The second batch of purchased drugs enters the hospital, including a large amount of commonly used drugs for chronic diseases

  Another batch of price-cutting drugs benefit the people (health focus)

  Our reporter Li Hongmei

  In January of this year, the second batch of state-organized centralized procurement of medicines resulted in a successful selection. The purchase of 32 varieties was successful, and the price of medicines was greatly reduced. The 32 varieties contain many familiar and familiar medicines, such as antipyretic and analgesic acetaminophen, antibiotics amoxicillin, clindamycin hydrochloride, azithromycin, cefradine, diabetes drugs acarbose, glimepiride, Metronidazole tablets used for toothache, indapamide tablets for hypertension, bisoprolol fumarate, etc., among which there are 4 original drugs. Since April, the results of the election have landed all over the country. These medicines are entering the hospital, and patients can buy these medicines with sharp price reductions.

  Patient burden is significantly reduced

  The price of some commonly used medicines for patients with chronic diseases with large dosages has been greatly reduced, and the prices of various conventional medicines have returned, benefiting a wider range of people

  Mr. Li, a resident of Jinan City, Shandong Province, is a hepatitis B patient. On April 15th, he purchased adefovir dipivoxil tablets in Jinan Central Hospital and found that this medicine is now only 27 yuan per box, which was previously 204.46 yuan. Each box is less than 170 yuan. Save 411 yuan.

  On the same day, some diabetic patients went to prescribe acarbose tablets, and an imported original research drug unexpectedly cost only 5.42 yuan, which was more than 90% lower than the original price of 61.29 yuan. Calculated based on the use of 3 boxes per month, it costs only about 16 yuan a month now, before the price reduction was more than 180 yuan, saving 167.6 yuan per month. There is also an anti-cancer drug with a value of tens of thousands yuan, which has dropped by 9,000 yuan. It is noticeable because of the relatively high absolute amount. This anti-cancer drug is Abiraterone Acetate Tablets. The original price of the Internet connection in Shandong Province was 12,800 yuan, and the price after the price reduction was 3828 yuan, a decrease of 70.09%.

  These price-reduced medicines are the second batch of selected medicines purchased by national organizations. From April 15th, the implementation of the election results in Shandong Province will be implemented. All public medical institutions and military medical institutions in the province will participate in the province. Medical institutions designated by the medical insurance and medical retail institutions will be encouraged to participate voluntarily. Compared with the online price of the Shandong Procurement Platform in 2018, the average price reduction of this batch of selected drugs reached 74.45%, and the highest price reduction reached 95.9%, which significantly reduced the burden on patients.

  The person in charge of the pharmacy department of Jinan Central Hospital told reporters that among the selected drugs, some commonly used drugs for chronic diseases patients have greatly reduced their prices, and the prices of a variety of popular conventional drugs have returned to the benefit of patients. For example, in this round of collection, the drug Baitangping was selected. It is a very large amount of drugs used by diabetic patients. Many patients have used this drug for many years. The price reduction of more than 90% this time greatly reduced the burden on patients and was welcomed by patients. There are also many conventional medicines such as paracetamol tablets, which are antipyretic and analgesic drugs. The original price was 14.4 yuan. The price after this price reduction was 0.59 yuan, a decrease of 95.9%. It returned to the price level of a few years ago. The wider crowd is a good thing for the common people.

  From April 1st, various provinces have successively issued documents to clarify the results of the implementation of the election by the end of April, and patients across the country will gradually use the second batch of centralized procurement of drugs.

  Since the beginning of the centralized drug procurement pilot in 11 cities in December 2018, more and more good medicines have benefited patients throughout the country through price reduction through centralized procurement. Because most of the selected drugs are drugs for chronic diseases and major diseases such as hypertension, psychosis, viral hepatitis, and malignant tumors, patients have a long-term drug burden. Through volume purchasing, the burden of patients is significantly reduced, and the accessibility of medicines is greatly improved. At the same time, the procurement by volume uses the evaluation of the consistency of quality and efficacy as a finalist standard for generic drugs, which has improved the quality of drug use by the masses. Judging from the situation in the "4 + 7" pilot areas, the proportion of people using generic drugs and original research drugs that have passed the consistency evaluation has greatly increased from about 50% to more than 90%.

  As of the end of 2019, the 25 selected drugs in the “4 + 7” centralized drug purchase pilot areas completed an average of 183% of the agreed purchase volume, and the selected drug purchases accounted for 78% of the purchase of the same generic drug. After the nationwide expansion of the pilot program, all 25 generic varieties were successfully expanded, and the price of the expanded system decreased by an average of 59%. On the basis of the "4 + 7" pilot program, the price was reduced by another 25%.

  Selected drug priority

  Patients can still prescribe non-selected drugs, but the medical insurance payment standard is not higher than the price of selected drugs, which means that the proportion of patients ’self-payment will increase

  According to regulations, 32 kinds of selected drugs will be given priority to use after entering the hospital. Prioritizing the use of selected drugs and completing the agreed dosage is the key to centralized volume purchasing.

  Prior to this, the national health department issued a document requesting medical institutions to unblock the policy channels for the use of selected drugs, improve the rational use of selected drugs, establish and improve the incentive mechanism and performance evaluation system, strengthen the monitoring of the clinical use of selected drugs, and ensure the selection of selected drugs use. The medical security department provides strong guarantees for the use of selected drugs through incentives such as prepayment of medical insurance funds, encouragement of direct settlement of medical insurance funds with enterprises, and retention of medical institutions.

  According to the person in charge of the pharmacy department of Jinan Central Hospital, after the selected drugs enter the hospital, they will complete the agreed dosage, and at the same time carry out training, promote policies to doctors and patients, interpret the concepts of selected drugs, consistent evaluation of generic drugs, etc. Enjoy the policy dividend.

  The reporter learned from Shandong Province's "Notice on the Implementation of the Second Batch of National Organizations for the Centralized Purchase and Use of Drugs" that medical institutions will not use the "one-size-fits-all" method to simply deactivate unselected drugs in order to ensure the diversified drug demand of the people. However, if the patient chooses a higher price under the same generic name, the payment standard will be gradually adjusted; if the generic drug that has not passed the consistency evaluation is selected, the payment standard is not higher than the selected price, which means that the patient's self-payment ratio will increase.

  In January 2019, the General Office of the State Council “Notice on Printing and Distributing the Pilot Program for the Centralized Purchase and Use of Drugs by National Organizations” clearly stipulates that for centralized procurement of drugs, the centralized procurement price within the scope of the medical insurance catalogue shall be used as the payment standard for medical insurance. The medical insurance fund shall settle the original research drugs, reference preparations and generic drugs that have passed the consistency evaluation under the same common name according to the same payment standard. Patients use drugs with a price higher than the payment standard, and the part beyond the payment standard is paid by the patient. If the price of the drug used by the patient is significantly different from the centralized purchase price of the selected drug, the payment standard can be adjusted gradually and adjusted in 2-3 years. And formulate supporting policies and measures; patients using drugs whose price is lower than the payment standard will be paid at the actual price.

  In Shanghai, in order to ensure the preferential use of selected drugs, medical institutions can continue to purchase non-selected drugs under the premise of preferential purchase of selected drugs, but the number should not exceed the selected drugs. At the same time, non-selected medicines with the same common name as those with higher prices than those of selected medicines are regarded as "high-priced medicines", and the proportion of patients paying for "high-priced medicines" will be increased by 10%, 20%, or the standard payment standard will be raised.

  In fact, the second batch of 32 kinds of medicines purchased by national organizations is not only one type. There are more than one selected manufacturer for each selected medicine, and some have even reached 6 varieties through the consistency evaluation. The market for these medicines is fully competitive and the quality is guaranteed, which can meet the people's demand for medicine.

  Ding Jinxi, a professor at the China Pharmaceutical University, believes that because these drugs are original drugs or generic drugs that have passed consistency evaluation, preferential use will help protect the enthusiasm of enterprises. Promoting the replacement of generic drugs through medical insurance payment standards is an internationally accepted practice, which is conducive to improving the quality of medicines and guiding patients to use drugs reasonably.

  Adhere to the principle of quality first

  Centralized procurement on the premise of consistent evaluation of quality and efficacy, prompting enterprises to return to cost and quality competition, which is beneficial to patients, doctors, enterprises, medical insurance funds and other parties

  On March 25, the State Food and Drug Administration issued an announcement. It was recently discovered in an overseas production site inspection that the original drug selected for the second batch of national organization centralized procurement of paclitaxel for injection in the United States (albumin-binding type) was used in some key production facilities. It meets the basic requirements of China's pharmaceutical production quality management, and there are problems such as the lack of sterility guarantee measures in the production process. According to law, the import, sales and use of a paclitaxel (albumin-binding type) for injection in the United States are suspended.

  The National Procurement Office for the Centralized Purchase and Use of Drugs issued an announcement immediately to cancel the eligibility for a paclitaxel (albumin-binding) for injection in the United States; the procedure was immediately initiated and two other companies selected for replacement were supplied.

  The person in charge of the Joint Procurement Office said that the handling of this incident fully reflects the attitude of the state to organize centralized drug purchases to treat domestic and foreign enterprises equally, strict requirements, and zero tolerance for quality issues. At the same time, all enterprises are reminded that the quality of medicines is directly related to people's health. Regardless of foreign or domestic investment, original medicines or generic drugs, overseas or domestic production, it is necessary to strengthen quality awareness and effectively take quality responsibility. There are no exceptions to quality issues and there is no " Super national treatment ".

  The person in charge of the Joint Procurement Office emphasized that the national organization of centralized drug procurement always adheres to the principle of quality priority, and adopts multiple approaches to ensure the quality of selected drugs: first, strict quality shortlisting standards; second, the consolidation of the responsibility of selected companies to ensure the quality and supply of selected drugs by contract Clarify the disciplinary punishment and disposal mechanism; third, the drug regulatory department strengthens the supervision and inspection of the selected drugs and product sampling to ensure that the price reduction does not reduce the quality.

  Ding Jinxi said that the centralized procurement of medicines organized by the state has strict quality requirements. This case has made the public eat reassuring pills and rely more on the medicines purchased from the centralized organization of the state.

  Chen Qiulin, director of the Social Security Research Office of the Institute of Population and Labor Economics, Chinese Academy of Social Sciences, said that centralized procurement, premised on consistent evaluation of quality and efficacy, has prompted companies to return to cost and quality competition, and to patients, doctors, companies, medical insurance funds and other parties. All are beneficial, forming a benign mechanism.

  The person in charge of the pilot office said that the next step would be to establish a normalized and standardized centralized volume procurement system on the basis of improving the "4 + 7" pilot and expansion and the experience and practices of the second batch of national organizations for centralized drug procurement and use More products are included in centralized procurement.

  At present, because there are fewer generic drugs that have passed the consistency evaluation, there are fewer drugs purchased centrally by national organizations, and more drugs are not selected. According to regulations, these unselected drugs will be subject to gradient price reduction. Since last year, many places have carried out centralized volume purchases specifically for the exploration of some medicines, and more and more medicines are under pressure to reduce prices.

  On April 21st, Sanming Alliance, a joint limited price procurement of pharmaceutical consumables, successfully completed the purchase of 7 non-conformity-evaluated centralized medicines. Compared with the purchase prices of the generic drugs in use in all participating cities, the overall average price drop was 69.52%, and the largest single-category drop was 91.63%. Based on the agreed purchase volume, it is estimated that the annual drug cost savings will be 124 million yuan. The purchase of the Sanming Alliance was pre-reported by 19 inter-provincial cities, and the time for the winning bid was determined to be June 1st.

  On April 15, the Hunan Provincial Public Resources Trading Center issued a notice announcing the results of winning the bid for the special centralized procurement of antibacterial drugs in Hunan Province, and will officially implement online procurement from May 1. Wuhan, the first city to implement the procurement of medicines alone, also set the landing time as May 1. The first batch of 45 purchased varieties in Wuhan covered the proton pump inhibitors, antibacterial drugs and insulin of the peptic ulcer system, and 39 varieties were successfully negotiated. Compared with the national lowest price, the average drop is 31%, and the highest drop for a single product is 93%.

  Experts suggest that for most varieties that are not included in the state's centralized procurement, the market should play a decisive role in resource allocation, adopt a new online procurement model under the guidance of medical insurance payment, and promote a market-led price formation mechanism.