19 provinces and cities have responded! Change and unchangeability of drug collection and expansion

One year later, the first round of 4 + 7 volume procurement has not ended Now 19 provinces and cities have responded in succession The nationwide expansion of volume procurement is about to be implemented, which seems to ring the bell again in the industry Compared with the first round of "4 + 7" volume procurement, what kind of storm will be set off after the nationwide expansion? On the afternoon of November 2, at the Symposium on the implementation policy of national drug centralized procurement and expansion hosted by the Research Institute of China Pharmaceutical Materials Association, Professor Chen Hao of Huazhong University of science and technology pointed out that 4 + 7 volume procurement has solved the problem of drug price reduction, but it is to ensure the sustainability of long-term drug supply, taking into account the demands of all stakeholders, Saving more money without medicine is also a big problem Zhang Lan, director of the Pharmaceutical Department of Xuanwu Hospital, also noticed the problem She shared a group of data about the purchase amount of amlodipine in 11 city hospitals before and after the official landing of 4 + 7 Zhang Lan said that whether winning the bid or not, the use rate of amlodipine was 38% before 4 + 7 and 39% after 4 + 7 "It's gratifying from the data Before, we were worried about whether the implementation of the policy would have a great impact on the use of drugs; after the 4 + 7 band, will not only the winning varieties not be used, the original research will not be used, and even this molecule will not be used? This data shows that there is no such situation, but the overall sales volume of amlodipine has declined significantly, indicating that the market share of the winning varieties is relatively high " Zhang Lan also noted that after the official landing of 4 + 7, the whole purchase volume has peaks and troughs The price may cause the dosage to change in a period of time, but the doctor's prescription behavior or the patient's medication behavior may return to a normal state according to the scientificity of medication after the policy fluctuation "Those who won the bid at the beginning, because of the price advantage, went up in the quarter after the 4 + 7 city pilot, and the purchase volume increased from 26% to 31% But as the implementation of the policy gradually comes down, it basically returns to the fluctuation before the implementation of the policy " The 25 varieties included in the 4 + 7 volume procurement, including this nationwide expansion, are all selected from generic drugs corresponding to generic drugs that have passed the consistency evaluation, and most of them are slow disease drugs and common drugs From the above data, we can see that the impact of 4 + 7 volume purchase is more for a product of a single enterprise, but less for the same category From the national level, the core of all the starting points of the medical insurance bureau is to return to value medical care, not only considering the issue of medical insurance fund The most important is to change some medical models and doctors' prescription behaviors through these policies, and the implementation of 25 varieties has seen changes It is worth noting that according to the pilot program for centralized procurement and use of drugs organized by the State Council issued on January 17, 2019, the procurement volume is 60% - 70% of the total drug consumption in each pilot year, while the remaining consumption can still purchase other online varieties with appropriate price The centralized procurement document of the alliance region also indicates that the agreed procurement volume in the first year of the 4 + 7 expansion region accounts for at most 70% of the agreed procurement volume in the first year, among which, if one enterprise is actually selected, the agreed procurement volume accounts for 50% of the agreed procurement volume in the first year, that is to say, 30% - 50% of the remaining margin market of 25 4 + 7 varieties is not equal With the formal implementation of the 4 + 7 national expansion, how to deal with the surplus market beyond the agreed purchase volume in the alliance purchase area? Niu Zhengqian, executive vice president of China Pharmaceutical Enterprise Management Association, said that in the reality of great differences across China, a one size fits all policy is not desirable The provisions of "surplus market share" in the national volume purchasing policy take into account the diversity and imbalance of market demand, and give hospitals, doctors and patients appropriate free choice, but the surplus market mechanism must be high Cost performance mechanism The margin will also give opportunities to non winning enterprises, at least through consistency evaluation Liu junshuai, vice chairman of the pharmaceutical policy committee of the China Association for the promotion of drugs, said that the problem of surplus is the choice of patients How the government guides patients to choose the right thing is a very important issue for us now Japan has done more than ten years of generic alternative education, but we do not have this foundation, so there are some problems 4 + 7 procurement with volume, including many technical difficulties in expanding the scope, will also involve that the national medical insurance should give local medical insurance a space for reform, with an open attitude, based on the relationship between quality and price and the relationship between volume and price, through the adjustment of medical insurance payment price According to incomplete statistics of e drug managers, up to now, 19 provinces or autonomous regions, including Hainan, Guangdong, Hunan, Jilin, Henan, Gansu, Anhui and Hubei, have issued documents to determine the execution time of "4 + 7" expansion results Provinces are intensively preparing for volume procurement, including formulating specific measures, building procurement platforms, strengthening medical personnel training, etc from the end of 2019 to the beginning of 2020, the results of national pilot expansion will be fully implemented To ensure the successful admission and rational use of the selected varieties is the key to determine whether the nationwide expansion of volume procurement can be successfully implemented Many provinces and cities clearly give priority to the use of the selected drugs Medical institutions shall not restrict the selection of drugs into the hospital on the basis of cost control, drug proportion, the requirements for the number of drugs used by medical institutions, the review of the pharmaceutical Committee, etc The medical institutions that do not purchase and use drugs according to regulations and the medical personnel who do not use drugs according to regulations shall be punished For the remaining consumption beyond the agreed purchase, several provinces clearly stipulate that each relevant medical institution can still purchase other online varieties with appropriate price through the provincial drug centralized purchase platform For the 25 generic drugs included in the pilot expansion, if there are more than 3 manufacturers of the same type of drugs that have passed the consistency evaluation of quality and efficacy, the varieties that have failed the consistency evaluation will not be used in the centralized purchase of drugs under the condition of ensuring the supply Some provinces, based on the consideration of localization and localization management, have cooperated in the implementation measures of the national 4 + 7 expansion policy and issued specific implementation details.