Intensive, diversified and large-scale Guangdong Province has set a "five-year plan" for drug procurement

Pan Shilin recently, the Guangdong Provincial Medical Security Bureau issued "guidance on doing a good job in the procurement of pharmaceuticals and medical supplies" (the following body is referred to as "Opinion"), proposed that by 2025 to basically achieve the standardization, institutionalization and normalization of the procurement of pharmaceuticals, medical supplies, to form a fair, transparent, convenient and efficient public procurement market environment, and put forward 9 specific reform measures, including the realization of the procurement model of 3 changes, promote the procurement mechanism of 3 kinds of coordination, strengthen the procurement behavior of the three kinds of supervision.
Opinions" reflect three bright spots: "intensive" procurement, exploring regional alliances, medical associations, medical associations, hospital unions and other ways to carry out group procurement;
Industry insiders said that the reform in Guangdong Province has improved the procurement model, promoted policy coordination, strengthened the supervision of procurement behavior, can gradually build a fully competitive, reasonable price, standardized and orderly drug supply guarantee system, for other provinces to carry out group procurement provides experience and set a model.
three changes in the procurement model proposed in guangdong Province's Opinions to achieve the procurement model of the three changes, including the comprehensive development of group procurement, orderly implementation of centralized volume procurement, the independent procurement of specific varieties.
means that in Guangdong Province, GPO will be the main group procurement.
China Health Information and HealthCare Big Data Society, a member of the Chinese Medicine Special Committee, medical practitioner Qi Zhengwei on this analysis, said that the Shenzhen GPO can be traced back to June 2016, Guangzhou GPO launched in June 2018, after these years of operation, can be said to have accumulated a lot of valuable experience, therefore, in Guangdong Province to carry out GPO as the representative of the group procurement has sufficient conditions.
and compared with "with volume procurement" and "autonomous procurement of specific varieties", group procurement represented by GPO can maximize the coverage of clinical varieties currently used in public medical institutions, through regional price linkage and the coordination of medical insurance expenditure standards, a wide range of drug procurement prices in Guangdong Province.
This newspaper's special observer Gu Pioneer focused on the analysis of Guangdong Province's GPO Group procurement and the national level of "concentrated volume procurement" similarity and differences: "GPO as the representative of the group procurement model, the core of which is based on the group-based bulk demand as the premise, through the volume-for-price procurement ideas, to achieve the purpose of reducing drug prices, and the essence of national volume procurement is the same."
However, the national volume procurement is currently mainly aimed at the products through consistency evaluation, based on the projected demand of public hospitals (the sum of the local volume), and the GPO is the 'quantity price linkage, recruitment, group procurement' model.
In addition, the main body of GPO Group procurement in Guangdong Province is all public hospitals in Guangdong Province, the variety covers the whole, but because of the different bidding methods, so the price reduction is very different from the national collection, and the main body of national volume procurement is the national public hospital, the variety is part of the over-rated products, the use of mutual bidding, limited number of selected game mode, so the price fell more thoroughly.
" in the comprehensive development of group procurement at the same time, the Opinion also proposed in batches of steady and orderly implementation of centralized volume procurement.
, how to balance the relationship between "concentrated volume procurement" and "group procurement" to minimize adverse effects on the enterprise? Gu said that the first should focus on centralized volume procurement, because this is the national level procurement policy, local policies should be subordinate to national policy.
such as the formulation of price adjustment mechanism, each time after the results of the national collection and selection announced, timely changes in the province's platform selected enterprises and prices, shielding the same variety of other winning enterprises.
The National Health Insurance Administration also needs to notify the provincial health insurance departments at the first time after each round of national collection results, timely adjustment of relevant data, so that the local health insurance departments have a time window for data adjustment.
Qi Zhengwei said that the two can be said to complement each other.
After all, the national volume procurement covers a limited number of varieties, so far only 111 varieties, and mainly for the original drug (expired) and through the consistency evaluation of generic drugs, and the formation of three or more competitive situation, so "imitation alternative to the original research (expired)" means more obvious.
GPO Group procurement is mainly for a wider range of clinical varieties, especially large dosage, high proportion of medical insurance amount of varieties, can cover chemical drugs, traditional Chinese medicine, oral dosage form, injection type, external dosage form.
therefore, as a provincial procurement platform, should concentrate on doing a good job in the procurement of drugs outside the national collection.
so for enterprises, the access and procurement path of clinical drugs is becoming more and more clear, over-evaluation and the formation of a competitive pattern of participation in national collection, the rest of the drugs to participate in provincial group procurement.
The Opinion also points out that medical institutions may negotiate the purchase price in accordance with the principle of fairness and determine the purchase price, and negotiate the purchase price independently within 5% of the total annual procurement amount, for the shortage of varieties on the procurement platform, emergency approval or emergency shortage varieties for public health emergencies, no actual transactions or other reasons leading to procurement difficulties and clinical necessity, and very little clinical use.
"autonomous bargaining" to ensure the fairness of both sides? Qi Zhengwei said that the principle of ensuring fairness is to meet the production enterprises do not lose money, at least a small profit.
For medical institutions, the quantity and unit price of the drugs in short supply may be approved within the range of 5% of the total amount purchased each year, and the production enterprises can communicate and negotiate with the medical institutions by accounting for the unit price under the minimum production quantity according to production and operating costs.
that as long as the acceptable conditions are met, the fairness of the transaction is guaranteed.
Gu Pioneer also analyzed that the scope of "autonomous bargaining" is determined within 5% of the total procurement, that is, in order to reduce the risk of the use of health insurance funds, the policyholder is a fair;
To promote the policy coordination of the procurement mechanism in terms of policy coordination, the Opinion proposes "to improve the coordination mechanism between the centralized purchase price of drugs and the payment standard of medical insurance, to focus on the purchase of drugs with the selected price as the payment standard, and to encourage non-selected enterprises to take the initiative to reduce prices".
"to the selected price as the payment standard" will be selected generic pharmaceutical enterprises, non-selected generic pharmaceutical enterprises, and the original research enterprises how to affect? Qi Zhengwei analysis, this will become an effective measure to restrain the price of non-selected products, that is, whether or not the drug is selected in the future, in accordance with the selected price as the standard of medical insurance payment, can be said to be from the system to regulate the price of drug sales.
in the past, non-selected products lack the initiative to reduce prices, and now through regional price linkage and health insurance to pay the price of the unity, so that the same drugs can only return to the same price.
this poses a greater challenge to non-winning products and enterprises, and as group procurement in each province advances, these enterprises have the opportunity to seize the existing stock market for differentiated games.
and selected enterprises can use good selection opportunities, through cost reduction, price exchange, the pursuit of economies of scale.
original research enterprises can according to their own development strategy, choose to give up the collection market, or price-for-volume efforts to win.
added that the country's production procurement of both generic pharmaceutical companies, as well as original research enterprises, such as Bayer's Akapo sugar tablets.
to the provinces and cities of the price (not necessarily exactly the same) as the price of health insurance payment, non-selected enterprises do not have the amount of support, obviously at a disadvantage.
These enterprises can reduce the cost and efficiency at the same time, according to their actual costs and market network in Guangdong, and refer to the product in Guangdong's selected price, to measure their own affordable cost space, and then decide whether to participate in the competition, and how to compete.
Opinion also proposed to speed up the settlement of the purchase price.
Actively promote the direct settlement of purchase prices between medical insurance funds and pharmaceutical enterprises, establish a performance guarantee system for special accounts for procurement and settlement, and withdraw a certain percentage from medical institutions' medical insurance settlement funds and advance working capital to be allocated to special settlement accounts, specific for the settlement of loans.
fact, the issue of payment settlement has always been a difficult problem in the field of pharmaceutical bidding.
said that this time Guangdong Province proposed a direct docking of health insurance funds and pharmaceutical enterprises, can avoid the intermediate link may cause interception, reduce the ideological burden of enterprises in bidding.
, however, the following obstacles need to be overcome in implementation: 1. Information docking difficulties.
Because the drug sales process, from the hospital orders, to enterprise distribution, to hospital receipts, broken returns, etc. , is a dynamic process, now the health insurance department and production enterprises directly docking, need data support, how to ensure timely and accurate data transmission, is a problem that must be solved.
2. Resistance by interested parties.
At present, the hospital intercepts and misappropriates the enterprise's money is a very common phenomenon, if the capital chain is cut off, the operation of the hospital may be a problem;
in accordance with the Guangdong Provincial Opinion, directly cut off hospitals and businesses to control the funds, weakening their funds to flash the space, so the resistance of the parties involved can be expected.
The simplest way to solve this problem is to implement information-based full-path management, requiring commercial enterprises and hospitals to timely transfer procurement, storage, sales, returns and other information, and to clarify the relevant responsibilities and incentives and punishment measures.
will ensure that the health care sector to pay for the safe, timely and accurate.
opinion also stressed that medical institutions and pharmaceutical production enterprises or circulation enterprises settlement and repayment time does not exceed 30 days.
Sealth this may seem good on the surface, but in fact we all know that this is an old problem, "opinion" also only stressed that "not according to the contract supply, not on time payment of goods and other breach of contract, regularly informed in the province-wide."
how binding is this on the payment terms of medical institutions? Qi Zhengwei believes that there may be limited binding force on medical institutions.
because under the current market mechanism, hospitals have a great say.
If we want to fundamentally solve the problem of hospitals defaulting on the purchase price of pharmaceutical enterprises, we also need to continue to explore, such as medical insurance drugs are all settled by the medical insurance bureau to enterprises;
Pioneer also said, in fact, only need to strictly implement the State Council issued earlier "to protect small and medium-sized enterprises payment regulations", the regulation issued by the authority of the department, the severe punishment means, are unprecedented.
In addition, other relevant documents of the State Council also have clear penalties for hospitals for defaulting on payments, such as directly restricting their medical insurance funds, paying overdue interest, including credit information in the national credit information sharing platform, and punishing public hospital supervisors and officials in accordance with the law.
said he believed that after the implementation of these measures, hospitals can significantly improve the phenomenon of delays in payment of payments.
as the frontier province of reform and opening-up, Guangdong Province's "Opinion" issued this time is undoubtedly very forward-looking and implementable, far-reaching significance.
said, first of all, based on high distance.
its guiding ideology and overall requirements are to promote the procurement platform from price-oriented to value-oriented, from passive service to active service, from simple transactions to supply chain services, which is a great progress.
second, dare to face difficult problems, such as fee settlement, shortage or urgent need for medicine self-procurement.
is the continuity of policy.
compared to the previous quarter or even once a month tender frequency, this given five-year unchanged bidding policy, to the bidders ate a heart-stopping pill, which can promote pharmaceutical companies in the Guangdong market to do a longer period of layout.
Qi Zhengwei also said that guangdong Province's Opinions have improved the procurement model, promoted policy coordination, strengthened the supervision of procurement behavior, and can gradually build a fully competitive, reasonable price, standardized and orderly drug supply guarantee system, for other provinces to carry out group procurement provides experience and set a model.
, of course, there may be areas for improvement in the Opinion.
E.g., in the Group procurement model, the lack of price competition under the same standard between generic drugs and expired original drugs, the lack of price competition under the same standards between generic drugs, in addition, procurement and payment synergies due to deep-seated problems, there may be a lot of resistance, not a document can be resolved, but also need to be gradually cracked and explored."
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