The country's first centralized procurement of proprietary Chinese medicines with volume opened for bids, which is expected to save more than 2.6 billion yuan in drug costs each year——
The centralized procurement of proprietary Chinese medicines is here, and the price of medicines is "slim down" and the people "reduce the burden"
Our reporter Wang Weiyan
"The cost of western medicine has dropped a lot, and proprietary Chinese medicines have become the bulk of the cost of medicine." Zhang Jie, a citizen of Xiangyang, Hubei, sighed when sorting out the bills of medicine for the previous year.
It is the aspiration of many people to reduce the inflated cost of proprietary Chinese medicines.
At present, my country has successfully carried out centralized procurement of 6 batches of drugs, but Chinese patent medicines have not been able to carry out centralized procurement due to the special characteristics of difficult to evaluate the quality and many exclusive products.
Recently, Hubei Province led a coalition of 19 provinces to carry out the nation's first centralized procurement of proprietary Chinese medicines, with a procurement scale of nearly 10 billion yuan.
This means that the "water" in the future drug fee will be further squeezed out.
In this centralized procurement, 97 companies and 111 products were selected. The average price of the selected products decreased by 42.27%, and the largest decrease was 82.63%.
According to the calculation of the annual demand of the 19-province alliance, it is expected to save more than 2.6 billion yuan in drug costs each year.
Why is it difficult to carry out centralized procurement of Chinese patent medicines?
"There is no way for proprietary Chinese medicine to do centralized procurement." This is a view circulated in the industry before.
Since the reform of centralized drug procurement in 2018, the country has successfully carried out 6 batches of centralized drug procurement, covering mainstream drugs for chronic and common diseases such as hypertension, diabetes, hyperlipidemia, chronic hepatitis B, etc., but no Chinese patent medicine has been included in a large-scale centralized delivery. purchase.
Why is it difficult to carry out centralized procurement of proprietary Chinese medicines?
The person in charge of the Department of Medicine Price Bidding and Purchasing of the National Medical Insurance Administration explained that the particularity of Chinese patent medicines increases the difficulty of centralized procurement.
First, the quality of proprietary Chinese medicines is difficult to evaluate.
The consistency evaluation of the quality and efficacy of chemical drugs ensures the efficacy and safety of generic drugs, but Chinese patent medicines are generally made according to the inherited classic prescriptions, and there is no such thing as "original drugs" and "generic drugs".
The lack of support for consistent evaluation means that there is no unified and convincing judgment standard for the quality and efficacy of proprietary Chinese medicines.
其次，中成药独家产品多。按照以往化学药、耗材与生物制剂的集采规则，进入集采的药品均为非独家产品，这样能够保证其具有充分的竞争性，有降价空间。但是，由于中医“一源多流”的学术及文化特色，中成药分类和命名复杂，配方与工艺稍有变化便成为新的品种，因此独家产品众多。目前，我国有1000多个中成药独家品种，竞争并不充分，少数“独家”甚至是专为规避市场竞争而“量身定制”，这也是中成药集采的另一大现实困境。
独家中成药如何降价
针对中成药的特点、难点和争议点，70余位医疗机构临床专家、药学专家、高校及行业政策专家组成专家组，制定出极具创新性的中成药集采方案，确保药品优质优价。
由于中成药没有一致性评价作为支撑，质量体系复杂，直接采用价格竞争方式容易引起“劣币淘汰良币”争议。为此，本次集采创造性采用综合评分的方法，价格竞争得分占60%，技术评价得分占40%，技术得分中涵盖医疗机构认可度、药品企业供应能力、企业创新能力、招采信用评价、产品质量安全等方面。
“这样既考虑价格因素，又考虑企业供应能力、信用、质量等因素，破解了无质量评价体系的难题。”湖北省医疗保障局有关负责人介绍说。
值得关注的是，本次集采在综合评分中引入医疗机构认可度指标，由联盟地区19个省份所有二级及以上医疗机构(共2.4万余家)参与评价，相当于进行了全样本评价，提高了质量疗效评分的公信力。
针对中成药独家产品过多的难点，本次集采通过“合并通用名采购”破题。按照化学药集采的方式，进入集采的同一通用名药品，需要有多家企业通过一致性评价，开展竞争。本次集采根据中成药全国销售金额排名，结合医疗机构实际使用品种，遴选出部分大额品种，对功能主治相近的不同名称药品进行合并集采，最终确定了17个产品组76种中成药采购目录。
此外，由于不同部分企业的产品价格在集采前已经较低，降幅空间不大，为避免出现“低价药反被淘汰”局面，本次集采规定，对无倒扣分项的同组内“日均治疗费用最低产品”，给予增补中选机会，从而保证人民群众获得感和企业公平感。
Drug prices "slim down" and people "reduce the burden"
After sorting out the published results, we can see that the collection of Chinese patent medicines includes 17 large varieties of Chinese patent medicines, such as Shenmai, Xuesaitong, Xueshuantong, Ginkgo biloba, Salvia miltiorrhiza, and Shuanghuanglian, 76 kinds of medicines, and 111 products.
"Clinically commonly used varieties and commonly used brands are basically selected. The vast majority of clinically commonly used products, especially those with a large purchase volume, have achieved a considerable drop." Director of the Price Recruitment and Procurement Office of the National Medical Security Research Institute Jiang Changsong said that the results of the selected price in this centralized procurement with volume have reached expectations.
This also means that the prices of standing medicines and commonly used medicines in many people's homes will be more "close to the people".
The reporter found that a certain brand of ginkgo leaves for the treatment of stroke had the highest decline, with a drop of 82.63%, and the price of each box (30 pieces) of ginkgo leaves dropped from 24 yuan to 4.17 yuan.
Another brand of Ginkgo biloba leaves from the same product group costs as low as about 0.08 yuan per piece.
Shuanghuanglian oral liquid for treating colds dropped by up to 55%, and the price per box (12 pieces) dropped from RMB 25 to RMB 11.25; Xuesaitong dropping pills for treating cerebral arteriosclerosis dropped by up to 55.01%, and a box (90 The price of pills) dropped from 30.32 yuan to 13.64 yuan, which can save patients from 2.78 yuan to 5.56 yuan a day.
"It is necessary to let the people enjoy lower drug prices, but also to purify the industry environment, so that drugs can return to the essential attributes of curing diseases and saving people." The person in charge of the Department of Drug Price and Bidding and Purchasing of the National Medical Insurance Bureau said that the reform of centralized procurement has changed from the initial chemical drugs. Centralized procurement, advanced to the centralized procurement of high-value medical consumables and biological preparations, and then to the centralized procurement of proprietary Chinese medicines, to build a "puzzle" for promoting the reform of centralized pharmaceutical procurement in an all-round way, saving more than 260 billion yuan in medical insurance and patient expenditures.
The National Medical Insurance Administration said that in the next step, the national centralized procurement of drugs will be normalized and institutionalized, and the scope of centralized procurement of high-value medical consumables will continue to be expanded to benefit more patients.