Another province's purchase with quantity landed in the medical insurance bureau's response: no objection to local exploration, but to ensure the quantity

On December 17, 2018, after one week's publicity, the results of "4 + 7 city drug centralized procurement" were officially announced on Shanghai Sunshine pharmaceutical procurement network In addition to the 4 + 7 pilot area, e drug managers learned that many other provinces in the country have also followed the example of "4 + 7 urban drug centralized procurement" and introduced a new round of drug centralized procurement program of their own province, which has reached the stage of implementation According to the news, at present, Fujian Province has sent letters to all enterprises to follow up the results of 4 + 7 centralized purchase, and the purchase price of drugs with the same chemical name shall not be higher than the price of the products that have passed the consistency evaluation, otherwise, the qualification of product networking will be cancelled E drug managers confirmed the news to the authorities in Fujian Province, and got the reply: it is under discussion At the provincial level, the work of drug procurement in public hospitals in Hebei Province has already been in the actual deployment Previously, Hebei health and Family Planning Commission and other four departments jointly issued the notice on printing and distributing the implementation opinions on the pilot work of drug volume procurement in public hospitals in Hebei Province (jwyh [2018] No 107) On December 6, that is, on the day of "4 + 7 urban volume procurement", Baoding health and Family Planning Commission, human resources and Social Security Bureau and other four departments jointly issued the implementation plan of Baoding public hospital drug volume procurement In the same nature, Handan City Health and Family Planning Commission, food and Drug Administration and other four departments jointly issued the "Handan public hospital drug volume procurement work plan" on December 10 Although the "4 + 7" city's volume procurement is only a pilot, from the response of provinces in non pilot regions after the results are published, such a procurement pattern may soon spread across the country In an interview with e-drug managers, the relevant head of the National Medical Security Bureau said, "we are not opposed to the exploration of volume procurement everywhere, but the key is whether the volume can be really guaranteed." 1 The enterprise can not refuse to renew the contract From the content of the documents issued by Baoding and Handan, an important idea reflected in the whole is still to reduce the drug price through the mode of volume purchase, but it is still different from the "4 + 7 city volume purchase" And these differences may not be good news for companies First, it's about purchasing volume One of the key factors for the establishment of "4 + 7" mode is that it has made clear the procurement volume of each variety, and emphasized in the procurement document that "medical institutions should give priority to the use of the selected varieties in centralized procurement and ensure the completion of the agreed procurement volume" The purchase plan of Baoding City specifies the purchase plan, which clearly states that "the purchase consortium shall prepare the purchase plan in accordance with the clinical drug demand and not less than 60% of the actual drug use of each medical institution of the consortium in the previous year" However, for the purpose of ensuring the completion of the purchase amount, the strength of the statement is obviously insufficient, just mentioning that "each medical institution shall purchase according to the declared annual purchase amount" Whether the planned quality regulations and quantity of drugs can be achieved has not been explained Secondly, there are great differences in the regulations on the agreed purchase volume in advance, and it is worth noting that the documents of Baoding and Handan also put forward the concept of "step price reduction" "4 + 7" with quantity purchase agreed that if the agreed purchase quantity is completed in advance within the purchase week, the excess part will still be purchased at the selected price until the expiration of the purchase cycle; while Baoding and Handan stated that "in the purchase cycle, the drugs exceeding the planned quantity of centralized purchase are encouraged to be subject to step-by-step price reduction from the next month when the planned quantity is exceeded." Step price reduction is not a new concept At the end of November, Bozhou medical reform group of Anhui Province issued the centralized drug procurement plan for public medical institutions in Bozhou, which also stipulated that for drugs exceeding the procurement budget in the procurement cycle, the price should be reduced step by step from the next month beyond the procurement budget For drugs that fail to meet the purchase expectation, the purchase time limit shall be extended until the purchase budget is completed In addition, Baoding city also stipulates that if the purchase of drugs exceeds the declared purchase plan, an additional contract can be signed with the drug production and trading enterprise The key point is that "the drug production and trading enterprise shall not refuse." For enterprises, the next big headache will be whether the non pilot areas will conduct price linkage based on the enterprise quotation after the "4 + 7 urban drug centralized purchase" In principle, each province has greater autonomy on whether to link the volume purchase price this time In particular, in this 4 + 7 volume purchase, a large number of enterprises reported a decline that exceeded the previous external expectations, making other provinces in non pilot regions have sufficient motivation to carry out the price link It is understood that at present, there are voices in Anhui, Shandong, Sichuan and other places, saying that they will follow up the results of 4 + 7 centralized mining in succession But for price linkage, challenges and difficulties exist at the same time and cannot be ignored The reason why 4 + 7 urban volume procurement can get a relatively low enterprise quotation is largely derived from the single source commitment, guaranteed procurement volume and guaranteed prepayment and collection in this model, and also has strong requirements for transportation time, distribution link, hospital coverage and other aspects At the same time, even in Shanghai, where relevant implementation rules have been issued, the issue of how to issue invoices for 4 + 7 volume purchase has not been clear, and there are too many rules to be further implemented At present, the non pilot areas still fail to meet the relevant requirements in the above aspects, so the comprehensive price linkage still has its challenges This is also the reason why Shanghai Pharmaceutical Institute said in its communication with enterprises that the price linkage in the non pilot areas is aimed at, and the Pharmaceutical Institute can send a letter to the bid winning enterprises and products to suggest not to collect the 4 + 7 centralized price, which is also the reason for enterprises What can the Ministry of government affairs strive for when working with local health insurance bureaus However, from the current trend, even if the price linkage is not completely adopted, the trend of the new round of belt quantity procurement in the region of our province has basically appeared by referring to the mode of "4 + 7 urban belt quantity procurement" 2、 The medical insurance bureau intervened and gave priority to the use of 4+7 negotiation price to clearly refer to the quotation of "4+7" purchasing enterprises The first response was made by Shaanxi province The first move is that the procurement function of drug consumables in Shaanxi Province has been transferred to the medical insurance bureau On December 14, Shaanxi public resources trading center issued the letter of Shaanxi Provincial Health and Health Commission Office on the transfer of functions of drug consumables procurement According to the document, Shaanxi Provincial Health and Health Commission has transferred the procurement of drug consumables to Shaanxi Medical Security Bureau on December 12, 2018 As the payer, the medical insurance bureau takes over the purchasing work, which is of great significance The second move was on December 18, the Shaanxi provincial centralized purchase network of pharmaceutical machinery issued the notice on issues related to sunshine purchase of drugs through consistency evaluation, which clearly stated that "those enterprises that voluntarily use 4 + 7 negotiation price to link to the network in our province will be listed in the limited price list first." According to the regulations, medical institutions shall give priority to purchasing and using the products included in the list of limited price and network For the products directly linked to the online catalogue, the medical institutions and the online enterprises shall negotiate the price independently, and the agreed purchase price shall not be higher than the reference price provided by the purchase platform in principle Although Shaanxi province does not force price linkage with "4 + 7" price as the benchmark, for enterprises, the wind vane has been revealed It is worth noting that at present, there are also enterprises that take the initiative to declare and implement the bid winning price of 4 + 7 centralized procurement in non pilot provinces On December 18, the pharmaceutical purchasing office of Gansu public resources trading Bureau issued a document saying that youmeituomidine hydrochloride injection of Yangzijiang Pharmaceutical Group Co., Ltd actively applied for the implementation of "4 + 7 city drug centralized purchase winning price" in Gansu Province, and the drug was transferred to Gansu Province drug centralized purchase platform for online trading, and the province's unified price procurement, and the online results have been completed since December 24, 2018 Provincial execution For Yangtze River, the product has not won the bid in Gansu Province before, and this time will undoubtedly help it better expand its market in Gansu Province 3 Price is the key factor in the change of generic drug pattern after price shock, whether it is "4 + 7" urban volume procurement or the new round of centralized volume procurement of drugs that has been clearly proposed in Anhui, Hebei and other places In addition, the scope of price reduction is not limited to the 20 or 30 varieties that have been announced A clear trend is that with the continuous expansion of the number of conformity evaluation products and product specifications, the coverage of volume procurement bidding will continue to expand And the city scope of carrying out volume procurement will inevitably expand from the current 11 areas to a larger scope On the basis of the sharp reduction of drug prices, the market pattern of generic drugs and the development and operation logic of generic drugs enterprises may face great changes First, the concentration of generic drugs will increase rapidly On the one hand, if the "4 + 7" mode of single source commitment continues to be maintained, then only access to competitive market position is obtained through consistency evaluation, and the number of enterprises that can win the bid in the end is actually very limited; on the other hand, under the current procurement mode, price competition among generic pharmaceutical enterprises will continue to intensify, and enterprises with less strength will naturally Gradually be eliminated, so as to realize the situation of the strong and constant The second is that the era of blockbuster generic drugs may come to an end When the price is greatly compressed, it is difficult for enterprises to obtain the high profit space before In terms of business model, relying on the number of products and the continuous product pipeline to reshape their competitiveness, this may be a way for generic pharmaceutical enterprises to grow and strengthen in the future at home.