It is an inevitable trend that the purchase of the second tire will be expanded to reduce the drug price at one's own expense

"4 + 7" volume procurement and subsequent expansion, 25 pilot varieties are all drugs listed in the national medical insurance catalog Among the 35 varieties purchased in the second round, there have been many drugs not listed in the national medical insurance catalogue In addition to expanding the scope and expanding the varieties with volume procurement, the policy objectives are becoming more and more prominent in all provinces and cities, not only reducing the financial burden of medical insurance through volume for price, but also exploring a new mechanism to reduce the drug price through volume procurement bidding On December 6, 2019, just one year before the first "4 + 7" volume procurement, the joint procurement office announced that the second round of volume procurement officially entered the critical countdown by convening more than 100 related enterprises to hold a symposium Half a month to two months later, the second round of bidding will be launched, and 35 varieties of volume reported by medical institutions previously circulated on the Internet have also been confirmed as the second round The final products with expanded purchasing capacity It is worth noting that the number of purchased varieties of the second wheel amount is not only 10 more than that of the first wheel amount, but also has a great change in the nature and structure of the varieties Compared with the two versions of the national medical insurance catalog in 2017 and 2019, it can be found that the first round of "4 + 7" and the subsequent expansion of the procurement volume of 25 pilot varieties are all drugs in the national medical insurance catalog, but This means that the influence of volume purchase, which was originally intended to reduce the pressure of national health insurance funds by volume for price, is spreading beyond the national health insurance catalogue after being included in the pilot of self funded drugs This paper analyzes the situation of the purchase of 35 pilot varieties of the second tire quantity, among which 5 varieties are self paid drugs not included in the national medical insurance catalog in 2017 Among these five varieties, solanesin has been included in the national health insurance regular catalog adjustment in 2019, and acarbose has finally entered the national health insurance catalog in 2019 through drug price negotiation, Among the five varieties, solina was successfully included in the 2019 new national health insurance regular catalogue in August this year after a series of expert evaluations According to the relevant data, the number of original research drugs has reached 4 through the consistency evaluation After entering the second tire purchase, the price competition will be fierce Acarbose is facing a more severe situation than solina new, and it also suffers from the double policy impact of the national health insurance drug price negotiation and the new round of national volume purchase In the new round of national health insurance negotiations, acarbose has successfully entered the new national health insurance catalog Although the negotiated price of acarbose for medical insurance is still in a confidential state, the recent change of online drug information announced by Yunnan drug centralized purchase platform on December 3 shows that the price of acarbose chewable tablets (50mg) produced by Hangzhou Zhongmei Huadong Pharmaceutical Co., Ltd has changed, from 2.6877 yuan / tablet to 1.1 yuan / tablet, a decrease of 59.11% Acarbo's glycogen research pharmaceutical company is Bayer, and only two domestic pharmaceutical companies, East China Pharmaceutical and LVYE pharmaceutical, have passed the consistency evaluation of generic drugs According to the terminal data of the city public hospital of minenet, Bayer accounts for 69% of the market share of acarbose, China, the United States and East China account for 26%, and Sichuan LVYE Baoguang pharmaceutical accounts for 5% According to the annual report data of listed companies, the sales revenue of acarbose in East China medicine in 2015 was more than 1 billion yuan, that in 2016 was more than 1.5 billion yuan, and that in 2017 was more than 2 billion yuan At the same time of entering into the national health insurance price negotiation, acarbose has entered into a new round of national pilot procurement of 35 varieties with volume, indicating that the relevant policy level has further price reduction expectations for the diabetes drug acarbose, and acarbose also faces greater price reduction pressure In addition to acarbose and solanesin, adefovir dipivoxil, tadalafil and enrisentan are all self funded drugs, which means that the war of volume purchase has extended to the price of drugs outside the national health insurance catalog Adefovir dipivoxil is used for hepatitis B According to the data of minenet, the total market of anti HBV drugs in China has reached 15 billion yuan in 2017 In terms of market share of various varieties, entecavir accounts for 67.25%, adefovir dipivoxil accounts for 11.97%, lamivudine accounts for 9.36%, telbivudine accounts for 6.47%, and tenofovir dipivoxil accounts for 4.96% Adefovir dipivoxil has formed the "1 + 2" pattern of original research and local generic pharmaceutical enterprises, and the price fight among them will undoubtedly be very fierce Tadalafil is an anti ed drug In the domestic market, because tadalafil entered China late and was not well known by Chinese people, the main share of the market of anti ed drugs is still occupied by the original foreign drug sildenafil and domestic sildenafil generic drugs In 2017, the overall market size of PDE5 inhibitors for ED drugs in China reached 2.994 billion yuan, including 2.23 billion yuan for sildenafil and 739 million yuan for tadalafil Tadalafei has not been included in the national medical insurance catalog, and is also a prescription drug that can be purchased in retail pharmacies The original research pharmaceutical enterprises are Lilly There are three domestic imitated pharmaceutical enterprises with consistency evaluation, namely Qilu, Zhengda Tianqing and Changchun Haiyue Four of them are engaged in fierce price fight Whether they will also affect the drug prices of retail pharmacies and other channels is worthy of attention While alisentan was used for pulmonary hypertension The sales volume of primary research of alisentan tablet, a pulmonary hypertension drug, is close to US $1 billion a year However, due to the expiration of GSK and Gilead patents and the high price, the sales volume of domestic public hospitals of alisentan is only RMB 310000 according to the data of minenet However, only two of the domestic manufacturers, Allison Tanzania, have been listed and passed the consistency evaluation On December 13, 2018, Jiangsu Haosen anlishentan was listed and deemed to have passed the consistency evaluation On May 9, 2019, Zhengda Tianqing anlishentan was listed and deemed to have passed the consistency evaluation Shortly after the two domestic generic drugs went on the market, Allison Tanzania entered into the volume purchase, which also prompted that the volume purchase is not only to start with the expired original research drug varieties that have been on the market for a long time, some varieties just after the patent period may soon encounter volume purchase, and China's "patent cliff" will accelerate under the help of volume purchase It is worth noting that although the key policy intention of volume purchase at the initial stage is to reduce the drug expenditure in the national medical insurance catalog and reduce the financial burden of the national medical insurance, with the gradual maturity of the relevant experience of volume purchase, volume purchase is also becoming a new mechanism to regulate and manage the drug price, and the pilot projects in various provinces and cities are blooming everywhere In March last year, the dust of "major reform" of state institutions was settled, and the "one in four" National Health Insurance Bureau came into being The newly established state health insurance bureau has merged the basic medical insurance and maternity insurance responsibilities of the Ministry of human resources and social security of the people's Republic of China for urban workers and urban residents; the new rural cooperative responsibilities originally belonging to the health and Family Planning Commission; the medical assistance responsibilities of the Ministry of civil affairs; the price management of drugs and medical services of the development and Reform Commission; the bidding and purchasing responsibilities of drugs and consumables; the right to supervise the medical service behaviors and charges of medical insurance; and the right to levy them at the same time The responsibilities of medical insurance and maternity insurance expenses shall be assigned to the tax department The second round of belt purchase is included in self paid drugs, which means that the state health insurance bureau is not only reducing the unreasonable high price of drugs in the national health insurance catalog by means of belt purchase, but also exploring a new way of drug price management by means of belt purchase to assume the responsibility of drug and medical service price management of the development and Reform Commission in the past On November 29, 2019, the leading group of the State Council for deepening the reform of the medical and health system issued a notice on several policies and measures to further deepen the reform of the medical and health system with the breakthrough of centralized purchase and use of drugs It was also emphasized that for drugs not included in the scope of centralized purchase and use of national organizations, all regions should rely on the provincial centralized purchase platform of drugs and learn from the national drug collection China's experience in purchasing and using drugs has taken the form of individual or cross regional alliance to intensify reform and innovation in the scope of purchasing drugs, shortlisted standards, centralized purchasing forms, etc., so as to form a work pattern of mutual promotion between the state and local governments At the same time, the notice encourages the exploration of group procurement, joint procurement of specialized hospitals, and joint procurement of medical treatment to form reasonable prices, and encourages the active participation of non-public medical institutions and social pharmacies to jointly promote the formation of a market-oriented drug price formation mechanism.