The third batch of national drug collection work starts a positive trend, anti-corruption promotes reducing the burden of drug use by the masses
Extrusion of medicine price moisture purification industry atmosphere
The price of metformin hydrochloride tablets for the treatment of type II diabetes was as low as 1.5 points per tablet, a decrease of more than 90%; the antibiotic linezolid tablets for pneumonia treatment dropped from RMB 300 per tablet to less than 34 yuan, a decrease of 90% ...
On August 20, the third batch of nationally organized drug procurement with a procurement scale of tens of billions opened bids in Shanghai, and the results of the proposed selection were produced. A total of 189 companies participated in this purchase, resulting in 125 companies to be selected, and 191 drug products to be selected, with an average price reduction of 53% and a maximum reduction of 95%. At the bid opening site, many star drugs were quoted at ultra-low prices.
As an important project to improve people's livelihood and well-being, the implementation of the national drug centralized procurement system has not only accelerated the transformation of China's pharmaceutical industry, but also brought tangible changes to the people's medical treatment. What are the advantages of centralized procurement over decentralized procurement? How to squeeze out the false high price of medicine? Can the selected drugs enter medical institutions smoothly? How will the anti-corruption campaign in the field of pharmaceutical purchase and sale deepen?
Reshape the drug price discovery mechanism in the market, and squeeze out the false high moisture out of volume purchases
The state organizes a pilot program for centralized drug procurement and use in 11 cities in early 2019. Centralized procurement and use of drugs organized by the state is an important measure to deepen the reform of the medical and health system. It mainly adopts the form of "national organization, alliance procurement, and platform operation" to promote the linkage of medical, medical insurance, and pharmaceutical reforms, and eliminate the use of drugs to provide medical services. Further reduce the burden of the masses on medication.
In October 2019, the National Medical Security Administration and other nine departments issued opinions on the implementation of the national organization of centralized drug procurement and use pilots to expand the regional scope, and the pilot scope was expanded to the whole country. At present, the pilot and expansion are progressing smoothly. All the expanded areas have started to implement the expansion procurement results at the end of last year, and the reform effect has benefited patients across the country.
"The most direct effect of the pilot and expansion is to reduce the burden of patients' expenses. Most of the selected drugs are drugs for chronic and major diseases such as hypertension, mental illness, viral hepatitis, and malignant tumors, and the long-term drug burden is very heavy. The drug purchase is significantly reduced by purchasing in quantity. The price of medicines that were previously unaffordable is now affordable. This solves the problem of accessibility to the common people. This is the most direct benefit for the common people.” said the head of the Joint Procurement Office for Centralized Drug Purchase and Use of the State Organization.
Why can mass purchase greatly reduce drug prices? The reporter learned that the traditional "separation of recruitment and procurement" model has the problem of only recruiting price without volume, and decoupling volume and price. Because there is no commitment to purchase volume, companies lack sales expectations, making it difficult for drug prices to return to a reasonable level. The national centralized organization and quantity procurement model requires that end-user medical institutions must complete the promised medication quota, so as to truly realize the integration of quantity procurement, recruitment and procurement. Under such a system design, drug procurement, use, medical insurance payment, and payment settlement have formed a closed loop, and the unreasonable links in the middle have been cancelled.
In terms of absolute prices, a considerable part of the drug prices have long been falsely high. The prices of some generic drugs are more than twice as high as the international prices. The cost of circulation accounts for the main part of the price. This is the main space for price reductions in centralized procurement. .
"In the past, a company developed a new drug that could recruit a marketing team of two to three thousand people, and the sales expenses accounted for too high a proportion." said Fu Gang, vice president of the China Pharmaceutical Business Association and chairman of Baiyang Pharmaceutical Group.
Gong Bo, director of the Pharmaceutical Price and Bidding Purchasing Department of the Shanghai Municipal Medical Security Bureau, said that the above-mentioned circulation links may have gray income, promotional activities, and even illegal activities. “Bulk purchases can reshape the discovery mechanism of drug prices under the market mechanism, so that It can trade quantity for price or price for quantity."
In addition, according to historical procurement data, some drugs with low production costs and sufficient competition have originally low prices. However, due to the circulation mode, low-priced drugs are difficult to open the market and are "reversely eliminated" by high-priced drugs. After the centralized procurement of drugs organized by the state, companies no longer need to conduct sales public relations, which helps to return the original low-cost drugs to patients.
"It should be noted that centralized procurement squeezes out the unreasonable water that has existed for a long time in the circulation field in the past, not the production cost, and does not affect the quality of drugs." According to the person in charge of the Joint Procurement Office, in promoting the reform of centralized drug procurement, In order to avoid the phenomenon of “bad money driving out good money” in the competition, relevant departments set strict standards on the raw materials, production technology, quality testing and curative effect of drugs, and consolidate the responsibilities of the selected enterprises by contract, and clarify the punishment and punishment for breach of contract. At the same time, we will strengthen the supervision and inspection of selected drugs and the random inspection of products to ensure that price reductions do not degrade quality. Judging from the situation in the pilot areas, the proportion of people using drugs that passed the consistency evaluation has increased from about 50% to more than 90%, and the quality of the drugs has been significantly improved.
As the centralized procurement of medicines has landed in various places, many patients have enjoyed tangible benefits. Mr. Li, a resident of Jinan City, Shandong Province, who suffers from hepatitis B, found when buying adefovir dipivoxil tablets at Jinan Central Hospital that this hepatitis B treatment drug, which was previously priced at 204.46 yuan, now only costs 27 yuan to buy a box. Ms. Zhang from Shenyang City, Liaoning Province also stated that the price of her long-term anti-diabetic drug Acarbose Tablets has dropped from 61.29 yuan per box to 5.42 yuan. “The cost of medicine in the past month is enough for one year now. ."
Form a market brand effect and promote the transformation of national industry from generic drugs to innovative drugs
The catalog of procurement products released by the Shanghai Sunshine Pharmaceutical Purchasing Network shows that the third batch of centralized procurement involves 56 varieties, which are close to the sum of the first two batches, including drugs for diabetes, hypertension, cardiovascular and other diseases, anastrozole and ibu Luo Popular drugs such as fen, amoxicillin, desloratadine, olanzapine, and metformin are among them.
In order to ensure the stable supply of bid-winning drugs, this centralized procurement has made fine-tuning and optimization on the basis of the second batch of centralized procurement, increasing the maximum number of companies that can be selected from the original 6 to 8. On the day of bid opening, 189 companies actively participated, and a variety of drugs appeared "floor prices". Among them, the competition for metformin hydrochloride tablets for the treatment of type 2 diabetes was the most intense. Nearly 30 companies had been evaluated, and the lowest price fell to 1.5 cents per tablet. Qilu Pharmaceutical's 25mg 12 tablets of sildenafil also reported an average price of 2.08 yuan per tablet, a decrease of 92%. In the end, 191 specifications of 55 drugs were included in the proposed selection.
"In the third national centralized procurement, 55 drugs won the bid, which will play a great role in increasing the concentration of pharmaceutical companies, standardizing the circulation of drugs, improving the hospital drug catalog, and improving the availability of drugs for patients." Shanghai Fudan University Public Professor Hu Shanlian of the School of Health said.
Chen Qiulin, deputy director of the Health Industry Development Research Center of the Chinese Academy of Social Sciences, said that this centralized collection also involves drugs for leukemia, anti-tumor, and psychiatric drugs. "These drugs are actually some drugs commonly used by patients, which have a direct impact on the people. ."
It is worth noting that compared with the second centralized procurement at the beginning of the year, most foreign-funded pharmaceutical companies did not follow the price cuts this time. Most of the winning bidders were local generic drug companies, and only a small number of original products won the bid. According to Shi Luwen, a professor at the School of Pharmacy of Peking University, due to the decline in the price of generic drugs and the guaranteed quality, patients have become more and more assured after using them for a period of time, and the demand for generic drugs has begun to increase. "With the continuous expansion of consistency evaluation, domestic companies have gradually formed a market brand effect, and have more energy to focus on research and development, and under the condition of ensuring the brand of generic drugs, promote the transformation of the national industry from generic drugs to innovative drugs."
The reporter noticed that the National Drug Centralized Procurement Document (GY-YD2020-1) issued by the Joint Procurement Office at the end of July imposed strict restrictions on the qualifications of applicants, requiring applicants to participate in the drug production activities within two years before participating in the centralized drug procurement activities. There must be no records of serious violations of the law and responsibility for the quality of the drugs. Once selected, as the first person responsible for supply guarantee, it is necessary to organize production in a timely and sufficient amount as required, and send medicines to the distribution company.
In addition, the declaring company needs to fill in the National Drug Centralized Procurement Declaration Commitment Letter in advance, promising that it has no interest in the joint procurement office, will not make any improper contact with the purchaser in order to achieve the project, will not collude with other companies to declare, negotiate quotations, and not to Other companies that declare the same species have direct holdings, management relationships or the same person in charge of the company, do not interfere with the order of centralized procurement, and there will be no violations of laws and regulations during the declaration process, so as to ensure that the centralized procurement is carried out fairly and justly . The Joint Procurement Office can also conduct investigations on the drug production of the selected companies and the quality of the drugs to be selected according to work needs.
"Compared with the first two batches of centralized procurement, the third batch of procurement volume is larger. The company has adapted to the existing centralized procurement mechanism, which proves that the first two batches of centralized procurement have achieved good results." Chen Qiulin said that centralized procurement is in line with the industry. The law also conforms to the current reality and benefits from multiple parties. It should be continuously improved and promoted.
Continue to strengthen supervision to prevent corruption in the centralized procurement process
For a long time, drug procurement has been an area with a high incidence of corruption. Under the previous decentralized procurement model, some pharmaceutical companies did not pay attention to product innovation, quality and cost control, and over-relied on sales channels, causing pharmaceutical sales personnel and medical staff to face greater risks of violations of laws and regulations. Affected by factors such as performance and high commissions, the term "medical representative" is almost equated with "high-priced drugs", and the subsequent problems of drug rebates and excessive medical treatment have become difficult to eradicate.
According to industry sources, in the hospital drug procurement catalog, if there are multiple drugs that can be used to treat the same disease, doctors often choose drugs with a high rebate ratio, causing patients to have to bear more treatment costs. Sun Zhilong, former party committee member and vice president of the Second People’s Hospital of Fuyang District, Hangzhou City, Zhejiang Province, successively received 196 illegal drug rebates totaling more than 16 million yuan. Among them, a company’s medical representative Lin Mou promised Sun Zhilong that the rebate cost was as high as the drug price 45%, the high price of medicine and moisture is evident.
One of the advantages of the state’s organization of centralized drug procurement and use of pilots and expansion, which is different from the decentralized procurement model, is that under the premise of consistent quality and efficacy, drugs with the same generic name produced by different companies can compete on the same platform, making the quality and efficacy of drugs The concern within the industry has become the concern of the whole society, and the operational space has been further compressed.
"Under the centralized procurement model, corporate public relations behavior will be greatly reduced, competition between companies will turn into open and transparent product quality and cost competition, and gray operations under the water will turn into fair competition under the sun, which will fundamentally improve the ecological environment of the pharmaceutical industry. It is conducive to the transformation of the pharmaceutical industry from marketing-driven to innovation-driven." said the person in charge of the joint procurement office.
In spite of this, the implementation of the centralized drug procurement model still faces many uncertain factors such as corporate defaults, hospital non-cooperation, and power abuse. It is necessary to further improve the mechanism and strengthen supervision. The reporter noticed that the third batch of centralized drug procurement requires the establishment of a list of non-compliant companies, selected companies, and distribution companies. Violations include providing prescription kickbacks or other commercial bribes, conducting illegal promotional activities; bribing the purchaser and the joint procurement office to seek the selection; providing false certification documents and documents to defraud the selection. Enterprises included in the list of violations will be disqualified from being selected. At the same time, depending on the severity of the circumstances, the enterprises or varieties will be disqualified from participating in centralized drug procurement activities in various regions within 2 years from the date of inclusion in the list of violations.
How to ensure that the selected drugs enter the medical institution smoothly? The relevant person in charge of the Medical Administration and Medical Administration Bureau of the National Health Commission stated that it has put forward requirements for medical institutions, and shall not affect the reasonable use and guaranteed supply of selected drugs with requirements such as cost control, drug proportion and number of medical institutions' product regulations. At the same time, the health department should strengthen the guidance and supervision of public medical institutions, and urge public medical institutions to purchase and use selected drugs first in accordance with the agreed procurement volume.
The state's organization of centralized drug procurement and use of pilot projects and the promotion of expansion are also inseparable from the protection of supervisory power. The Disciplinary Inspection and Supervision Team of the Dongguan Municipal Commission for Discipline Inspection and the Municipal Medical Insurance Bureau of Guangdong Province aimed the daily supervision probes on the field of centralized drug procurement management, and urged the responsible entities of relevant business departments to change from "post responsibilities", "business processes", "institutional mechanisms", and "external environment" Investigate risks in four aspects, establish and improve the integrity risk prevention and control system for key posts and key links, and conduct integrity assessments on centralized procurement organizations, product selection, and work processes to ensure that the centralized procurement process is legal and compliant.
"We resolutely deal with violations of regulations and disciplines that occur in the centralized procurement management work, and strengthen the clear orientation of accountability and strict accountability." The relevant person in charge of the discipline inspection and supervision team said.
A few days ago, the National Health Commission issued the "Special Action Plan for the Construction of the Medical Industry Style in 2020", which requires strengthening the comprehensive management of drug circulation, bidding, procurement, and clinical use, and establishing bad records of commercial bribery in the field of pharmaceutical purchases and sales. Enterprises producing and operating drugs, medical equipment and medical consumables with bad records shall be dealt with in accordance with laws and regulations. With the continuous deepening of the medical reform, the anti-corruption campaign in the field of pharmaceutical purchases and sales is also steadily advancing. Only by tightening the red line of the system and continuously strengthening supervision can we prevent corruption in the process of "centralized procurement" and ensure that the state organizes centralized drug procurement and use pilots and expansion Operate in the sun, and continue to consolidate the clean and upright industry atmosphere. (Our reporter Zuo Handi)