Discussion on the reform of medicine price from the shortage of common medicine

Source: economic reference daily at the beginning of the new year 2016-3-10, a kind of medicine named "youjiale" was out of stock in many cities Hospitals, pharmacies and online shopping malls were hard to buy, almost "a box is hard to find" Some patients try their best to find sales channels, but find that the drug price has doubled, and limited supply Yujiale is a commonly used medicine for hypothyroidism patients, which is produced by Merck schlandau company in Germany Although it is an imported medicine, but the price is not expensive A box of medicine is about 30 yuan, which is the first choice for the patients with hypothyroidism This shortage has caused a lot of inconvenience to the patients with hypothyroidism In fact, this is not the first time that a large number of commonly used drugs are out of stock According to the survey, the reasons for the shortage of commonly used drugs can be roughly summed up into six categories: first, the drug price is too low, the manufacturer has no profit to plan, and chooses to stop production; second, the drug purchase catalogue that does not enter the hospital; third, the problems in the drug circulation channels, such as the problems in the customs declaration process of some imported drugs; The fourth is due to production technology problems, or raw material supply problems, leading to short-term shortage of drugs; the fifth is due to public health emergencies, leading to a shortage of supply of some drugs; the sixth is necessary for clinical use, but the amount is small, which is likely to lead to insufficient inventory In recent years, the main reason for the shortage of commonly used drugs is that the price of drugs is too low to be profitable In April 2014, in order to solve the problem of insufficient supply or even shortage of commonly used low-cost drugs, eight ministries and commissions, including the national health and Family Planning Commission, issued the notice on printing and distributing opinions on ensuring the supply of commonly used low-cost drugs, proposing to improve the price control methods of commonly used low-cost drugs According to the document, the maximum retail price limit for each specific variety shall be cancelled, and the manufacturer and operator shall be allowed to independently set or adjust the retail price according to the drug production cost and market supply and demand, so as to ensure reasonable profits Subsequently, the national development and Reform Commission issued the notice on improving the price management of low-cost drugs, which clearly put forward the standard of daily average cost of low-cost drugs as follows: Western medicine does not exceed 3 yuan, Chinese patent medicine does not exceed 5 yuan, and gradually establish the entry and exit mechanism of low-cost drugs list, and dynamically adjust the catalog Although the management department has released the maximum retail price limit of commonly used low-priced drugs, the shortage of commonly used drugs has not been stopped In 2015 alone, there was a shortage of dipyridamole for treating coronary heart disease, actinomycin D for treating common malignant solid tumors in children, bromepiramine for treating myasthenia gravis and ACTH for injection for treating infantile spasm According to the survey, the main reason for the shortage is still that the low price leads to unprofitable production enterprises Although the state cancels the maximum retail price of low-cost drugs, if these commonly used drugs are to enter the hospital procurement catalogue, they still need to be tendered and settled according to the bid winning price In order to enter the hospital purchasing catalogue smoothly, it is difficult for the manufacturers to obtain reasonable profits by increasing the drug price Generally speaking, in the face of the situation that the price of some commonly used drugs is too low, drug manufacturers have three options: first, strive to reduce costs, constantly innovate production processes, and increase profit space This requires a longer-term process, and enterprises may face losses in the short term The second is to squeeze out competitors by monopolizing raw materials or production, and then raise prices by virtue of monopoly Some large and powerful pharmaceutical enterprises may choose this way For example, in January 2016, several pharmaceutical companies monopolized the production of allopurinol tablets, a common drug for gout treatment, and were punished by the national development and Reform Commission Due to monopoly production, the price of drugs has nearly tripled from 2013 to 2015, which fully reflects the price risk of monopoly production of commonly used drugs Third, because there is no profit, enterprises will choose to stop production or transfer production, resulting in a shortage or even interruption of drug supply It can be seen that for commonly used drugs, especially low-cost commonly used drugs, simply relaxing the ceiling price cannot effectively solve the problem of drug shortage Therefore, we should further explore the innovation of price formation and management methods of commonly used drugs First of all, promoting the reform of drug separation is the key and core to solve the drug pricing management Drug pricing mechanism reform is an important part of medical system reform It is the key to rationalize the drug pricing mechanism to gradually explore the implementation of drug separation and let the hospital pay more attention to drug effect rather than just price when formulating drug purchase catalogue Second, change the management goal of commonly used drugs from "low price" to "high quality and low price" With the promotion of the reform of the national medical system and the improvement of the residents' income, the demand of the people for medicine and medical services has gradually changed from "have" to "excellent" Common drug management should not only focus on low price, but also emphasize high quality and encourage innovation Therefore, we should gradually explore the establishment and dynamic adjustment of the list of commonly used drugs in accordance with the clinical effect, sales volume and market share of drugs, and appropriately increase the price of drugs for high-quality drugs that have passed the long-term clinical and market tests, and provide reasonable price protection and subsidies Third, explore a variety of price management models According to different drugs, the combination of negotiated pricing, free pricing and controlled price is implemented More attention should be paid to the role of market mechanism in measures to reduce drug prices For example, drawing on the experience of the UK and other countries, we should gradually turn the price level of single drug to the profit of drug manufacturers When the profit of a specific drug reaches a certain level or the total sales volume of a pharmaceutical company reaches a certain amount, it is required to reduce the drug price, or disclose the cost and profit data This can not only ensure that pharmaceutical companies have enough funds for innovation, but also ensure that drug prices remain at a reasonable level In addition, we should take advantage of Internet economy and other favorable conditions to vigorously develop Internet medicine, innovate drug distribution channels and inventory management, reduce drug distribution costs and ensure the supply of commonly used drugs Finally, we should strengthen the management of drug market, and focus on combating monopoly and hoarding To establish and improve the early warning mechanism and reserve system for the shortage of commonly used drugs of the state, provinces and cities, hospitals, pharmacies and other organizations at all levels Dynamic monitoring of common drug supply We will promote the orderly development of the supply market of commonly used drugs, focus on cracking down on the hoarding of raw materials for the production of commonly used drugs, increase the penalties for monopolistic production enterprises, and reasonably introduce a competitive mechanism for the production of commonly used drugs Strengthen cooperation with foreign medical institutions to ensure the smooth import of low-cost and high-quality commonly used drugs.