Focus on new drug purchase: the average price reduction of "group purchase" in China is 52%

11 cities carry out pilot projects with an average price cut of 52% and "group purchase" by the state Drug prices are low (first line exploration of people's livelihood and attention to new drug procurement) How to solve the false high drug prices? Now, 11 cities are experimenting with a new mode of centralized drug procurement, with public medical institutions as the main body of centralized procurement, forming a Procurement Alliance, appointing representatives to form a joint procurement office, forming a combination of measures of "national organization, alliance procurement, platform operation" In addition, new methods such as consistency evaluation and quantity purchase are used to ensure drug quality and reduce drug cost A few days ago, the results of the competition announced that 25 varieties won the bid, with an average decrease of 52% and a maximum decrease of 96% The pilot of centralized drug procurement organized by the state was launched in 4 + 7 cities (Beijing, Tianjin, Shanghai, Chongqing and Shenyang, Dalian, Xiamen, Guangzhou, Shenzhen, Chengdu and Xi'an) Public medical institutions were the main body of centralized procurement, forming a Procurement Alliance Each pilot city appointed representatives to form a joint procurement office, forming a model of "national organization, alliance procurement, platform operation" In December last year, the results of the pilot drug centralized procurement of 4 + 7 cities and countries announced that 25 varieties won the bid, with an average decrease of 52% and a maximum decrease of 96% 4 + 7 centralized purchase, is it just price reduction? Will such a high drop affect the quality and supply of drugs? On these issues of public concern, the reporter went to Shanghai, Xiamen and Fuzhou to interview drug purchasing institutions, hospitals, enterprises and experts, investigate the reform of centralized drug purchase system and its impact on drug enterprises and medical institutions For the first time, the price of asparagus tablet, a cancer adjuvant treatment drug, increased to 213 yuan when it was sold to patients through many links, with a profit of 1300% A few years ago, the media exposed the inside story of the drug price Under the influence of many circulation links, the higher the price of medicine is In contrast, the result of the centralized purchase of drugs in 4 + 7 cities shows that the price reduction effect based on the consistency evaluation is significant, jumping out of the strange circle that the higher the price is, the higher the price is According to the analysis of the bidding results, the prices of three varieties are close to the lowest prices recognized by foreign countries For example, amlodipine besylate tablets with a price of 0.15 yuan per tablet, which are suspected to be too low, are actually only close to the lowest price of us generic drugs of 0.01 US dollars per tablet (about 0.07 yuan), as well as rosuvastatin tablets and paroxetine hydrochloride tablets, which are also close to the lowest price in the US There are 9 varieties lower than the lowest selling price in the United States, including irbesartan tablets, risperidone tablets, lisinopril tablets, cefuroxime ester tablets, tenofovir dipivoxil tablets, entecavir dispersible tablets, fosinopril tablets, enalapril tablets, imatinib tablets, among which entecavir dispersible tablets are 0.62 yuan each, about 1 / 20 of the lowest selling price of US $1.81 (about 12.49 yuan) It is estimated that among the selected drugs, the purchase amount of generic drugs will rise from 40% to over 97% In 11 cities, the purchase cost of 25 selected drugs dropped to 1.9 billion yuan, saving 5.9 billion yuan If the conditions are mature and extended to the whole country, it is estimated that the purchase cost of 25 drugs can be reduced to 6 billion yuan, saving 19 billion yuan Among the 25 varieties that won the bid, the original research drugs of foreign enterprises whose prices dropped precipitously for the first time decreased by more than 70% "Many of the original research drugs abroad will have a patent cliff after the patent period, and the price will drop precipitously, but it has not appeared in China The "cliff" of patents appeared in this 4 + 7 urban centralized procurement, which was brought about by the market mechanism of volume procurement led by the government " Hu Shanlian, a professor at the school of public health of Fudan University who has long been concerned about the reform in this field, believes that the functions of the medical insurance bureau have changed In the past, the public health system was responsible for drug bidding, and it was difficult to achieve a real low price In this procurement, the medical insurance returns to the buyer standard, adopts the way of quantity based procurement and quantity price linkage, and exchanges 60% market share of pilot cities for low price This highly centralized procurement mode conforms to the law of economic buyer monopoly, and can greatly reduce the price Secondly, quality assurance In the past, bidding was essentially the only way to win the bid at a low price In the past two years, China has started to evaluate the consistency of generic drugs to ensure the quality of drugs At the same time, drug companies reduce prices mainly by reducing the cost of circulation and controlling the source of raw materials "Enterprises that fail to pass the consistency evaluation will withdraw from the market, which clarifies the direction of innovation in the future and helps to promote China from a big country of generic drugs to a powerful country of generic drugs." As all public hospitals in China have cancelled drug mark up, the winning drugs will be sold to patients at the winning price in hospitals, which will greatly reduce the burden of patients, save the national medical insurance fund and improve the level of medical security For the first time, purchasing pharmaceutical companies with volume expected to make clear that before the marketing cost was reduced, because of the existence of kickbacks, Chinese patients would pay high costs whether they take foreign original research drugs or domestic generic drugs The head of the pilot office of centralized drug purchase of the state organization said that a large number of imitated drugs have huge rebate space, resulting in high prices However, in the past, the volume and price of centralized purchase of drugs were not linked, the purchase was decentralized, the competition was insufficient, the supervision was not strict enough, and the policies were not coordinated Drug recruitment, purchase, use and payment were all in one department, and generic drugs pursued the pricing of original research drugs These reasons lead to high drug prices In response to the above problems, the national pilot program has set up important rules for implementing the volume procurement Liang Hong, a professor at Fudan University's School of social development and public policy, believes that volume procurement solves the core problem of raising prices in the circulation sector "In the past, enterprises had to spend money on circulation in order to sell drugs With volume procurement, pharmaceutical companies have a clear expectation that production, packaging, marketing and other costs can be reduced " Volume procurement is not the first one in China, but the international practice Before that, the centralized procurement of drugs was mentioned repeatedly in China, but it was not implemented This time, why can it be realized? It turns out that volume purchasing is not only a concept, but also a whole set of systems Gong Bo, deputy director of the pharmaceutical Purchasing Department of Shanghai Medical Insurance Bureau, said that the reason why the varieties purchased in volume in Shanghai increased from the first three to 21 was not only to determine the dosage, but also to establish a set of comprehensive evaluation methods for drug quality, and prepay medical insurance funds to pharmaceutical enterprises as the revolving fund for payment for goods "Determination of dosage, comprehensive evaluation of drug quality, turnover fund of medical insurance, and supervision system of hospital's clinical his system, etc., all of these make the procurement with quantity truly implemented." Gong Bo concluded Zhang Ming, director of Shanghai Pharmaceutical centralized bidding and Procurement Management Institute, introduced that the pilot adopted the combination measures of "national organization, alliance procurement and platform operation" based on the experience of Shanghai 11 cities with large drug consumption and coordinated medical insurance at the municipal level were selected and entrusted to the joint procurement office The specific work was undertaken by Shanghai Pharmaceutical office In addition, the country has carried out the consistency evaluation of generic drugs, which has also brought great advantages to the pilot For the first time, the state took the lead to set aside a choice space to ensure the quality, high price and low price of 4 + 7 urban drug centralized procurement, which is a pilot of drug centralized procurement organized by the state At the national level, a pilot leading group was established with offices under it It is the first time in our country that the concentration is so high and the centralized purchase of drugs is organized by the state Since 2017, Fujian Province has carried out the joint limited price sunshine purchase of drugs based on the settlement price of medical insurance payment, and launched three prices: purchase price, maximum sales price and medical insurance payment standard Due to the lack of sufficient competition in drug prices, there will be a phenomenon of price inversion, which makes the hospital cry In addition, the monopoly of APIs is more serious, leading to the phenomenon of price inversion more common "In the past, the biggest problem in drug procurement was to take the province as the unit The consumption of each province accounts for only a small part of the whole country, and the negotiation weight is not strong enough, which leads to the problem of price inversion of drugs with insufficient competition " "However, if the whole country plays chess, the purchase price can be reduced," said Zhang Xuanhua, director of Fujian Medical Insurance Bureau Changfeng, a professor at China Pharmaceutical University, said that the centralized procurement in 4 + 7 cities is not a single source of goods, but a certain amount of non bid winning quantity is set aside to give hospitals a certain choice of drugs The selection rules have also been designed elaborately to distinguish fully competitive and insufficiently competitive drugs, set the proportion and range of price reduction, and ensure the high quality and low price of the selected drugs At present, the results of 4 + 7 city centralized procurement selection have been officially announced According to the relevant person in charge of Fujian Medical Insurance Bureau, the effect of combined mining is very good It is suggested that the mode be extended to other regions, to all varieties, and to include consumables in the scope of bidding and mining, so as to prevent the emergence of other alternative drugs under the same general name, and to overhead the reform results At the same time, improve the clinical efficacy evaluation after the one-way evaluation, implement the reform of medical insurance payment, and pay by disease, DRGs In addition, the balance can be retained to mobilize the enthusiasm of medical institutions According to the person in charge of the pilot office, there are still a series of supporting works, such as ensuring the enterprise's payment, prepaying 30% of the payment for medical insurance to the hospital, encouraging the direct settlement of medical insurance; establishing the payment standard according to the difference between the bid price and the original research drug; the total prepayment is not deducted, and the balance is left to the hospital At the same time, we should adopt agreement management, strengthen monitoring, ensure the quality of drug supervision department, and ensure the use of health care department, so as not to affect the use of drugs due to the assessment of drug proportion.