.
"We knew we wouldn't be able to win the price, but we came anyway. We want to support the country's policies, and we hope that the country will support us. In a telephone interview with a reporter from China Youth Daily and China Youth Network, the relevant person in charge of Chongqing Runze said that their product is a porous tantalum bone filling material made of metal tantalum, which is significantly different from hydroxyapatite and other materials commonly used in synthetic bone, and the efficacy and cost are also completely different. However, the materials are not grouped and differentiated in the declaration documents, which also makes their quotation far exceed the maximum effective declaration price.
It is understood that in January 2019, the innovative product porous tantalum bone filling material developed by Chongqing Runze was approved and registered by the State Food and Drug Administration, which belongs to the "Catalogue of Innovative Medical Devices Approved by the State Food and Drug Administration". The relevant person in charge of Chongqing Runze said that they had previously fed back the group's questions to the centralized procurement office, and the reply they received was that they could choose whether to participate in centralized procurement or not. "But our synthetic bone material category is included in the collection of bone reconstruction materials. In the future, medical institutions will give priority to the purchase and use of the selected products and ensure the completion of the agreed amount, which means that if we do not participate in centralized procurement, our sales space is very small, so we still decided to reflect this situation. "The relevant person in charge of Chongqing Runze said that they are currently in further communication with the National Centralized Procurement Office." I hope that the problem can be solved well, and I also hope that the society can care about innovative medical devices. ”
In September 2022, the National Healthcare Security Administration mentioned in its reply to Recommendation No. 9 of the Fifth Session of the 4955th National People's Congress that it is difficult to implement the volume method because the clinical use of innovative medical devices is not yet mature and the amount of use is temporarily difficult to predict. In the process of centralized volume procurement, the National Health Insurance Administration will reasonably determine the proportion of volume according to factors such as clinical use characteristics, market competition pattern and the number of selected enterprises, and set aside a certain market in addition to centralized volume procurement, so as to provide space for innovative products to open up the market.
Jiang Changsong said in an interview with the media that the organizers will conduct detailed research and demonstration of the enterprises that can participate in the centralized procurement and meet the application qualifications, and there is generally no big difference in cost, value and price between enterprises. "For example, if someone else's cost is 10 yuan, and you are 100 yuan or even 1000,<> yuan, this should not be included, and you can not participate in centralized procurement." In Jiang Changsong's view, this requires a particularly personalized and targeted analysis of what the breakthrough innovation of the enterprise is and how much innovation there is.
Gao Xue pointed out that through centralized procurement, many people think that many companies may not be willing to invest in R&D after the price reduction of centralized procurement, but this is not true. Only through price competition can the price of products that everyone can produce be reduced, so that more companies can sprint new products and develop new products for patients to use. "Whether it is the centralized procurement of drugs or consumables organized by the state, we can see that more companies are investing in the research and development of new products, and centralized procurement has played a role in promoting."
China Youth Daily, China Youth Network Intern Reporter Yu Bingyue Reporter Liu Changrong Source: China Youth Daily