National action to remove the high drug price cancer "with gold sales"

Medical network may 25 news what goods can be in the virtual high dozens of times the price can still continue to sell? < br / >In January this year, at the opening of the second batch of "centralized procurement of drugs organized by the state" (hereinafter referred to as "procurement with quantity"), Bayer, a German pharmaceutical company, reported a "fracture price" of 5.42 yuan per box, less than 1 / 10 of the original priceThe drug, originally developed by Bayer, has occupied the first market share of diabetes medicine in China for many years since it entered China in 1995< br / >In the first batch of pilot procurement, a bid winning enterprise of entecavir, a commonly used hepatitis B drug, reduced the price from 310.8 yuan to 17.36 yuan< br / > < br / > on March 18 of this year, the state health insurance bureau issued the letter on actively and steadily promoting the implementation of the second batch of national organization drug centralized procurement results, and the provinces successively issued documents to clarify the implementation of the results of the selection before the end of April, and patients from all over the country will use the drugs with high prices in successionAccording to the industry research report released by < br / > < br / > ey, in 2018, the market scale of China's < br / > market reached $137 billion, which has become the second largest drug market in the world, but the drug price is still highThe disbandment of the abnormal combination of "big country and expensive medicine" means that the difficulty of centralized recruitment and acquisition in the past ten years has been brokenAt the same time, this also means that the weak status of domestic innovative drugs is about to change< br / > < br / > In the reply to the reporter from the State Medical Insurance Bureau, it is really important for the common people to reduce the drug price after the state centralized purchase with quantityIn the long run, it is equally important to guide the industrial ecology < br / > < br / > < br / > < br / > Zhang Ping, a hypertension patient living in Shexian County, Anhui Province, took a domestic amlodipine besylate tablet for a long time, which suddenly couldn't be opened in < br / >The average price of this brand of medicine is only a little more than 10 cents per tablet, and the price of another brand of medicine has increased dozens of times, 2.77 yuan per tabletThis happened in early 2019, when Anhui was not in the scope of pilot drug volume procurement< br / >According to Gong Bo, director of the medical price and bidding and Purchasing Department of Shanghai Medical Security Bureau, when Shanghai began to study the pilot volume purchase in August 2012, it was found that the price difference of similar drugs entering the hospital after bidding was huge, the high price was several times higher than the market price, the low price was close to the production cost, the people were afraid of using the quality, and some used brands were not selected, Patients should go to the secondary and tertiary hospitals in the surrounding cities to prescribe< br / > < br / > this kind of situation is closely related to the previous recruitment systemBefore the national pilot drug volume procurement, through the provincial drug centralized procurement platform bidding, the common practice is "group bidding", also known as "quality level" In general, the original research drugs and imported drugs are divided into one group, which is called "VIP private room" group in the industry, with small quantity and poor competitiveness, and can be shortlisted with a little price reduction; the generic drugs and domestic drugs are divided into several groups according to the quality level, and the internal bidding of each group, the more fierce the group competition with lower quality level, and dozens of enterprises "fight" for one or two quota, the lower the price, This is also the reason why the prices of original research drugs and imported drugs remain high after the national development and Reform Commission has adjusted prices for many times < br / > < br / > in some provinces, 5-7 quality groups of the same drug will appear, each group is allowed to have 1-2 winners, and the most extreme result is that more than 10 enterprises win the bidding after a drug is purchased In the actual purchase, the hospital usually selects one from the imported and domestic ones, and the one who does not depends on the promotion of each pharmaceutical enterprise or pharmaceutical representative, which is commonly known as "sales with gold" < br / > < br / > the core problem of high drug price in China is to sell drugs with gold, which can be said to be cancer Medical reform has been fighting against it for more than 20 years An official of the national health insurance administration, who declined to be named, told reporters The formation of this "cancer" can be traced back to the mid-1980s Before that, the drugs were monopolized by Chinese pharmaceutical companies, with fixed prices and unified purchase and exclusive sale, forming a circulation mode of three-level wholesale stations of large administrative regions, provinces (autonomous regions, municipalities directly under the central government) - Cities (prefectures, counties), and finally entering hospitals, health stations and pharmacies after layers of distribution With the reform of the economic system and the marketization of medicine, the top-down three-level wholesale circulation channels have been broken All levels of wholesale stations can purchase goods from pharmaceutical factories and sell them to hospitals Pharmaceutical enterprises and wholesale stations at all levels have successively established pharmaceutical sales companies and engaged in marketing activities Such pharmaceutical circulation mode once occupied a leading position < br / > < br / > ZHU hengpeng, deputy director of the Institute of economics of the Chinese Academy of Social Sciences and director of the public policy research center of the Chinese Academy of Social Sciences, reviewed in the article "malpractice of medical system and distortion of drug pricing" By the end of the 1990s, the number of pharmaceutical circulation enterprises had increased to more than 16000, forming a "small, scattered and disorderly" pharmaceutical business feature < br / > < br / > public hospitals are the largest customers in the domestic drug market The latest catalogue of drugs for national basic medical insurance, work injury insurance and maternity insurance contains 2709 kinds of drugs, with sales accounting for 80% of the total, becoming the only place for sale < br / > < br / > after a period of decentralized procurement, in 1999, the state re tried the centralized bidding procurement of drugs, first in cities and then in provinces, allowing the winning drugs to increase the circulation price difference on the basis of the bid price According to the system at that time, Zhu hengpeng divided the hospital's profit from selling drugs into four parts: the purchase and sale price difference stipulated by the policy and the discount publicly returned by the pharmaceutical factory into the public legal income, i.e "explicit deduction"; the other two are the discount privately agreed between the hospital and the pharmaceutical enterprise (i.e "secret deduction"), and the rebate obtained by the relevant personnel, including the medical students, which belong to the behind the scenes transaction out of supervision, That is the main part of "sales with gold" < br / > "The amount of prescriptions in the hospital determines the life and death of a variety or even a manufacturer More than ten years ago, when the bidding was launched, the price was reduced, but it could not be prescribed, resulting in the situation of "one bidding and one death" Gong Bo told reporters < br / > < br / > < br / > subsequently, the central government issued a series of documents to gradually cancel the drug mark up However, these measures did not touch the fundamental link of false high drug prices, "gold sales" Zhan Jifu, former director of Fujian Medical Security Bureau, found out the price of drugs before leading Sanming medical reform The price of drugs collected at the provincial level was several times or even dozens of times of the factory price The main sources of the difference were the prescription rebate (30%) of the hospital, the Marketing Fee of the medical representatives (20%), and the ticket reversal fee (10%) of the companies from other provinces < br / > < br / > at this time, there is almost no direct proportion between the actual selling price and the production cost of drugs According to an internal data obtained by the reporter, the production cost of olanzapine in 2020 is only 0.5 yuan / tablet, including main and auxiliary materials, packaging materials, personnel, quality inspection and all other costs, which is far lower than the lowest bid price of 2.48 yuan / tablet in the first batch of procurement expansion in 2019, less than 7% of the original research drug company Eli Lilly's 6.74 yuan / tablet < br / > < br / > < br / > To change the path dependence of pharmaceutical enterprises, a new path must be provided After volume purchase, there will be no need for sales promotion and no gold sales " Said the official of the National Health Insurance Bureau < br / > < br / > the Sanming medical reform, which started in 2012, is known as the 1.0 version of volume purchase It is led by Sanming medical security fund management center, the largest payer of medical insurance It is centralized in the purchase, medication and payment links of centralized purchase center, hospital and medical insurance, and supervises the circulation and use of drugs in the whole process Who pays the bill is more motivated to control the fee At the same time, we will increase the price of medical services, optimize the remuneration, and decouple the doctor's income from the cost of drugs and consumables < br / > < br / > Sanming medical reform has its own urgency Before the reform, the medical insurance fund was underperformed In 2010, the medical insurance fund of Sanming City failed to pay more than 140 million yuan, and the medical insurance fund owed more than 17 million yuan to 22 public hospitals in the city After medical reform, by the end of 2014, Sanming City had a medical insurance balance of more than 86 million yuan, and the proportion of drugs decreased from 46.77% in 2011 to 27.36% in 2014 The per capita hospitalization drug cost of public hospitals above county level in the city was less than half of the provincial average level < br / > < br / > however, the "volume for price, prepayment, only low price and exclusive bid" in Sanming medical reform has brought results, but also raised questions In addition, at that time, the "generic drug consistency evaluation" was not implemented nationwide, and there was a lack of supporting measures to ensure the quality, supply and use of drugs < br / > < br / > since 2010, the pilot drug centralized purchase in Shanghai has been called "volume purchase version 2.0" in the industry "It's a big risk to talk about price without quality." Gong Bo introduced that Shanghai has explored and established a set of comprehensive quality evaluation indicators, which he derided as the "consistency evaluation of local laws", covering seven indicators, including the scale of production enterprises, environmental impact assessment, quality certification, internal control indicators, laboratory testing and other links, stipulating that at least five indicators can be shortlisted to participate in the bidding The original imported pharmaceutical enterprises compete with generic drugs in the same field, and the low-priced ones win the bid < br / > < br / > according to Gong Bo, the biggest difficulty at that time was that there was no national authoritative consistency evaluation as the quality threshold To stand the test of monitoring standards, a lot of work had to be done, one drug, one drug Take the internal control indicators as an example In the early stage, they asked drug companies from house to house to determine which of the dozens of national standards of a drug production process had the greatest impact on the quality Then they invited clinical and pharmaceutical experts to have a discussion and selected three or four items to be included in the tender < br / > < br / > Gong Bo explained that after winning the bid, the pharmaceutical companies will provide 6 consecutive batches to the drug inspection institute to establish a near-infrared spectrum model and carry out batch inspection Previously, only blood products had such inspection specifications < br / > < br / > in order to carry out "volume purchase", it is necessary to accurately master the demand of the hospital and the actual supply of the enterprise At that time, the provincial online bidding and procurement platform was only responsible for registering and publishing procurement information In fact, specific information such as how many medical institutions bought and the price level was not required to be publicized on the Internet For the reasons of interest demand and lack of system, the phenomenon of missing, underreporting and over reporting existed Without accurate information, the correct decision could not be made, How much "quantitative" can we achieve both price reduction and ensure that medical institutions can use up? < br / > In 34 months, "Shanghai Medical Procurement Service and supervision information system" was built in July 2015 and covered the designated hospitals of medical insurance in the city < br / > < br / > in June 2015, Shanghai carried out the first batch of trial volume purchase