Dried food! 5 major problems of purchasing with quantity to be solved

In the reform of China's medical and health system, drug purchase is not only a controversial point of view, but also a difficult point for all parties to choose their interests From the perspective of development direction, centralized procurement, volume procurement, competitive procurement, price reduction procurement, and standardized procurement will be high probability In December 2018, the first batch of pilot 4 + 7 drugs were purchased by the State Health Insurance Bureau in a centralized way By April 1, 2019, all 11 cities had been implemented Before that, some provinces have also experimented with centralized procurement at the provincial level, and made great achievements On January 1, 2019, the general office of the State Council issued the pilot program for centralized procurement and use of drugs organized by the state (hereinafter referred to as document 2) The biggest achievement of this centralized procurement is to set things right in theory Over the years, the idea of centralized purchase of drugs has been confused What is right? What is wrong? There is no final conclusion The new approach of centralized procurement with volume has realized regression in the following aspects 1 Open purchase quantity Whether it is bidding or negotiation, it is necessary to make clear the quantity of procurement We can't talk about price and purchase without quantity 2 Volume price linkage Quantity and price are in the opposite direction: quantity plus price decreases, quantity minus price increases If the quantity of goods that cannot be purchased is reduced, but the price is required to be reduced 3 Perform the contract The signed contract is to be abided by If it is not abided by, it is to be liable for breach of contract We can't fix the price and then change it through the second negotiation This is a matter of law-abiding 4 Keep your promise Promises and promises are to be kept or fulfilled You can't say anything but count This is a matter of keeping faith 5 Payment for goods The sale requires the payment of money and goods, and the payment of liabilities and interest shall be made in case of default It's also taken for granted that we can't default on drug payments Lack of money is not a reason for default 6 The rights and responsibilities are the same Whoever chooses the Distributor shall bear the responsibility during the delivery period It is not allowed for the buyer to designate the distributor, but also for the seller to pay and bear the responsibility during the delivery period 7 Independent quotation When selling goods in centralized purchase, the Seller shall make its own quotation It is not up to the purchaser to set a price reduction margin as a condition for market access There are many problems in the former centralized purchase of drugs Although a number of problems have been solved and eased in this centralized procurement, some problems still need to be studied 1 How to establish a scientific and reasonable mechanism for the formation of drug prices: this time, the centralized procurement with volume only relies on competition and price reduction, and there is no scientific and reasonable mechanism for the formation of drug prices The current reality of drug price is the coexistence of virtual high and virtual low On the one hand, the prices of some drugs are falsely high; on the other hand, the prices of some drugs are falsely low, below the cost Drugs with low prices will withdraw from the market, resulting in a shortage, and the market share will be replaced by high-priced drugs of the same kind Therefore, high and low drug prices will increase the burden of patients and medical insurance This is the law of the economy: when the drug price is falsely low and not through fair market competition, it is not far from the appearance of falsely high drug price According to some media reports, in recent years, due to the lack of a reasonable price formation mechanism, about two-thirds of basic drugs have been in varying degrees of shortage Moreover, the more low-cost and effective drugs with large sales volume are, the more likely they are to be lowered to below cost, and the more likely they are to be short Therefore, a reasonable price formation mechanism must precisely adjust the price to suit the situation: lower the drug price of the virtual high and raise the drug price of the virtual low The two seemingly opposite phenomena of the virtual high and the virtual low of drug prices originate from the same reason: disrespect for economic laws This is the same cause and different effect under different external conditions The principle of "quality first, price reasonable and cost-effective" set by the state for centralized drug procurement is correct At present, the practice of "only low price is to take" is adopted, which makes one-sided use of the characteristics of the mechanism of bidding and price reduction It is not in place to reduce the virtual high drug price, but forces to death the drugs with the virtual low price At the same time, ignoring the quality, curative effect and credit makes the low price "qualified products" flood the market If scientific drug price formation mechanism can not be established, not only more good drugs that are in urgent need are difficult to enter the medical insurance, but also good drugs that have already entered the market will gradually be forced to exit the market On January 3, nimesuli of Kangzhi Pharmaceutical Co., Ltd announced that due to the rising cost, the enterprise could not continue to supply at the original price, and proposed to withdraw from the alternative product, which was the alternative product in the second batch of centralized procurement of medical institutions in Shanghai in the second half of 2018 Shanghai Pharmaceutical centralized bidding and procurement management office immediately issued a notice, and the qualification of drug procurement will be cancelled from January 7, 2019 At the beginning of this year, it was also announced on the pharmaceutical website that in 2018, a lot of drugs in Inner Mongolia, Shanxi, Ningxia, Liaoning and other provinces were purchased in a centralized way in addition to Shanghai Due to the low price and rising cost of centralized purchase, the company applied for suspension of production and cancellation of Internet access, and promised not to supply drugs in a unified way throughout the country Among them, there are 135 in Inner Mongolia, 47 in Ningxia and 44 in Liaoning Therefore, it is urgent to determine a scientific and reasonable drug price formation mechanism as soon as possible We should not only pay attention to the virtual high and ignore the virtual low; only pay attention to the real virtual high and ignore the potential virtual high We should not only make the effective drugs with low profit and low price, market circulation, and patients can buy and afford them, but also make the drugs needed by the market have reasonable profits, be able to digest the production cost and research and development cost, have the ability of simple reproduction and expanding reproduction, and ensure the market supply The No 2 document proposes to "explore and improve the centralized purchasing mechanism and the market-oriented drug price formation mechanism", which should be aimed at all drugs, first of all, the drugs with high and low prices It is hoped that it will be reflected in the centralized purchase of drugs in the future 2 How to prevent and eliminate the shortage of drugs: it is undeniable that the decrease of drug price is beneficial to patients and medical insurance, and will certainly be welcomed by the society However, a proper decline in drug prices should first have supply accessibility, quality assurance and production sustainability There are various reasons for the shortage of drugs, but the basic reason is the price problem Therefore, the establishment of scientific and reasonable drug price formation mechanism can not only prevent the emergence of short drugs, but also eliminate the existing shortage of drugs The state has made clear the measures for designated production of drugs in short supply However, if the reasonable price of short drugs can not be determined scientifically, the designated production of short drugs will not be able to achieve the expected effect and will not be sustainable Generally speaking, the supply shortage of products always coexists with the capacity shortage, while the excess supply of products always coexists with the overcapacity However, there are market demand (sometimes even urgent need), production capacity (sometimes even excess), product image (generally obvious curative effect), social reputation (some life-saving drugs even need to be purchased through the back door) In the situation of the whole industry's capacity reduction, deleveraging and inventory removal, there are still shortages, and there are many What's the reason? It is in the most important link of product entering the market that there is a problem in price Of course, there are also reasons for the shortage of drugs, such as the monopoly of raw materials, the lack of approval documents, the lack of competitive alternative products, and the lack of communication between relevant parties But price is the main factor Therefore, in order to solve the problem of drug shortage fundamentally, it is not enough to rely on the response of drug production enterprises' designated production, and government departments must be involved And the most appropriate intervention point is the centralized procurement of drugs In the process of centralized procurement, we should ensure the implementation of measures such as "designated production", "base construction" and "one product, one discussion" determined by the government departments, and ensure that good wishes receive due results In addition, winning the bid for a single variety in centralized procurement also has a great risk, which is easy to lead to a large area of drug shortage due to the supply interruption of an enterprise No 2 document requires that "people-centered and clinical drug demand guaranteed", first of all, we should prevent the lack of commonly used, effective and low-cost drugs 3 How to further support the consistency evaluation: the support of the centralized procurement for the market access of the evaluated drugs is undoubted Now 99% of the drugs that need to be evaluated have not passed the consistency evaluation, among which the evaluation cost is an important factor If the cost of evaluation cannot be reflected in the drug price, it will be very difficult to continue to push forward the consistency evaluation in the future The society is worried that the consistency evaluation has the technical characteristics of no consideration of process, no consideration of side effects, no consideration of adverse reactions and no consideration of the amount of impurities The combination of the technical characteristics and the economic characteristics of only taking low price is bound to encourage enterprises to produce qualified low-quality products The consistency evaluation may become the so-called "one-time evaluation", which will damage the patients' economy Benefits and health To this end, the head of procurement of the State Council said: "after winning the election, the drug regulatory department will strengthen supervision and inspection and product sampling, strengthen the quality supervision of the whole life cycle, and ensure that the consistency evaluation is not a" one-off evaluation " The words of the person in charge of joint procurement and the supervision of the pharmaceutical supervision department are naturally credible However, in the economic accounting that has lost the reasonable price increase, the actual effect remains to be tested Millions of dollars are needed for consistency evaluation If the effect of sales expansion of centralized procurement with volume can not offset the effect of price reduction, the procurement will still fall into the original "price reduction - sales expansion - loss - supply interruption - shortage" cycle In addition, the cost caused by consistency evaluation increases with the decrease of sales price Therefore, in the new line of deficit and shortage, over evaluation drugs may bear the brunt Today, the next step of consistency evaluation is about what happens: (1) centralized procurement is very powerful for promoting consistency evaluation This time, there are only 25 drugs selected, obviously because the number of over evaluated products is too small On December 22, 2018, there were nearly 20000 drug varieties requiring consistency evaluation nationwide, only 132 of which were completed By the end of March 2019, 240 varieties have been evaluated for consistency Therefore, it is expected that the next step to launch the centralized procurement with volume will greatly increase the variety of procurement (2) Generic drugs that have not yet been evaluated and want to take a share in the drug market, especially those that have already been evaluated, will speed up their pace and participate in the evaluation with all their strength (3) There are three generic drugs that have been evaluated for the same kind of drugs, which can no longer be selected by centralized purchase In addition to other sales strategies, the enthusiasm of enterprises to participate in the evaluation of such drugs will be affected (4) It is possible to reduce the price of centralized procurement by a large margin after the cost increase caused by the comprehensive consistency evaluation and the cost reduction caused by the implementation of volume procurement This is conducive to the interests of drug companies, patients, medical insurance and social atmosphere, but the response of hospital doctors is still unknown Because the number of hospital purchases arranged is not exactly the same as the number of hospital purchases that can be implemented and the doctor's prescription results (5) Compared with the competition of the original drugs after price reduction, the generic drugs after evaluation will transition from the competition of inferior quality and lower price to the competition of the same platform with similar quality and similar price The advantages of the original research drug have also changed from high price and easy sale to high quality and easy sale It's going to be on both sides