The average price of three batches of medicines was reduced by more than half
Core reading
The state organizes centralized drug procurement to move towards normal operation, benefiting patients.
So far, three batches of centralized drug procurement have been carried out, involving 112 varieties, an average decrease of 54%, which greatly reduces the burden of patients’ expenses; more patients can afford drugs, and the availability of drugs has been greatly improved; The quality of generic drugs and original research drugs certified by sexual evaluation quality has also improved significantly.
At the same time, it has a leveraging effect on industry ecological improvement and public hospital reform.
The results of the third batch of nationally organized drug centralized procurement will be implemented in November.
Up to now, the state has organized three batches of centralized drug procurement, involving 112 varieties, an average decrease of 54%.
Centralized procurement progressed smoothly
Drug price reduction and quality assurance
A 69-year-old Ms. Yang from Shanghai suffers from non-small cell lung cancer. She goes to the Tongren Hospital affiliated to Shanghai Jiaotong University School of Medicine to prescribe medication every month.
After March 20 last year, her commonly used gefitinib tablets (trade name Iressa) dropped from 2,280 yuan to 547 yuan per box, and her monthly out-of-pocket expenses dropped from 2,730 yuan to 630 yuan, which made Ms. Yang abnormal. Surprise.
Iressa, which has significantly reduced prices, is an imported original research drug, which has been expensive for many years.
After the state organized the centralized procurement of drugs, the price of the drug dropped sharply to the lowest in the world, benefiting a large number of patients who could not afford this expensive and good drug.
From the “4+7” pilot program in 11 cities to the third batch of centralized drug procurement results on August 20 this year, the state organizes centralized drug procurement to move towards normal operation.
At present, the centralized procurement is progressing smoothly.
In the “4+7” pilot, the actual purchase volume of 25 selected drugs reached 2.4 times the agreed purchase volume, and the purchase volume of selected products accounted for 78% of the purchase volume of the same generic name; as of the end of August this year, the national expansion pilot procurement progress at the end of 2019 Reached 1.8 times the agreed procurement volume; except for Hubei, which was postponed to June, other provinces implemented the second batch of centralized procurement results on time. As of the end of August, the procurement implementation progress reached 74%; the third batch of centralized procurement was produced on August 20 this year. According to the results of the selection, compared with the current lowest purchase price of the same drug, the prices of the selected drugs are reduced by an average of 53%. The results of the selection will be implemented in November.
Reduce the burden of medication.
The three batches of centralized procurement totaled 112 varieties, an average decrease of 54%.
According to the agreed procurement volume, the annual cost has dropped from 65.9 billion yuan to 12 billion yuan, saving 53.9 billion yuan.
Calculated on a 60% reimbursement ratio, it can save patients 21.6 billion yuan and save 32.3 billion yuan for medical insurance funds.
Among them, the annual treatment cost of tenofovir dipivoxil and entecavir for the treatment of hepatitis B has been reduced from about 20,000 yuan and 9,000 yuan in 2015 to about 70 yuan, which is highly praised by the World Health Organization.
Promote access to medicines.
Among the nearly 30 million patients with chronic hepatitis B, the standard treatment rate is only 11%.
There are about 245 million patients with hypertension, and the blood pressure control rate is only 17%.
After the substantial price cut, the sales of entecavir for hepatitis B drug in 11 pilot cities increased from 68 million tablets to 207 million tablets, and the number of patients treated with the drug increased nearly twice.
Sales of hypertension medications amlodipine, irbesartan, and losartan generally doubled in sales, and the availability of medications to patients has been greatly improved.
Improve the quality of medication.
After the "4+7" pilot drugs were launched, generic drugs that passed the consistency evaluation were quickly put into clinical practice, and high-priced original research drugs were forced to be promoted, so that people who were ill and could not afford the drugs used high-quality drugs.
The proportion of people in pilot areas who have used high-quality drugs such as generic drugs and original research drugs for consistency evaluation has increased from 50% to more than 90%, which has significantly improved the level of drug quality.
Enhance the level of protection.
Centralized procurement has led to an overall decline in the price of drugs of the same disease, freeing up room for local outpatient coordination and increasing the proportion of reimbursements for chronic diseases and serious illnesses, strongly supporting the negotiation of medical insurance access for innovative drugs, indirectly expanding the scope of drug protection, and effectively improving the level of protection.
Innovative procurement mechanism
Squeeze the price of water
These results are attributed to the major innovation of the centralized drug procurement mechanism.
Procurement with quantity, integration of recruitment and procurement.
The sales expenses of major pharmaceutical companies in my country account for up to 40% of their operating income.
In the past, "volume and price decoupling, separation of procurement and procurement" procurement methods, low-priced drugs won the "price cut" because there is no so-called sales cost space.
The core of the national organization of centralized drug procurement is to promise to complete the agreed procurement volume within the procurement cycle in the form of a contract, and to clarify the market expectations of pharmaceutical companies by changing prices and ensuring use, so that they no longer need to do various marketing tasks for drugs to enter the hospital. , To reduce sales costs, and really squeeze out the space for falsely high drug prices.
Government organization, alliance procurement.
Creatively establish the working mechanism of "government organization, alliance procurement, platform operation", set up a two-tier structure of government and joint procurement, and form an operating system that is closely connected and independent of policy formulation and specific operations.
Various provinces have formed a relatively mature policy implementation system in the implementation of pilot projects and expansion.
Independent quotation and fair competition.
By formulating rules and strengthening guarantees, qualified companies are allowed to "voluntarily participate, independent quotations, and fair competition", guide companies to conduct fair competition on the basis of cost and quality, and continue to improve the market-led drug price formation mechanism.
At the same time, generic drugs that have passed the consistency evaluation are included in the selection range, so that drugs with similar quality and efficacy are "competed on the same platform", avoiding the phenomenon of "bad money driving out good money" in the bidding process.
Policy linkage forms a joint force.
The medical insurance department has adopted three supporting measures to leverage the leverage of the medical insurance fund: The medical insurance fund shall advance the payment of not less than 30% of the agreed purchase volume, and encourage direct payment to enterprises, Promote medical institutions to settle the payment in time; establish an incentive mechanism for medical institutions to use selected drugs, and directly reserve medical institutions at a rate of no more than 50% for the medical insurance costs saved due to price drops and rational use of selected drugs; formulate based on the selected prices Generic name drugs and medical insurance payment standards, thereby encouraging patients to use lower-priced selected products.
At the same time, relevant departments work closely together. For example, the health department has done a lot of work in giving priority to selected drugs in public hospitals and training medical staff; the drug regulatory department actively promotes the consistency evaluation of generic drugs, strengthens the supervision and inspection of selected drugs, and strictly prevents quality problems. ; Departments of Industry and Information Technology and Commerce have provided strong support in ensuring production capacity and distribution.
Shi Luwen, a professor at the School of Pharmacy of Peking University, believes that the centralized procurement of drugs organized by the state has solved the problem of the inability to bring in quantity and timely payment of the original centralized procurement. The supporting policies are in place, and the centralized procurement is used as a breakthrough to realize the linkage of the "three medicals" to ensure drug quality and Timely supply.
For patients, the cost of medicine is reduced and the quality of medicine is improved.
As the consistency evaluation continues to expand, it will promote the continuous integration of enterprises, and enterprises will have more energy to focus on research and development, which will enhance the overall innovation capability and development level of the pharmaceutical industry.
Improve industry ecology
Reduce costs and promote R&D
Some companies have selected multiple products from the three batches of centralized procurement. Due to the high degree of procurement implementation, the cost of sales has dropped significantly, and the payment is returned in time. This has given companies a lot of confidence. At the same time, they actively innovate and develop new products and greatly increase their research and development enthusiasm.
A well-known company selected for multiple products invested 3.9 billion yuan in R&D in 2019, an increase of 46% year-on-year. Another well-known company invested 3.7 billion yuan in R&D, which is expected to reach 10 billion yuan within 3 years...
Reduce sales costs, stabilize market expectations, promote product research and development, and centralized procurement is like a lever, which has spurred industry reform and changed the ecology of the pharmaceutical industry.
Centralized procurement reduces corporate sales expenses by ensuring the amount of use, and reduces corporate financial costs through timely payment, thereby reducing drug prices while ensuring reasonable profits for manufacturers.
The more bid-winning products and the more thorough the marketing transformation, the more obvious the effect.
Data from key enterprises shows that the sales staff of selected products have been compressed by an average of 49%, and the proportion of sales expenses in the sales amount has dropped from 40% to 5%-10%.
Since the implementation of the two batches of centralized procurement, the procurement progress of the selected products has been faster than expected, and the timely payment rate has approached 100%, which has played an important role in maintaining the company's cash flow and promoting the resumption of production.
The cost of sales has fallen, but the market share of the product has been strongly guaranteed, and the effect of generic drugs instead of original research drugs is obvious.
The sales volume of the "4+7" pilot products that won the bids increased significantly, and 20 of the 25 products had a market share increase of more than 10%; during the pilot period, the proportion of the original research drug sales fell from 33% to 17%, and continued to drop to 11 after the alliance expanded. %, over-rated generic drugs can effectively replace the original research drugs.
At the same time, centralized procurement by volume has changed the ecology of the pharmaceutical industry and promoted pharmaceutical companies to focus on R&D and innovation.
“Previously, there was no quantity in centralized bidding for medicines. Although medicines won the bids, there are still barriers to entering hospitals. The centralized and quantity procurement of medicines organized by the state has given companies expectations and understands that there will be a market for selection, so they consider cost, market, and development strategy. Wait for the quotation to achieve sufficient market competition. Saying goodbye to unreasonable models will help improve the development ecology and promote the healthy development of the industry." said Wu Ming, assistant to the director of the Medical Department of Peking University and professor of health economics. The centralized procurement of drugs is compensation for public hospitals. The breakthrough point of mechanism reform and promotion of "three-medicine linkage".
After several rounds of centralized procurement, doctors and patients gradually agreed to promote market optimization, and medical insurance freed up space to optimize the drug structure, which is conducive to drug innovation.
The surplus of medicines purchased by medical insurance can be retained by hospitals, which encourages hospitals to actively control costs and spur public hospital reforms.
Our reporter Li Hongmei