"4 + 7" variety expansion begins: define the highest price and give 100% market

Give all the market shares of the selected enterprises in the whole province! On November 20, Hebei medical equipment purchasing center officially issued a purchasing invitation to carry out centralized purchasing of 15 outpatient drugs for urban and rural residents with hypertension and diabetes (referred to as "two diseases") After the expansion of "4 + 7", the prelude of expanding varieties is slowly opening Today's "4 + 7" is far from the single event of drug procurement in 11 cities and 25 countries at the end of last year, but gradually becomes a synonym for a new centralized procurement trend in the Chinese pharmaceutical market For the centralized purchase of "two disease" drugs, Hebei Province requires enterprises to submit materials before December 11, and the information will be publicly declared in the afternoon of that day It is worth noting that there are several significant differences between this centralized mining in Hebei Province and the previous centralized mining organized by the state: First, this volume procurement will give the winning enterprises all market share That is to say, 100% of the agreed purchase volume If the agreed purchase volume of the year is completed in advance, more than part of the selected enterprises will still supply according to the selected price and enjoy the settlement policy until the end of the purchase cycle, which means that Hebei will bid for all the markets within the scope of "two diseases" medical insurance outpatient sales of residents in Qingcheng Township this time, while the employee medical insurance is not expected to be included Second, the highest price limit is listed for each variety, and there are many big varieties such as metformin and acarbose For example, the maximum price of 0.25g metformin is 6 cents a piece, and that of 50mg acarbose is 68 cents a piece Third, enterprises that fail to pass the consistency evaluation can also win the bid In this bidding, Hebei Province accepts the varieties that fail to pass the consistency evaluation Unless there are three or more drug manufacturers that have passed the consistency evaluation, and there are declared drug specifications that meet the requirements of the proposed selection in this centralized procurement, the drugs that fail to pass the consistency evaluation will not be selected For "4 + 7" centralized procurement, Hebei Province has been positive After "4 + 7" came into being, Hebei and Fujian became the only two provinces that followed up quickly, leading the "4 + 7" national expansion alliance region centralized procurement organized by the state health insurance bureau Since then, officials have repeatedly said they will continue to push forward the centralized purchase of drugs The action of Hebei Province officially opened the curtain of expanding varieties In line with the previous national policy on drug security for diabetes and hypertension clinics, the 15 drugs purchased in Hebei Province are all "two disease" drugs But compared with the previous policy, Hebei Province unexpectedly gave all shares to the winning enterprises this time For the non winning enterprises, the outpatient market within the medical insurance of urban and rural residents in Hebei Province closed the door In the same way as the "4 + 7" expansion, more than one company won the bidding For the 15 drugs bidding, Hebei Province has issued the specific purchase quantity List of purchase varieties and specifications and agreed purchase quantity For drugs of the same generic name, if one enterprise is actually selected, it has all the agreed purchase quantity; if two enterprises are actually selected, the first selected drug enterprise accounts for 60% of the agreed purchase quantity, and the second selected drug enterprise accounts for 40% of the agreed purchase quantity, and after the agreed purchase quantity is reached, the medical institutions can use it freely; if three enterprises are actually selected, the first selected drug enterprise accounts for the agreed purchase quantity 50%, the second selected drug enterprise accounts for 30% of the agreed purchase volume, and the third selected drug enterprise accounts for 20% of the agreed purchase volume For the remaining consumption after the agreed purchase quantity is completed, Hebei Province stipulates that the selected enterprises shall still supply according to the selected price and enjoy the settlement policy until the end of the purchase cycle As for the products purchased by the selected enterprises, the medical institutions shall determine on their own But how to determine the selected enterprise? Hebei Province stipulates that each variety should be selected with the lowest price ratio of specified specification difference That is to say, each specification shall be quoted with the "minimum unit of measurement amount", the same specification shall be shortlisted according to the low price, and the shortlisted varieties of the same variety and different specifications shall be compared according to the principle of differential price ratio, and the drug with the lowest price shall be the drug to be selected However, the declared price of the enterprise shall not exceed the maximum purchase price limit of this centralized procurement, and shall not be higher than the lowest price of the enterprise in each province and the lowest stock in price in Hebei Province since January 1, 2018 If there are three or more drug manufacturers that have passed the consistency evaluation, and the specifications of the declared drugs have met the requirements of the proposed selection, the drugs that have failed the consistency evaluation will not be used If there are less than 3 drug manufacturers through the consistency evaluation, if the two specifications of the declared drugs meet the requirements of the proposed winning selection, at most one main specification of the drugs in the non conformity evaluation shall be determined as the proposed winning drug; if one specification of the declared drugs meets the requirements of the proposed winning selection, at most two specifications of the drugs in the non conformity evaluation shall be determined as the proposed winning drug For the enterprises that fail to pass the consistency evaluation, there are price restrictions in Hebei Province For example, if there are two declared enterprises that pass the consistency evaluation, after determining the enterprises to be selected, one enterprise to be selected will be determined in the non consistency evaluation drugs, but the price should be more than 20% lower than that of the drugs to be selected for the consistency evaluation If there is only one specification declared drug in the two drugs to be evaluated for consistency If the products meet the requirements of the proposed selection, two specifications of non conformity evaluation drugs shall be determined, but the price shall still be more than 20% lower than that of the proposed selection of conformity evaluation drugs If there is only one declaration enterprise that has passed the consistency evaluation, and it meets the requirements of the proposed selection, it is directly determined as the proposed selection of drugs, and the non conformity evaluation drugs can also be selected at a price lower than 20% Among the 15 drugs selected this time, 9 varieties of hypertension and 6 varieties of diabetes In terms of production capacity, Hebei Province has put forward specific requirements for enterprises: in 2018, based on meeting the stable market supply in other regions outside Hebei Province, the remaining production capacity has reached more than three times of the agreed purchase volume of this centralized procurement In addition, in terms of the use of drugs, Hebei Province focused on the use of selected drugs for the patients locked in the "two diseases" outpatient medication guarantee mechanism of urban and rural residents, and ensured the completion of the agreed purchase volume, with a purchase cycle of one year It is worth noting that Hebei province limits the price of each specification of drugs, and reminds enterprises that the declared price includes all costs such as taxes and distribution fees However, Hebei Province has not given much explanation on how the government's "ceiling price" is calculated Take acarbose as an example At present, only Germany Bayer pharmaceutical, China and the United States, East China and Sichuan LVYE Baoguang three acarbose preparations are listed in China Among them, Bayer pharmaceutical, the original research enterprise, has two specifications of 50mg tablet and 100mg tablet, and Sichuan green leaf only has 50mg capsule dosage form In 2017, the domestic market scale of acarbose was about 7 billion yuan, of which Bayer accounted for 4.4-4.5 billion yuan, China US Huadong about 2-2.1 billion yuan, and green leaf about 400-500 million yuan The maximum price limit of 50 mg acarbose in Hebei Province is 0.68 yuan / tablet According to the database query of yaozhi.com, the bid price of acarbose, a 50 mg capsule form of green leaf, in Sichuan, Hubei, Zhejiang, Guangdong, Jiangxi, Gansu, Yunnan, Guizhou and other provinces in 2018 and 2019 is about 1.3-1.5 yuan; the bid price of Bayer's 50 mg tablet is between 2.0-2.2 yuan; the bid price of China, the United States and East China is between 1.35-1.50 yuan It can be seen that the price of acarbose in Hebei Province is expected to be more than 50% off this time For valsartan, another large variety for the treatment of hypertension, the maximum price limit in Hebei Province is 0.62 yuan per tablet of 0.25g, and there are many competitors for this variety The manager of E medicine found that the bid price of 80 mg valsartan capsule was about 0.7-5 yuan in recent two years, and the bid price of 80 mg Valsartan Dispersible Tablets was about 1.3-2 yuan, but it should be noted that the conversion of specifications was involved This round of centralized procurement has already been heralded At the 11th China Pharmaceutical entrepreneur scientist investor conference held this year, Ding Yilei, deputy director of the medicine price and bidding procurement department of the state health insurance bureau, said straightly that the next procurement with volume will be carried out normally, "not only by the state, but also by the local; not only by the variety evaluation, but also by the non evaluation; No Only more than one product can be purchased with quantity, and exclusive products can still be purchased with quantity, such as exploring the purchase of bulk commodities; not only in the field of drugs, but also in the fields of high value consumables and low value consumables The idea of the national health insurance bureau is to normalize the volume procurement work, realize the nationwide blooming, make the volume procurement gradually become the leading mode and the mainstream mode of the centralized procurement of medicine, and also make the expectation of the majority of enterprises and industries change in a timely manner " The voice of classified and centralized drug purchase has been heard in the industry for many times This centralized purchase of "two disease" drugs is related to the policy of improving the medical insurance treatment of "two disease" patients proposed in the government work report at the beginning of the year At the beginning of October this year, the state health insurance bureau, together with the Ministry of finance, the health and Health Commission and the drug administration, officially issued the guiding opinions on improving the drug use guarantee mechanism of urban and rural residents' outpatient service for hypertension and diabetes (hereinafter referred to as the opinions) The opinion is mainly aimed at the "two diseases" patients who participate in the medical insurance for urban and rural residents, and the employee medical insurance still implements the existing policies The document specifies that the expenses of blood pressure and blood glucose lowering drugs for the insured patients of "two diseases" in the outpatient department of medical institutions shall be paid by the overall planning fund, and the proportion of payment within the policy scope shall be more than 50% All regions are required to set reasonable payment policies on the basis of finding out the actual situation of the number, quantity and amount of drugs used in outpatient clinics of "two diseases" Usually, the cost of controlling blood pressure in one year for a high blood pressure patient is between 2300 yuan and 1000 yuan A diabetic needs about 1500 yuan a year for oral medication, 35000 yuan for injection therapy and 8000 yuan for expensive ones Wang Fanglin, director of the treatment and Security Department of the State Medical Security Bureau, previously analyzed that the security measures benefit more than 100 million patients with "two diseases" It is estimated that nearly 40 billion yuan of medical insurance fund will be involved in one year Wang Fanglin pointed out that the "two diseases" safeguard measures, in addition to the corresponding policies in the safeguard treatment, there are many supporting management measures It is not surprising that Hebei adopts the policy of centralized drug purchase In the future, more regions are expected to include more "two disease" drugs in the scope of centralized procurement, and the supply enterprises of these two types of drugs will usher in a new round of price reduction.