Where does "4+7" go next: Four questions to be solved, five major purchasing trends!

In the reform of China's medical and health system, drug purchase is the focus of all kinds of arguments, but also the difficulty of interest game In December 2018, the first batch of pilot 4 + 7 drugs of the state health insurance bureau began to be purchased in a centralized way By April 1, 2019, all 11 cities had been implemented The current implementation effect is obvious since the general office of the State Council issued the pilot program for centralized procurement and use of drugs organized by the state (hereinafter referred to as No 2 document) on January 1, 2019 1 Correction of past problems Including the open purchase quantity (not separate from quantity and price, not separate from quantity and purchase); quantity price linkage (quantity plus price decrease, quantity minus price increase); performance of contract; keeping promise; payment for goods; consistent rights and responsibilities (whoever designates the Distributor shall bear joint liability during the distribution period); and independent quotation, etc These problems have not been solved well for many years and have been corrected in this pilot project 2 Pricing by volume in practice Volume purchase is the most important, necessary and easy link in the centralized purchase of drugs For a long time, with quantity purchase is only a good vision of centralized drug purchase, but the actual implementation effect is greatly reduced This time, the decision-making level really wants to bring quantity: first, the name is centralized procurement with quantity, which becomes an unavoidable key word in the procurement process; second, it defines the quantity with quantity, which is no longer replaced by the quantity with hospital 3 Substantial price reduction It's unexpected, but it's reasonable, that the price of centralized volume purchasing will be greatly reduced Because the state promised to take the amount, in fact, it is no longer necessary for the marketing expenses and benefit transmission of kickback and bribery nature, and the price reduction is reasonable, besides, there are "30% advance payment" and "timely payment collection" concessions 4 Over evaluated drugs began to replace the original imported drugs The drug price in China is both high and low The vast majority of virtual high are imported original research drugs This time, a large number of domestic generic drugs that have been evaluated won the bidding, and there will be no unfair (or super national) treatment of "one product and two regulations", and the former drugs began to replace the imported original drugs The sharp price reduction and fair competition of domestic generic drugs have also promoted the price reduction of original research drugs 5 Pay attention to consistency evaluation The purpose of focusing on consistency evaluation in centralized procurement is: (1) to replace imported original research drugs with domestic generic drugs; (2) to promote the price drop of original research drugs; (3) to promote fair competition between original research drugs and generic drugs; (4) to eliminate a batch of backward drug production capacity The actual procurement achieved the above objectives, and 88% of them were selected and evaluated generic drugs 6 Medical insurance prepayment for drug purchase It's a good thing for the medical insurance fund to prepay 30% of the total price in advance, but if the prepayment is given to the hospital, it's still up to the system software to reduce the arrears One is how to establish the price formation mechanism This time, we will focus on purchasing drugs with high prices, not drugs with low prices, and not establish a scientific and reasonable drug price formation mechanism A reasonable price formation mechanism should lower the false high drug price and raise the false low drug price No 2 document proposes "to explore and improve the centralized purchasing mechanism and the market-oriented drug price formation mechanism", which should be aimed at all drugs, first of all, drugs with inflated high and inflated low prices Second, how to prevent and eliminate the shortage of drugs Falling drug prices are good for patients and health care, and will certainly be welcomed by society However, the extreme of excessive price reduction is shortage Once there is a shortage of drugs, it will cause great or even irreparable damage to peers, patients and enterprises themselves Third, how to further support the consistency evaluation There is no doubt that the centralized purchase supports the market access of over evaluated drugs However, if the cost of evaluation cannot be reflected in the drug price, it is not easy to continue to push forward the consistency evaluation in the future Fourth, how to realize the price balance of drugs in different places legally and reasonably Although this centralized procurement does not approve of the "linkage of the lowest price" of the provinces, some media disclosed that some provinces and cities have plans for linkage of the lowest price At the same time, this purchase has resulted in the price difference of the same drugs between provinces, cities and cities several times, dozens of times, which has aroused great social repercussions The best way to solve this problem is to speed up the pace of reform, take the lead in the price highland, implement centralized procurement with volume as soon as possible, and reduce the excessive price In the interim transition process, high price regions can also be entrusted to low price regions for procurement, sharing low price achievements, and the cost of entrusted procurement shall be borne by the entrusted regions Next purchase trend In my opinion, the next step is to continue the trend of centralized procurement, which will include multi City consortia, provincial centralized procurement, and perhaps medical consortia procurement; the second is to match with volume procurement, economic laws and market credit are more and more respected; the third is to promote competitive procurement, that is, to rely on the competition between drug manufacturers; the fourth is to push forward price reduction procurement, In order to achieve the goal of maintaining a low profit without loss; fifth, pay attention to standardized procurement, according to the law will be strictly followed by the procurement subject Among them, centralized procurement with volume will be the largest market in front of pharmaceutical enterprises The first round of purchase volume is not large, mainly because the number of domestic evaluated generic drugs is too small, so only 31 drugs have been launched It is expected that the next step of procurement will be a substantial increase in varieties, and fewer and fewer drugs will remain outside the centralized procurement At the same time, relevant parties need to effectively perform the volume purchase contract In this procurement, the state has traded the volume for the low price, which is the way of market allocation of resources The lower prices are mainly illegal and unreasonable marketing expenses and interest transmission Therefore, most enterprises can still keep surplus Even if the price of raw materials and energy rises, drugs still need to be delivered according to the agreement, which is the responsibility of the enterprise, which is also to maintain its image of abiding by the law and trustworthiness It can be expected that in the future, the purchase volume and price cannot be implemented, which will be greatly reduced From the first pilot, 27% of the expected purchase volume has been completed in half a month It is a good thing that the hospital has not been able to implement the predetermined purchase volume and price Although the reserved purchase volume has not been completed completely, it has made a good start We hope to gradually establish a set of accountability, accountability, accountability and accountability measures in the future to ensure the implementation of procurement contracts On the other hand, the consistency evaluation of quality and efficacy of generic drugs will further promote the survival of the fittest, and the drug purchase quotation of enterprises will be more scientific and reasonable In this regard, it has been made clear that the No 2 document of centralized volume procurement requires "effectively prevent winning the bid at a low price regardless of quality" Only by scientific calculation and rational quotation can enterprises return a fair market, a fair peer and a fair self In this way, we can prevent and eliminate the shortage of drugs Because "only low price is to take", reducing the false high drug price is not in place, but will force the drugs with low price and low price to go nowhere In addition, the author believes that winning a bid for a single variety in centralized procurement is also risky Whether a company's cut-off of supply will lead to a large area of drug shortage needs to be reconsidered Recently, we saw that the executive meeting of the State Council discussed the issue of drug shortage guarantee, identified the measures for designated production of drug shortage, and established the purchase mechanism and pricing mechanism of drug shortage, which is expected to alleviate the drug shortage Finally, the author predicts that in the future procurement, generic drugs may change the competition pattern with the original research drugs The competition between generic drugs and original research drugs after price reduction will change from inferior quality and lower price to the same platform competition with similar quality and similar price The advantages of the original research drugs have also changed from high price and easy sale to high quality and high reputation and easy sale At that time, it will enter a new battlefield where both sides need to re study their competitive strategies.