The National Medical Insurance Administration established a credit evaluation system to crack down on improper prices and marketing practices
Rebates will be included in the list of untrustworthy to promote the return of drug prices to reasonable
For a long time, the pharmaceutical sector has given rebates and monopolized sales control, which has caused falsely high prices of medicines and medical consumables, rapid growth of medical expenses, and massive loss of medical insurance funds, which has increased the burden of people's medical care.
In response to this, the National Medical Insurance Administration recently issued the "Guiding Opinions on Establishing a Medical Price and Recruitment Credit Evaluation System" (hereinafter referred to as the "Opinions"), requiring all localities to establish and implement a credit evaluation system by the end of this year, and will give rebates, etc.7 This kind of improper price and marketing behavior is included in the list of medical prices and the list of untrustworthy items in the procurement and procurement, to promote the return of medical prices to reasonable.
The relevant person in charge of the Price Recruitment and Procurement Department of the National Medical Insurance Bureau said in an interview with this reporter that appropriate measures will be taken against untrustworthy pharmaceutical companies, and relevant drugs or consumables will be suspended from bidding and online listing. Pharmaceutical companies that are seriously untrustworthy will be out of the centralized procurement. ".
7 behaviors included in the list of dishonesty
"The issue of rebates and monopoly price increases in the pharmaceutical field have long existed. Some have affected prices through manufacturing or caused a tight supply of pharmaceutical products, and some induced excessive medical treatment and harmed people's health rights." The person in charge pointed out.
Taking the issue of drug rebates as an example, according to court judgments, over half of the 100 compulsory drug companies nationwide from 2016 to 2019 were found to have given or indirectly given rebates. Among them, the most frequent companies involved more than 20 cases in three years. , The rebate amount in a single case exceeded 20 million yuan.
The average sales expense ratio of listed pharmaceutical companies exceeds 30%.
In addition to the issue of pharmaceutical commercial bribery, including drug rebates, the "Opinions" clarified that there are six other types of behaviors that violate honest pricing, including tax-related violations, monopolistic behavior, improper price behavior, disrupting the order of centralized procurement, and malicious violation of contractual agreements. , Included in untrustworthy matters.
In order to improve the standardization of credit evaluation, the National Medical Insurance Bureau recently announced the draft of the "Opinions" supporting operating rules, and proposed to divide the untrustworthy behavior of pharmaceutical companies into four levels: general, moderate, serious and particularly serious.
Among them, a pharmaceutical company's single commercial bribery amount of 10,000 yuan can be deemed to be untrustworthy, and 100,000 yuan will be suspended for the product involved in the case, bidding or distribution qualifications.
"Pharmaceutical companies are often insensitive to the fines of kickback cases, but giving kickbacks will lose the opportunity to enter the centralized procurement market, which will have a powerful deterrent effect, which will form a systemic governance effect by analogy." The person in charge said.
In his view, in correcting the unhealthy trends in the field of pharmaceutical purchases and sales, the National Medical Insurance Bureau has played the functions of pharmaceutical prices, bidding and procurement, and actively promoted the effective governance of pharmaceutical rebates. Among them, the establishment of a pharmaceutical price and a credit evaluation system for recruitment and procurement is an important measure. First, it can solve the problems of difficulty in the collection and disposal of responsibilities under the traditional governance system.
Sharing source information of medical commercial bribery cases with multiple departments
The reporter learned that the innovation of the credit evaluation system is first reflected in the system based on the relationship between sales and purchase contracts.
Different from the traditional credit supervision based on administrative management relationship, the system is mainly in the market scope of centralized procurement.
"The approach adopted is to rely on a centralized procurement platform, connect buyers and sellers with trustworthy commitments as a link, guide medical institutions to purchase pharmaceutical products from honest companies, and reduce the purchase of pharmaceutical products from untrustworthy companies." The person in charge said that the medical insurance department is not right. Enterprises adopting administrative restraint measures, and enterprises willing to only operate pharmaceutical products outside the centralized procurement market are not within the scope of the credit evaluation system, and credit rating results are not extended to the field of public management.
Under normal circumstances, the centralized procurement of medicines and medical consumables is guided by the medical insurance department to establish a system for the provincial centralized procurement agency, and the provincial centralized procurement agency builds a platform for the operation of the system.
However, no matter whether it is a medical insurance department or a centralized procurement agency, it does not investigate, characterize, and investigate violations of laws and regulations such as medical rebates. It mainly relies on the untrustworthy facts determined by court judgments and administrative penalties.
Therefore, the basis of evaluation depends on departmental collaboration.
In order to obtain timely, accurate and complete case source information, the National Medical Insurance Administration will explore the establishment of exchange and policy linkage mechanisms with courts, taxation, market supervision and other departments.
On September 17, the National Medical Insurance Administration stated that it had signed the "Memorandum of Cooperation on Information Exchange and Sharing of Commercial Bribery Cases in the Pharmaceutical Field" with the Supreme People's Court, established a regular notification system for commercial bribery cases in the pharmaceutical field, carried out information exchange and sharing, and continued to deepen Collaboration to control commercial bribery in the pharmaceutical field.
"We will advance the reform of medical service prices in a steady and orderly manner. By regulating the overall level of medical service prices and straightening out the relationship between prices, public hospitals can obtain more reasonable compensation through medical income and reduce their reliance on gray interests in the procurement and use of pharmaceutical consumables. "The person in charge revealed.
Our reporter Li Danqing