Bidding reduced by 24%! Who opened Pandora's box of drug price reduction?

Medical network, December 3, 2018 is not over yet, but the falling drug price is blindfolded and rushed to 2019 Recently, at a domestic pharmaceutical summit held in Beijing, relevant people in Wuhan solemnly introduced that in the newly launched drug volume procurement, the average drop of basic infusion reached 18.7%, with the highest drop of 24% In the context of the establishment of medical insurance bureaus around the world, the drug volume purchase in Wuhan has undoubtedly given the first shot of clear price reduction in winter to the drug bidding in the coming year! Only with extraordinary people can extraordinary things be achieved Under the background of the successive establishment of the medical insurance bureau and the tangled interests of drug prices, and in the careful transition stage of touching drug prices, Wuhan with "no knowledge of practice" emerged like Don Quixote in the windmill, declaring that no matter how powerful the "giant" is, I will march forward bravely The price reduction spearhead points to the instant disillusionment of some pharmaceutical companies Winter has come Does such a high space for drug price reduction mean that Pandora's box will be opened in advance in 2019? In the traditional sense, the top-level design of provincial drug centralized procurement is not perfect Whether it is the work specification for centralized drug procurement in medical institutions (wgcf [2010] No 64) or the guidance for establishing and standardizing the basic drug procurement mechanism in grass-roots medical and health institutions run by the government (GBF [2010] No 56), many innovative practices, such as the integration of bidding and procurement, the double envelope system, the linking of quantity and price, etc., are all eye-catching During this period, learn from Anhui pharmaceutical bidding good example! "Price cut to Anhui" has become a popular trend in the industry, but Anhui is quietly changing In 2014, Anhui 1118 basic medicine procurement still followed the previous "two envelope" bidding mode, but the implementation rules changed significantly, no longer taking "the lowest price" as the main factor of winning the bid, but more inclined to comprehensively consider the quality type, new GMP certification, actual quotation and decline and other factors But bidding addicted provinces bidding, still seize the "only low price is to take" article But at that time, there was a huge loophole in classified procurement, that is, drug procurement under administrative control, in terms of price, there was still a weak area of failure Taking the bidding documents of a province in 2012 as an example, in terms of quality level division, patents and original research drugs are listed in the first level of quality, while separately priced drugs and high-quality and good price drugs are listed in the second level, while drugs certified in Europe and America are listed in the third level, and GMP drugs are listed in the lowest fourth level In that era, those who get quality level get the world! For the agents at that time, the variety can be classified into a quality level independently, which basically means that they can avoid strangling other competitive products with the same generic name and specification, and the price system has been maintained by half Therefore, at that time, owning a relatively ideal price became the dream of many pharmaceutical companies And it is even more glorious to be able to rank among independent pricing and high quality and good price The products that can be priced separately and with high quality and good price can be called rare goods Therefore, at that time, we often saw some laughs: a product was priced separately in the name of original research in province a, but was included in the ordinary government guidance price in province B In the bidding procurement of a province, it will be classified into the first quality level, but in the adjacent B Province, it will be classified into the third quality level That's because, in the era of pricing by the national development and Reform Commission, a single pricing can set a "flower" in different places, and all places can explain all kinds of flowers, define all kinds of flowers, and need all kinds of materials to be renovated As for provincial drug bidding, this is even more true: a simple identification of the original research, different provinces seem to have little difference, but it contains mystery Sometimes, a small explanation is enough to kill the price of related drugs At that time, the bidding documents of many provinces showed that those with the same bidding name, bidding dosage form, bidding specification and quality level (i.e the same drug code and the same level grouping) were a competition (evaluation) group, and three of the same competition group were shortlisted according to the bidding rules, and those with high prices were eliminated The original research drugs and drugs priced separately, which are among the higher quality levels and have the same product specifications, enjoy the treatment of negotiation Therefore, there are a lot of chaos: on the one hand, there are fully competitive low-quality drugs In order to win the bid, in the bidding group, it can be said that the price is in darkness On the one hand, there is a high-quality bargaining group without any rivals In the process of two or even three rounds of bargaining, the symbolic point of reduction or even no reduction can win the bid Who can say whose fault lies in the coexistence of high and low drug prices, market competition and administrative control? In traditional sense, this kind of tangled provincial bidding procurement, in terms of the rationality of drug price differentiation, is really lacking Therefore, in 2015, the new guidance documents for drug bidding No 7 and No 70 were issued In fact, the new drug bidding document is a new definition of traditional provincial drug bidding based on document 56 and document 64: in terms of classified procurement, different procurement methods are adopted for different types of drugs, including bidding procurement, negotiation procurement, hospital direct procurement, fixed-point production and special drug procurement In the aspect of sunshine procurement, it is required to unify the standardized construction standards of provincial drug procurement platforms and promote the standardization of drug procurement codes Establish a drug purchase data sharing mechanism to realize the information interconnection and resource sharing of national platform, provincial platform, hospital, medical insurance agency, competent price department, etc In the aspect of volume purchase, it is emphasized to take the demand of the hospital as the guide, and the hospital shall make the purchase plan according to the actual use of drugs no less than 80% of the previous year Specific to the generic name, dosage form and specification, in principle, there are no more than 3 dosage forms purchased for each drug, and no more than 2 specifications corresponding to each dosage form In the aspect of pilot procurement, it is particularly required that provincial and municipal procurement should be synchronized and price linkage, and provincial bidding procurement and pilot city self procurement should be launched and implemented simultaneously If the transaction price of pilot city is significantly lower than the provincial bid price, the provincial bid price should be adjusted according to the transaction price of pilot city These four purchases basically take into account the links and disadvantages of drug purchase But the only thing that hasn't been taken into account is that the second negotiation will have such a great influence on Provincial bidding Among them, especially the impact of the second bargaining in the pilot province of medical reform In 2014, the second bargaining in Zhejiang Province started at 16 + 12015 in Anhui Province, and it has spread to many prefecture level cities, counties and even individual medical institutions in today's provinces, all carrying out the second or even three bargaining in the name of volume purchase For the cities, counties, medical consortia and medical institutions that carry out the second bargaining, with the implementation of the zero difference rate, the new financial compensation mechanism still needs to be established and completed Without money, there will be no job Therefore, everything is demanded from the market! Change people without changing their heads! Do not engage in second bargaining are sorry to bring the purchase of these four words! Therefore, the provincial procurement of administrative control has evolved into the regional single procurement of administrative decentralization, and the market competition has evolved into a price reduction war of killing pigs, slaughtering sheep and eating meat The difference is that in terms of top-level design, the centralized purchase of drugs should be conducive to breaking the mechanism of supplementing medicine with drugs, accelerating the reform of public hospitals, especially county-level public hospitals; helping to reduce the false high price of drugs, reducing the burden of drug use by the people; helping to prevent and curb corruption in the field of drug purchase and sale, resisting commercial bribery; helping to promote drug production and distribution enterprises Integration and reorganization, fair competition and healthy development of pharmaceutical industry In terms of actual implementation, drug procurement is centralized and decentralized Each procurement subject makes full use of the self dissimilation understanding of the incentive and constraint mechanism of "surplus retention and reasonable over expenditure sharing", and through round after round of second price negotiation, the invisible remedy with drugs is carried out again in the new situation Therefore, when GPO, Procurement Alliance, pilot procurement and other secondary bargaining become a new normal, the policy effect of centralized procurement of drugs at the provincial level cannot be discussed, No 70 document emphasizes that "we should adhere to the direction of centralized drug procurement, implement a platform, up and down linkage, open and transparent, classified procurement", to some extent, has become a Zen cloud, still see the charm, no trace For pharmaceutical companies, the price space is limited The common way of bidding and purchasing is to compare prices with each other: you are lower than me, and I am lower than you! In order to deal with the "second bargaining" and the drug purchase after the establishment of the medical insurance bureau in the future, enterprises have to maintain the price system from the perspective of overall planning, but how difficult is the way to maintain it! Another example is drug price negotiation At present, many provinces, cities and hospitals still conduct negotiations through man-machine dialogue This kind of negotiation seems fair and fair, but it is carried out against the background of poor information communication and inability to grasp each other's real purpose Experts did not give a scientific, fair and open basis for the price proposal, only to reduce the price as the ultimate goal, subjective and arbitrary color is strong Take a medical association and hospital bargaining in Southwest China as an example Some experts suggested that 60% of the price should be cut off from the bidding price in the first round, and even a ten cent price should be returned Some experts don't consider the reason why the enterprise gives a counter-offer, and the second round of price offer only floats a few cents on the basis of the first round of price offer This kind of negotiation did not allow the buyer and the seller to negotiate directly Instead, it was the experts behind the computer who set a price In the face of such bargaining, the policy connotation of "medical institutions as bargaining subjects" is misinterpreted, the basic market rules are overturned, and equal rights and opportunities are not given to enterprises How can such bargaining be realized?! Negotiate a real price? In fact, it is not only the market mechanism and the administrative mechanism that fail, but also the heart attack is sometimes more important Since 2017, pharmaceutical companies have suddenly found it difficult to maintain prices First, the large-scale promotion of the two vote system in China, and then the bloodbath brought by the consistency evaluation In the view of two vote system, there is a voice in the market: the virtual high price is determined by the centralized purchase control of drugs, which has nothing to do with the number of channel tickets In fact, it's only half right The drug price is regulated by centralized purchase, but there are still many people who don't understand the false high price The author believes that the virtual high price, in addition to being reflected in the field of centralized drug purchase, is a chain formed by binding all the reasonable and unreasonable prices of bright, dark and white The biggest reason why the price chain is black and white and the boundary is fuzzy is that the interest-seeking nature of the market breaks away from the rein of administrative control and breaks through The red line of open competition, the existence of these groups, encroached on the healthy development of the medical market, and ruined the healthy competition atmosphere of medical people However, consistency evaluation is expected to promote the full competition of drug market and reduce the drug price But the reality is that the original research is in the view