Circle catalog + price reduction? Auxiliary medicine and then tighten the hoop

Source: Xinkangjie 2015-10-26 review of laws and regulations since September 2015, the monitoring measures of auxiliary drug catalogue have become the focus of public opinion This momentum started from the guiding opinions of the general office of the State Council on improving the centralized drug procurement in public hospitals (No 7 document in 2015) In the section of "strengthening the training and assessment of rational use of drugs for medical personnel" under "strengthening the comprehensive supervision and management" of No A prescription review and doctor interview system shall be established, focusing on tracking and monitoring auxiliary drugs and drugs used abnormally in hospitals " No.38 guiding opinions of the general office of the State Council on the pilot comprehensive reform of urban public hospitals "reducing the cost of drugs and medical consumables": "strengthen the supervision of rational use of drugs and prescriptions, control the unreasonable use of antibacterial drugs in the form of negative list management of prescriptions, prescription comments, etc., and strengthen the intervention of clinical use of hormone drugs, anti-tumor drugs and auxiliary drugs" 。 In July 2015, Anhui Province issued the notice on the establishment of early warning management system for key drug monitoring catalogue, which "based on the procurement data of public medical institutions at all levels in the provincial drug procurement platform, and with reference to the proportion of new rural cooperative medical cost compensation amount in the province, the provincial key drug monitoring catalogue with high price, large dosage and non treatment assistance was established Carry out continuous monitoring and Analysis on the drug purchase and use of medical institutions at all levels in the province, and determine the key drug monitoring catalogue (specific product regulations, manufacturers and purchase amount) according to the ranking of drug purchase amount, referring to the price, dosage and normal purchase and use situation "The notice was originally scheduled to be implemented on October 1 According to the news report "Anhui Province will establish key drug monitoring catalogue" on the official website of the health and Family Planning Commission of Anhui Province, "the chief of the Drug Administration Office of the Commission said that the first catalogue is being developed, and it is estimated that 50 to 100 kinds of drugs will be included in the catalogue." In September, 21 auxiliary drug monitoring directories in Beijing flowed out In October, the list of auxiliary drugs in Yunnan and Jiangsu flowed out It is rumored that many provinces have set up a catalogue of auxiliary drugs in hospitals Catalogue development: provincial level? From document No.7 to document No.70, as well as the discussion draft of the formulation standard of medical insurance payment price circulated on the Internet, which involves the formulation of specific catalogue, will eventually be put into the province for decision-making Policy formulation is increasingly inclined to who has the final say, and now pays the provincial or municipal level Therefore, if the policy of supplementary drugs can finally be shaped, the list of auxiliary drugs has the final say that the provinces will have the final say According to Xianda data v3.2, there are less than 10000 approval document numbers and less than 800 common names mentioned in the indications of the approved drug instructions, including the largest number of approval documents related to vitamins, such as 1178 approval document numbers for vitamin C tablets and 648 approval document numbers for vitamin C injection Some of the lists previously released by Beijing only included the instructions of ribonucleic acid Ⅱ for injection, lentinan injection, compound vitamin B for injection and Shenqifuzheng injection, which included "auxiliary" treatment The indefinite definition of auxiliary drugs will make the formulation of provincial catalogue present a diversified trend The 2011 version of the detailed rules for the implementation of the evaluation standard of the third level general hospital requires that "the top ten drugs in the annual amount of drug use in the hospital are consistent with the nature of the hospital and the main medical tasks it undertakes" in "relevant regulations, rules and regulations for the implementation of clinical drug treatment, and follow the relevant technical specifications" The online version often reads as follows:“ Treatment auxiliary drugs can't enter the top ten of drug purchase amount in hospital " In 2013, Guangdong health and family planning discipline inspection and supervision network's "thinking about the construction of" three chain "system of sunshine drug use" formulated standards for the use restriction of hospitals: "establish and implement the early warning mechanism of clinical drug use monitoring, and increase the use amount of the top 10 drugs and single varieties by more than 30% and the use amount of single varieties by more than 10% The decision of limited use, suspension or discontinuation of use shall be made by the pharmaceutical Committee of the hospital at its discretion Establish and strictly monitor the rational use of drugs, establish the proportion of outpatient and inpatient drugs in each department, and control indicators such as the utilization rate of antibacterial drugs Establish and implement prescription review system Special comments shall be made on large sum prescriptions, special prescriptions for antibacterial drugs, special management level antibacterial drugs, top ten consumed drugs, etc The goal of rectification is to reduce the amount of auxiliary drugs used by the manufacturers with the highest transaction amount, but the list of drug use amount and distribution purchase amount of each province or city is rarely available on the public website In 2014, Zhejiang Province announced the top 200 distribution amounts in the notice on drug transactions of drug procurement platform in 2013 According to the statistics and analysis of drug generic name, dosage form, specification and manufacturer, the distribution amounts were ranked from high to low The top 200 products involve 135 manufacturers, with a distribution amount of 16 billion yuan, accounting for 37.6% of the total amount of drug distribution in Zhejiang Province Unfortunately, Zhejiang province did not disclose such transactions in 2015 The new bidding plan of Guangdong outflow also puts forward "regularly publish the exclusive varieties with large price difference and the transactions of the top 100 contracts", and Anhui also "implement the dynamic management of key drug monitoring catalogue, which is released once a quarter in principle", and it is expected that the product catalogue ranking the top in drug use of hospitals in all provinces will be gradually released The policy forces enterprises to develop and innovate According to the current outflow catalogue of Beijing, Yunnan and Jiangsu, the limited products are mainly traditional Chinese medicine injections, vitamins, anti hepatitis, anti-tumor and widely applicable drugs In addition to the previous restrictions on antimicrobial drugs in the guiding principles for clinical application of antimicrobial drugs (2015 Edition), many of the top products in hospital terminal sales are restricted by the state In addition, the public opinion thinks that drugs with wide indications should not be considered as "magic drugs" In fact, if there are rigorous clinical experiments, different specifications of drugs may treat different indications, such as aspirin At present, the main shortlisted "Shenyao" is safe, but the curative effect of nervous system drugs is not clear If such drugs want to get rid of their "Shenyao" charges, they can only use the European and American clinical guidelines According to the notice of Anhui Province on the establishment of early warning management system for key drug monitoring catalogue“ The provincial drug centralized procurement management agency, together with the provincial new rural cooperative medical system management agency, interviewed and admonished the corresponding production and operation enterprises about the drugs that may have problems in the key drug monitoring catalogue, and took intervention measures in accordance with laws and regulations, until the online transaction was suspended, and disclosed relevant information to the society In the future, when carrying out drug volume procurement, all procurement consortiums shall focus on the early-warning varieties in the monitoring catalogue In combination with the consumption information of corresponding drugs, the volume price linkage shall be implemented to further reduce the virtual high price " For drug manufacturers, the impact of entering the catalogue of auxiliary drugs is mainly as follows: first, the quantity price linkage is reduced, and the market is required to be traded with the price; second, the qualification of being disqualified from trading is required According to Guangdong's "thinking on the construction of" three chain "system of sunshine drug use", as long as it does not exceed the hospital's upper limit of auxiliary drugs, or 100000 or 80000, it can be safe For drug manufacturers, the impact is the decline of hospital output and the disqualification of transaction Whether in Anhui or Guangdong, the ultimate result of enterprises is limited growth, and the listed enterprises mainly engaged in auxiliary drugs are bad Some sources said that when the health and Family Planning Commission held a meeting in Zhengzhou the day before yesterday, it was more likely that the products in the catalogue of auxiliary drugs would adopt the scheme of price reduction linked to volume purchase If the estimated scale of the top 30 chemical drugs and the top 20 traditional Chinese medicine products is taken according to the CMH data source, it is estimated that the current terminal scale of the affected drugs is over 100 billion If the sales volume of products in Guangdong exceeds 100000 yuan per month, there are 2002 tertiary hospitals in China It is estimated that the top 10 auxiliary drugs in the sales volume of each hospital are over 100000 yuan It is estimated that the terminal scale of the affected drugs in tertiary hospitals is about 24 billion yuan However, due to the fact that the limited drugs are not simply and roughly disqualified from sale, the actual scale of the damage cannot be evaluated temporarily If the enterprise wants to prove that its own medicine is not an auxiliary drug, the manufacturers who are not single injections of traditional Chinese medicine can wash and sleep If other drugs are used, it is afraid that they should put out various high-level guidelines, data that can prove the clinical effectiveness, endorsement of experts from the main Committee at or above the provincial level, and have the ability to persuade the departments that formulate the auxiliary drug catalogue to approve the above information, so that they may be recognized "Wash white" For the industry, most of the resources of medical insurance reimbursement have been occupied by auxiliary drugs and antibiotics in the past The introduction of auxiliary drug catalog is conducive to the control of medical insurance expenses, promoting the medical reform and the standardization of clinical drugs, and promoting the development of new drugs for pharmaceutical enterprises However, for those enterprises and agents who used to live on adjuvant drugs, only rely on price difference and profit to move the middle link and do not need to rely too much on market promotion, the cold winter is indeed coming.