Anhui is suspected to launch a new version of "key monitoring drugs catalogue" or impact the continuous downward trend of pharmaceutical enterprises

Source: e drug manager 2017-01-18 a sentence goes through in the pharmaceutical industry: "Fujian for bidding, Anhui for basic drugs, Zhejiang for hierarchical diagnosis and treatment." These three provinces are often the first in the three areas in China As a pilot field, they are trying to explore the way for a variety of deep-water areas of medical reform At present, in the combination of payment by disease + clinical key monitoring, Anhui Province has leaped again Although hospitals at all levels are the direct implementation subjects of charges according to diseases, it is believed that no pharmaceutical enterprise is willing to stay out of the business at this time An important reason is that the basis of charging by disease is clinical pathway For pharmaceutical enterprises, only their products can enter the clinical pathway smoothly, can they have the qualification to enter the game Under the mode of payment by disease, the cost beyond the quota will become the cost of the hospital, so those expensive drugs with no obvious effect are bound to be out of the market A typical reference province is Anhui On the same day that the notice of the national development and Reform Commission on promoting the work of charging according to diseases was issued, a catalogue of drugs for key monitoring and inspection of Anhui clinical pathway management and guidance center was released on the network It is said that Anhui clinical pathway guidance center has released the second batch of "directory of key monitoring drugs", and the first batch of 21 key monitoring drugs has been published in the "clinical pathway implementation plan" of Anhui Province as early as February 2016 Different from the first batch of 21 catalogues, which clearly stated "Prohibition of clinical pathway", this catalogue is expressed as "key monitoring, dynamic adjustment" E drug managers haven't found relevant documents on the official website The reporter contacted the 38 major manufacturers related to the key monitored drugs, all of whom said they didn't know, but all expressed their concerns about being monitored If this internal document is true, it means that nearly 100 varieties with a market scale of more than 10 billion are included in "pay by disease + key monitoring" This also means that a large number of enterprises will be in a difficult situation in Anhui medical market in the future; if we want to go further, if other provinces and cities also follow this standard, then the impact on related pharmaceutical enterprises will be a long-term and sustained downward path For the related pharmaceutical enterprises, it will be more difficult to enter Anhui pharmaceutical market in the future From the point of view of the list of key monitoring drugs, Anhui Province has been in an unprecedented strict situation for the regulation of auxiliary drugs In February 2016, Anhui Province issued the implementation plan of clinical pathway, in which 21 kinds of auxiliary drugs were not included in the clinical pathway form, specifically including Gugua extract injection, calf serum deproteinized extract injection, gugua polypeptide for injection, Safflor for injection, brain protein extract for injection, Guhong injection, RNA for injection Ⅱ , spleen Aminopeptide Oral freeze-dried powder, Trichosanthes injection, lentinan injection, compound coenzyme for injection, Brucea javanica oil injection, hepatohydrolytic peptide for injection, compound 3D B for injection , monosialtetrahexosylganglioside, calf blood protein extract, invert sugar electrolyte, Shenqifuzheng injection, cerebrosine peptide injection, sodium creatine phosphate for injection, alprostadil It is obvious that those "magic drugs" which are widely used in various departments and have a large amount of therapeutic diseases are under special supervision Among them, such varieties as calf serum deproteinized extract, alprostadil, etc rank top 20 in the sales of domestic best-selling drugs all the year round As the implementation of clinical pathway and the realization of charging according to disease complement each other, the funds that medical insurance can pay are fixed, and the excess part is borne by the hospital, so the hospital naturally needs to consider from the actual clinical needs, "Chinese magic medicine" space will be greatly squeezed According to the circulated "key drug monitoring catalogue", these drugs are collected by the clinical pathway guidance center through sorting, analyzing and summarizing the inspection results in the first three quarters of 2016, including 38 generic drug names According to the statistics of e drug managers, the catalogue covers up to 300 pharmaceutical enterprises In Yu family, the scope is mainly concentrated in five categories, namely, activating blood circulation, removing blood stasis, improving microcirculation; electrolyte, energy and body fluid supplements; high price vitamins and coenzymes (bases); benefiting qi, nourishing Yin, promoting body fluid, strengthening and removing; auxiliary anti-tumor and immunomodulators In addition, there are a few other unclassified drugs It is worth noting that the key monitoring drug varieties disclosed in this catalogue are all injections without exception, and most of them are traditional Chinese medicine injections There is no doubt that the management and control of adjuvant drugs is firm, but for pharmaceutical companies, it is not without a trace of vitality Zhou Qin, director of the clinical pathway management and guidance center of Anhui county-level public hospital, once said that the first choice of clinical pathway form must strictly limit the auxiliary drugs, and the first choice of basic drugs However, if patients really need to use expensive adjuvants due to their condition, they can be used by the clinical pathway management team after discussion, and then by means of mutation or exit route How to determine the clinical pathway? As the first batch of pilot provinces of medical reform, Anhui Province has been active in the implementation of the national route of deepening the reform of medical and health system, including the two vote system, medical insurance payment and other aspects, especially in the management level of clinical pathway, and has been following the national pace In 2009, the former Ministry of Health launched the pilot work of clinical pathway management, and announced the first batch of clinical pathways of professional diseases By 2010, Anhui province had determined 62 clinical pathway pilot hospitals, and started the trial of "clinical pathway + payment by disease" The so-called clinical pathway refers to the most basic standardized diagnosis and treatment scheme for specific diseases Generally speaking, that is to say, what objects are suitable for settlement by disease type, how many days are the standard hospitalization days, what are the necessary examination items, how to treat the day after admission, and even the drugs needed for common complications should be listed one by one The clinical pathway plan should be detailed to every diagnosis and treatment method, project and link, and also include the clinical nursing pathway of disease Under the payment standard of "project payment", the implementation of clinical pathway is undoubtedly difficult The planned clinical path needs to take away a lot of irregular diagnosis and treatment behaviors in the medical service, and then pay according to the project, the hospital's income will be affected, so it is difficult to promote In addition, Anhui Province also found that in order to cope with the examination, some hospitals listed the clinical route form drug use very wide, doctors can still use drugs freely, and the functional departments do not supervise the inspection, resulting in very poor results Anhui Province obviously has such determination In 2014, Anhui province implemented the mode of "clinical pathway + payment by disease", referring to the actual cost standard of each disease in 2013, and handed over the saved money to the hospital for redistribution Zhou Qin once introduced with such an example that the local gallstone surgery medical insurance quota is 5000 yuan, which is beyond the responsibility of some hospitals When the cost is less than 5000 yuan, the medical insurance still pays 5000 yuan The hospital and the Department sign an agreement, and the surplus part of the Department is average As a result, the surplus of each gallstone surgery can reach 1000 yuan, and the maximum reward cost for gallstone surgery is 5000 yuan per month Yuan, the enthusiasm will naturally greatly increase In January 2016, the health and Family Planning Commission of Anhui Province printed and issued the implementation plan for clinical pathway management of public hospitals at county level in Anhui Province, which expanded the implementation target to 75 public hospitals at county level in the province, and put forward specific objectives, that is, to strive to achieve 70% of county-level hospitals carrying out clinical pathway management by the end of 2017 Of the patients discharged from the hospital, clinical pathway management was carried out, and the proportion of drugs was reduced to 30% Anhui Province has issued specific operation rules, such as clear supervision measures "Strictly limit the amount of auxiliary drugs in the top 20 hospitals, make statistics every month, use the top 6 departments of auxiliary drugs, and the functional departments to supervise the rational use of drugs, and give the winning prize to the departments that carry out the clinical pathway with all the data up to the standard, otherwise, they will be severely punished." Some districts and counties have more detailed standards For example, Linquan County stipulates that for cases that meet the standards of entering clinical pathway but do not enter clinical pathway, a fine of 100 yuan will be imposed for each case; for cases that enter clinical pathway and withdraw from the hospital due to the case management of the doctor or relevant departments, a fine of 100 yuan will be imposed for each case Yuan fine; also calculate the access rate, and report to the top three departments every month 3 How to connect with medical insurance? According to the provisions of the notice on promoting the work of charging by disease, the charging standard by disease includes all the expenses of diagnosis and treatment during the period of hospitalization, i.e the patients are admitted to the hospital, receive standardized diagnosis and treatment according to the management process of disease treatment, and finally discharge to the standard of curative effect The diagnosis, treatment, operation, anesthesia, inspection and inspection, nursing, bed Medicine, medical materials and other expenses There shall be no additional charge in addition to the cost of diseases, and the inspection and inspection fee after admission shall not be charged Therefore, under the standard of medical insurance payment that has not yet been issued, how to connect the clinical pathway and the payment by disease in the future has become the most concerned topic In Anhui Province, the clinical pathway has been connected with the payment of NCMS In 2014, Anhui Province launched a pilot implementation plan (Implementation) of payment by disease for common diseases in provincial hospitals, of which 51 Group A is included in the pilot area of paying by disease for common diseases in provincial hospitals If the patients have participated in the new agriculture and are hospitalized in the pilot provincial hospital, and the diagnosis, age and main treatment methods of main diseases meet the requirements, the payment by disease can be implemented Specifically, referring to the cost level of medical institutions in Anhui Province and the cost level of pilot provincial hospitals in 2011-2013, Anhui Province determines the quota standard of the second average hospitalization medical expenses for each common disease, and determines the payment quota of each common disease new rural cooperative fund according to a certain payment proportion, that is, the new rural cooperative fund implements "package payment" , patients also pay their own expenses according to the self payment proportion specified in the program Now, the new rural cooperative medical system of clinical pathway management in Anhui province implements single disease payment, and the payment standard is dynamically adjusted according to the proportion of patients and the increase and decrease proportion of the average secondary cost in the same disease county Moreover, the single disease payment standard is linked with the decrease of the proportion of patients outside the county and the increase of the average secondary cost lower than the current CPI and other indicators At the same time, Anhui Province also plans to propose the idea of encouraging the exploration of single disease double quota payment reform in conditional areas, that is, to fix the quota paid by patients and NCMS separately.