Health insurance fund to guide the reform of the pharmaceutical supply side to completely eliminate the drug priceins falsely high "persistent disease"

Author. Pan Shilin recently, the "State Council General Office on the promotion of the reform of the system of supervision of the medical security fund" (state office issued (2020) No. 20) (the following text is referred to as "Opinion") was officially released.
this is the first national level of the health care fund regulatory documents.
The Opinions put forward specific requirements for comprehensively improving the ability of medical insurance governance, operating environment of the deep purification system, and strictly guarding the fund safety red line, from the aspects of general requirements, clear supervision responsibility, promotion of reform of the regulatory system, improvement of safeguardmeasures and work requirements.
", in the "perfect safeguard measures", put forward, jointly promote the reform of the pharmaceutical service system, deepen the reform of the supply side of pharmaceutical services: constantly improve the market-oriented drug, medical supplies price formation mechanism;
industry insiders said that under the guidance of the health insurance "command inglis", the structural reform of the pharmaceutical supply side will usher in a breakthrough, the drug price is also expected to break the "persistent disease", the entire pharmaceutical industry will form a pyramid-type industrial structure, a small number of innovative pharmaceutical companies occupy the spire, share considerable profits, and most of the ordinary generic drug enterprises crowded at the bottom of the tower, can only earn some "hard money."
to improve the market-led price formation mechanism. Medical observers: First of all, please talk about the State Council level issued "opinion", for the promotion of pharmaceutical supply-side reform of the significance of what? Wang Zhenlin: The State Council issued the Opinion, which states that it is the top-level design, is the implementation of the work requirements of the CPC Central Committee and the State Council on strengthening the supervision of the medical insurance fund, which is of great significance for comprehensively improving the ability of medical insurance governance, the operating environment of the deep purification system, and strictly guarding the safety red line of the fund; The medical security fund is the people's "medical money" and "life-saving money", adhere to the bottom line of the medical coverage of the public has practical significance, in order to build the medical insurance fund strong supervision system and strict law enforcement system, to achieve the medical insurance fund supervision and rule of law, specialization, standardization, normalization, and in social practice and supply-side reform in the continuous development and improvement has far-reaching historical significance.
Tu Honggang: The quality and efficiency of medical service supply are related to the effective use of medical insurance funds.
therefore, high-quality health care system depends not only on the reform and optimization of the system itself, but also closely related to how to promote the supply side of medical services and the supply side of medicine through medical insurance.
the "Opinion" issued at the level of the State Council can be said to have made a top-level design for the supervision of the medical insurance fund, pharmaceutical enterprises as the source of the supply system, medical institutions as the provider of medical services, are included in the comprehensive scope of supervision.
through the reform of medical insurance, guide and adjust the allocation of medical resources, lead pharmaceutical enterprises and medical service system soriented value, establish the hospital "cost control profit" mechanism, on the basis of ensuring quality, improve capacity for the insured to provide the most appropriate services to improve health. Li Shiqiao,
: Since 2015, China has been promoting the reform of the supply side of medicine, in the research and development, production, consumer have taken a series of measures, but also achieved very great results.
the reform of the supervision of the health insurance fund mentioned in the Opinion, it is also further hope that the reform of research and development and production side should be promoted from the consumer side, and the research and development and production of pharmaceutical companies should be guided by clinical value, and finally promote the transformation and development of China's pharmaceutical industry to innovation, from "pharmaceutical power" to "pharmaceutical power".
Wei Baixing: "Opinion" in improving the national health insurance governance capacity, strictly adhere to the fund security red line, to protect the people's "life-saving money" and so on have a very important significance.
Pharmaceutical Observer: "Opinion" put forward: and constantly improve the market-oriented drug, medical supplies price formation mechanism.
now, the state, provinces, local municipal organizations at all levels of drug centralized volume procurement, is the real sense of "market-oriented" price formation mechanism? What aspects of this mechanism can be improved? Tu Honggang: The procurement of drugs organized by all levels of government is generally adhere to the principle of combining market mechanism and government role, whether to participate in collection, and to participate in the procurement of quotations, by enterprises in accordance with the production and operation of the independent decision. In addition,
, the current collection of prices and procurement volume linked, "quantity-for-price" so that the health care sector with centralized procurement rights have a greater pricing voice.
in the process of the promotion of volume procurement, procurement rules are also being revised and perfected, and constantly approaching the market mechanism.
such as the second batch of volume procurement and the "4 plus 7" at the beginning of the implementation of the "exclusive choice" and "lowest price selection" is different, the second batch of collection exploration to improve the market-led drug price formation mechanism, the use of bidding procurement model, and maintain a moderate competitiveness. wang Zhenlin,
: At best, semi-marketization, can not be a real sense of the market-oriented mechanism, after all, is the government-led "belt" as "bait" price negotiation mechanism, rather than enterprise independent pricing.
perfectthet "market-oriented" price formation mechanism needs to be considered from the following aspects: First, focus on market-oriented.
enterprises need to market demand as the center of the arrangement of production and business activities, do not be blind, do not be too optimistic. The second
is to start with the relationship between drug supply and demand.
must be in the process of competition with supply and demand interrelation, mutual constraints of the market price formation and operating mechanism, supply and demand determine the market price. The third
is to pay attention to the price adjustment mechanism.
this adjustment mechanism is the most sensitive and effective means of adjustment in the market mechanism, and price changes will have a very important impact on the entire pharmaceutical industry.
changes in drug prices will lead to changes in supply and demand, which in turn lead to price fluctuations.
Li Shiqiao: The state and provinces of the belt procurement, to reduce drug prices, reduce the pressure of health insurance funds has played a very big role, but whether the real sense of the "market-led" price formation mechanism is debatable.
the true sense of "market-oriented", the government's intervention should be less, must be the behavior of market subjects mainly, the government only establish fair competition rules, and combat monopoly, put an end to the operation of the dark box, reduce public hospitals "drug-based medicine", establish a unified standard of medical insurance payment standards and a unified drug procurement platform.
But because of the complex national conditions of our country, reform can not be achieved overnight, the current exploration is still worthy of affirmation.
Wei Baixing: Strictly speaking, the government-led purchase of volume is not a market behavior.
if the follow-up or simple practice, the individual believes that the price mechanism to form a disadvantage, or for a long time to form an effective price mechanism.
in fact, the Government only needs to do a good job of supervision, the rest of which can be handed over to the market.
medical observers: According to media reports, the third batch of national collection will soon land, in August will enter the quotation link.
please for the pharmaceutical enterprises to pay a trick, compared to the first batch and the second batch of national mining, pharmaceutical companies to participate in the third batch of national mining, in the quotation should consider what factors? What strategies can you take? Tu Honggang: the third batch of volume procurement to be included in 86 product regulations, involving the original research enterprises 24, domestic "over-rated" enterprises more than 140, the same product over-evaluation of the most up to 27, price killing is inevitable.
the experience of the previous two groups of countries, the third batch occupies the market-led original research drug will face a huge impact.
domestic leaders should also be wary of the more than expected bid from multinational pharmaceutical companies, to avoid a momentary and unexpected out of the game.
from the industry spread the new health insurance regulations, the health care sector will be health insurance payment and volume procurement combined, combined with DRG and other health insurance payment method reform measures, through the total budget, balance retention way, to maximize the use of medical institutions more selected drugs, non-selected products in the hospital market will be "more than the same."
For pharmaceutical companies participating in the bidding, non-selected products and non-original research products will basically withdraw from the clinical market.
the future volume procurement will become normal, enterprises need to their own stock of products for the overall planning and classification, based on different sales channels for different strategic choices.
Wang Zhenlin: According to industry sources, the third batch of national rules will be slightly adjusted, including the quotation of a number of enterprises involved, the price exceeds the minimum price of 1.8 times directly triggered the elimination mechanism, may be further adjusted to more than the minimum price 1.5 times automatic exit.
this will invisibly increase the pressure on the company's quotations.
, therefore, the most should be considered in the third round of national competition is the first entry, can not be shortlisted, everything equals zero.
adopted the strategy is no more than in accordance with the second round of experience, in the identification with the enterprise's lowest price procurement of drugs within 1.5 times the price of the quotation.
otherwise, it is likely to touch a one-time fuse of the elimination mechanism, which in turn led to the sale before the out.
Li Shiqiao: From the trend, the third batch may appear the situation of the original research drugs and generic drugs short-term soldiers, multinational pharmaceutical companies in the quotation will certainly make a lot of effort, according to the experience of the first two batches, they will reduce prices by at least 60%-70%.
, therefore, generic drug enterprises must seriously study the original research enterprise's quotation strategy, combined with its own characteristics, cost advantages, as well as in the market positioning, give a rational and reasonable price, not vicious price reduction.
because the purpose of collection is not to let enterprises have no way to develop, but to reduce the inflated drug prices, reduce sales costs, so that enterprises spend more on research and development and innovation.
Wei Baixing: The strategy of pharmaceutical companies is: excellent quality, reasonable profits.
medical observers: now participate in the volume of procurement is mainly public medical institutions, private medical institutions and drugstore industry participation is not high, the main reason is what? Should these two areas follow the example of public medical institutions for volume procurement? Tu Honggang: The second batch of national mining changed the previous practice of supplying only low-cost drugs to pilot public hospitals, allowing health insurance fixed-point private hospitals, medical insurance fixed-point retail pharmacies to voluntarily participate in the provincial procurement alliances.
so, it's not the low level of participation, but the inparticipation.
in the future, if private medical institutions and pharmacies do not participate in the volume of procurement, due to some drug prices more expensive than public hospitals and lose competitiveness, the situation is even more difficult.
this is not conducive to the establishment of multi-level medical services market, nor conducive to effective market competition.
we all participate in the volume procurement, share low prices, can eliminate the drug price difference between different agencies.
in fact, the drugstore collection is fully spread the momentum, there are now 13 provinces and cities, including Guangdong, has issued a detailed retail pharmacy to participate in the volume of procurement documents. Wang Zhenlin,
: Most of the public hospitals have completed the expansion of capacity, now the state requires public hospitals to return to public welfare, public hospitals have financial support, as well as their own technology and equipment upgrades, do not need to work drugs, but rely on the level of medical care to win trust and income.
, the refore, now the main participation in the volume procurement is the public hospitals.
private hospital is also the purpose of saving the dead and wounded, but after all, is for profit, and the state strictly limits the price, these drugs in the private hospital or micro-profit, or no profit to say, so, the private hospital to follow the public hospital with the initiative of procurement, even if involved in the procurement of some drugs, but also as a facade.
as for the pharmacy industry, drug business is the main business, if not profitable or small profits, can not support the operation, unless the health insurance bureau according to sales to give adequate subsidies, otherwise, it is difficult for pharmacies to follow the public hospital to carry the volume of procurement, because no one is willing to act as a "drug porter."
Li Shiqiao: At present, the volume of procurement is still a way to explore, public hospitals of drugs and supplies accounted for a largeproportion proportion of the cost of health insurance funds, so the first step to choose public hospitals to carry out the belt procurement pilot.
follow-up, with the unification of medical insurance payment standards, private medical institutions and pharmacies will certainly also participate.
the future, whether it is public hospitals, or private medical institutions and pharmacies, will be to control fees to benefit, enhance their market position in the value of medical care.
Wei Baixing: In fact, the least active participation in the purchase should be the public medical institutions, it is under the government's mandatory participation, is the government-led behavior.
to improve the mechanism of linkage between medical insurance payment and bidding and procurement prices.
How do you think the two should be "linked"? Now, is it feasible that some places are exploring the medicare payment standard gradually docking the winning bid? Wang Zhenlin: The combination of medical insurance payment and bidding and procurement price must be based on fairness and fairness.
the provinces to implement the premise of price linkage, fully learn from the national volume procurement practice, to volume for price, rather than simply low prices for lower prices, no procurement volume, distribution volume, return amount of guarantee, enterprises will be in the amount of procurement of varieties lost a mess, and finally will appear the enterprise exit mechanism of the embarrassing situation.
in short, it is not desirable, feasible, and has no future to reduce the purchase price.
provinces in the price linkage on the basis of the state to combine the requirements of the national medical insurance payment standards and take into account the "red line price", to develop the standard of medical insurance payment.
taking into account factors such as drug price decline, drug indications, etc., in the absence of increasing the larger personal burden of the insured personnel, the proportion of individual pay-out, according to the differential price rules, to the enterprise appropriate lying aside a part of the profit space.
, the non-selected drugs of the selected drugs and the manufacturers' different refined dosage forms, specifications and packaging shall be adjusted according to the price difference ratio of the selected drugs;
Tu Honggang: From the current trend, whether it is national negotiations or volume procurement, and health insurance payment standards began to play a synergy.
. Exclusive drugs are determined by means of medical insurance access negotiations in order to establish a bridging mechanism between the drug catalogue access and the standard of payment of medical insurance drugs; 2. 2. Non-exclusive varieties determine the payment standard through centralized tape procurement, access bidding, etc., in order to establish a collaborative mechanism between the standard of medical insurance payment and the price of the centralized drug collection procurement.
as far as some places have introduced health insurance payment standards and the cost of procurement of the policy, because the local and central understanding is not completely consistent, coupled with the network flat.