Hainan Medical insurance pays the equivalent Chinese price, and the payment price of the evaluated varieties is not higher than the national negotiation price

On October 12, Hainan Province issued the rules for price limit sunshine purchase of drugs (medical consumables) based on the payment and settlement price of medical insurance in Hainan Province (Trial) (Draft for comments) The aim is to further standardize and improve the price limit and sunshine purchasing behavior of drugs (medical consumables) in our province, squeeze the virtual high space of drug (medical consumables) price, and ensure the timely and effective supply of drugs (medical consumables), clinical safety and effectiveness It is suggested that the settlement price and price formation mechanism of medical insurance payment should be clarified Among all kinds of drugs (medical consumables) on the Internet, Hainan will take the "bidding price first" as the basic principle, and purchase drugs (medical consumables) priced by centralized bidding, national designated production, national negotiation and volume bidding will be carried out according to the bid winning (selection) price, and the settlement price of medical insurance payment will also be bid winning (selection) ）The price shall prevail For the drugs (medical consumables) involved in the negotiated drugs (medical consumables) that pass the consistency evaluation of the quality and efficacy of generic drugs, the price shall not be higher than that of the negotiated drugs (medical consumables) of the state and our province; for the drugs (medical consumables) that fail to pass the consistency evaluation of the quality and efficacy of generic drugs, the price of the negotiated drugs (medical consumables) of the state and our province shall be carried out at a discount The following is the original draft of opinions: Hainan province implements the price limit sunshine purchase rules for drugs (medical consumables) based on the payment and settlement price of medical insurance (Trial) (Draft for comments) According to the overall plan for the reform of the medical security system in our province, these rules are hereby formulated to further standardize and improve the price limit and sunshine purchasing behavior of drugs (medical consumables), squeeze the virtual high space of the price of drugs (medical consumables), and ensure the timely and effective supply of drugs (medical consumables), clinical safety and effectiveness 1、 Basic principle (1) adhere to openness and transparency The pharmaceutical bidding and procurement service platform (hereinafter referred to as "bidding and procurement platform") will implement the full disclosure of announcement notice, procurement price, transaction quantity, procurement unit and other information, leave traces in the whole procurement process, enhance the transparency of procurement behavior, expand the supervision of procurement activities, and ensure the sunshine, openness and transparency of procurement （2） Ensure fairness and justice Ensure equal participation and fair competition of Pharmaceutical (medical consumables) production (Marketing) enterprises in different regions and different ownership systems, and prohibit any form of local protection Encourage enterprises to apply for (invest in) lawsuits to ensure fairness and justice in all links （3） Follow the market rules Give full play to the decisive role of the market in resource allocation, closely focus on the center of "medical insurance payment and settlement price as the basis", guide enterprises to improve price competitiveness according to laws and regulations, and enhance the enthusiasm of medical insurance designated medical institutions in price negotiation （4） Bid winning price is preferred Among all kinds of drugs (medical consumables) on the Internet, the priced drugs (medical consumables) such as centralized bidding, national designated production, national negotiation and volume bidding shall be purchased according to the bid winning (selection) price 2、 Basic objective (1) to effectively guarantee supply We will conscientiously perform the government's regulatory functions, ensure the supply of drugs (medical consumables), and reduce the burden on people to use drugs (medical consumables) （2） Promote reasonable prices Under the premise of quality priority, reduce the false high price of drugs (medical consumables) and form a reasonable purchase price （3） Standardize purchasing behavior We will curb violations of regulations and disciplines in the field of drug (medical consumables) procurement and crack down on unhealthy practices in the field of purchase and sale （4） Stimulate market vitality We will promote the reform of "pipe laying service" in the field of drug (medical consumables) limited price sunshine procurement, standardize processes, improve efficiency, and stimulate market vitality 3、 The rules are applicable to the main qualifications and responsibilities of the parties involved in the bidding and purchasing platform, drug (medical consumables) production (operation) enterprises, medical insurance designated medical institutions and other related parties participating in the limited price sunshine purchasing activities of drugs (medical consumables) in our province （1） Bidding and mining platform 1 Qualification: it must have a comprehensive network platform for all kinds of Pharmaceutical (medical consumables) sunshine procurement activities with a complete service system, mainly including online bidding, price limit negotiation, online drug transaction, monitoring and early warning and other services, as well as other capabilities recognized by the provincial medical insurance administration 2 Responsibilities and obligations: be responsible for the basic work of limited price sunshine purchasing enterprises and product qualification review, application price review, etc.; strengthen monitoring and early warning, carry out dynamic monitoring of quality, price and shortage of drugs for enterprises, timely remove the network for the manufacturers with high price or without reason; do a good job of limited price sunshine purchasing, publicity of shortage of drugs and accept the application (investment) of enterprises, etc Work （2） Production (operation) enterprises 1 Qualification of the manufacturer: it has obtained the drug production license, GMP certification certificate and business license according to law, and there are no following circumstances: ① in the last two years (from the date of submitting the online application), it has been punished by the drug regulatory department; ② in the last two years, it has been punished or filed for investigation by the relevant law enforcement department for commercial bribery and promotion of drugs (medical consumables) Situated Other conditions stipulated by laws and regulations The state allows foreign pharmaceutical (medical device) manufacturers to be introduced in Hainan in advance, and the relevant qualifications shall be formulated separately 2 Qualification of the operating enterprise: it has obtained the drug business license (wholesale), GSP certification certificate and business license according to law, and has the ability to guarantee the supply of drugs (medical consumables) necessary for the performance of the contract, without the following circumstances: ① in the last two years (from the date of submitting the online application), it has been punished by the drug regulatory department; ② in the last two years, it has been traded Bribery and promotion of drugs (medical consumables) by relevant law enforcement departments or cases have been filed Other conditions stipulated by laws and regulations The state allows foreign drug (medical device) enterprises to be introduced in Hainan in advance, and the relevant qualifications shall be formulated separately 3 Responsibilities and obligations: Pharmaceutical (medical consumables) production (operation) enterprises shall abide by the relevant management regulations on the production and circulation of Pharmaceutical (medical consumables), ensure the supply of Pharmaceutical (medical consumables) For the varieties that are temporarily unavailable for drug (medical consumables) on the hanging net, the production enterprises shall provide the out of stock description in time to the bidding platform to temporarily remove the net until the supply is normal The declaring enterprise shall strictly fulfill its self-promise of the lowest price for hanging on the Internet, be honest and trustworthy, be responsible for the declaration and results of the declared quality, hanging price and transaction price of drugs (medical consumables), and promote the orderly operation of drug (medical consumables) bidding and purchase （3） Designated medical institutions for medical insurance 1 Qualification: obtain the approval for setting up medical institutions and the practice license of medical institutions according to law, meet the basic conditions for performing the functions of medical institutions stipulated in the regulations on the administration of medical institutions and its implementation rules, have signed the agreement on designated medical institutions for medical insurance, and have other conditions stipulated by laws and regulations 2 Responsibilities and obligations: be responsible for applying for regular statistics of the ordering and standardized use of the unit's purchase volume, reporting the actual purchase price of drugs (medical consumables), and commenting on the prescription of drugs (medical consumables) with high price and abnormal consumption; timely feedback to the Provincial Medical Security Bureau in case of any abnormality, and include it in the key monitoring; according to their own functional positioning and clinical drug demand, combine To put forward the purchase demand of drugs (medical consumables) 4、 Medical insurance payment settlement price and price formation mechanism (I) medical insurance payment settlement price of drugs (medical consumables) The payment settlement price of medical insurance refers to all expenses paid by the basic medical co-ordination fund and the insured The settlement price of medical insurance payment in designated medical institutions shall be determined through dynamic adjustment, and the settlement price of medical insurance payment shall be made public in time The payment and settlement price of medical insurance of designated medical institutions shall be in accordance with the following standards: 1 Drugs (medical consumables) winning the bid through centralized bidding The payment and settlement price of medical insurance shall be subject to the bid winning price, and the bid winning price shall be applied to the Internet 2 Drugs (medical consumables) designated by the state The payment and settlement price of medical insurance shall be subject to the price of drugs (medical consumables) manufactured by the state designated by the bidding and purchasing platform 3 National and provincial negotiated drugs (medical consumables) The payment and settlement price of medical insurance shall be subject to the price of negotiated drugs (medical consumables) on the bidding and purchasing platform For the drugs (medical consumables) involved in the negotiation, the price of the drugs (medical consumables) shall not be higher than that of the negotiated drugs (medical consumables) of the state and our province; for the drugs (medical consumables) that fail to pass the evaluation, the price of the negotiated drugs (Medical consumables) of the state and our province shall be reduced 4 Drugs (medical consumables) purchased by the state and our province The settlement price of medical insurance payment shall be subject to the selected price determined by relevant documents of volume purchase 5 Drugs (medical consumables) directly linked to the net The payment and settlement price of medical insurance shall be subject to the actual purchase price after negotiation between the medical institution and the pharmaceutical (medical consumables) production (operation) enterprise, but shall not exceed the price dynamically adjusted by the bidding platform every half a year, and the price declared and linked by the enterprise; for the clinically necessary or irreplaceable pharmaceuticals (medical consumables), the medical institution can temporarily record in the emergency procurement module of the bidding platform Purchase, bidding and purchase platform shall evaluate the price of the recorded purchase, and timely announce whether to adjust the price 6 The payment and settlement price of medical insurance drugs (medical consumables) of the troops stationed in Hainan and non-public medical institutions shall be executed with reference to the payment and settlement price of medical insurance of designated medical institutions （2） Inquiry and price negotiation All designated medical institutions and pharmaceutical (medical consumables) manufacturers need to log in the inquiry and price negotiation system of the bidding and purchase platform to negotiate their own prices After the price negotiation results are confirmed by both parties, they need to file with the bidding and purchase platform before purchasing The negotiated price is only valid for the designated medical institutions If other designated medical institutions want to purchase, they still need to negotiate on their own （3） Price tips The bidding and procurement platform will promote and guide the implementation of inquiry and price negotiation in the way of "information push, green line reference, yellow line reminder, red line locking" According to the method of "variety classification hanging net, price negotiated transaction", set the red, yellow and green line price prompt 1 Information push The bidding and purchasing platform will push the national purchase price of the drug (medical consumables) to the medical institutions, the result of price negotiation (including the lowest price, average price and highest price) in the medical institutions of the province and the result of price negotiation (including the lowest price, average price and highest price) in the medical institutions of the province for the same kind of drug (medical consumables) 2 Green price area (green area): the green area is the area between the green line and the yellow line The green line is the lowest price of medical institutions and the lowest purchase price of the drug (medical consumables) 3 Yellow price area (yellow area): the yellow area is the area between the yellow line and the red line Yellow line is the original bid price or online price If the negotiation result is higher than yellow line, the system will automatically remind 4 Red price area (red area): the red area is the area with red line and above For the drugs listed in the catalogue of drugs on the market in China that pass the consistency evaluation of quality and efficacy and the imitated drugs approved according to the new registration classification of chemicals, the red line corresponds to the highest price of the original research drugs; for other drugs that fall within the scope of direct online public price negotiation, the red line corresponds to the national average price (refers to the average value of the highest price and the lowest price) The bargaining result is higher than the red line, the system is locked in bargaining, and the bargaining result cannot pass the validation Drugs (medical consumables) that have been included in the list of drugs in clinical shortage shall be purchased through special channels The bidding and procurement platform will summarize the information and sort it out on a quarterly basis, and regularly