Normalized supervision embarks on the journey of "malicious price increase" and "price increase by car" without any hiding

In order to clarify the basic policies of drug price management at this stage, construct the institutional framework of the regulatory mechanism of drug price normalization, and implement various policies related to the supply and price stabilization of drugs in short supply, on December 6, the state health insurance bureau issued the opinions on doing a good job in the current drug price management (hereinafter referred to as the "opinions") to link up and improve the current drug price policies and do a good job in the short term Provisions shall be made for drug shortage, supply and price stabilization It is reported that after the issuance of the opinions, the state health insurance bureau will take further measures to prevent malicious price hikes of short drugs and "price hikes" of non short drugs This also means that China's drug price normalization supervision has embarked on a journey, and the price of drugs in short supply or not will be strictly controlled In this situation, all kinds of enterprises in the pharmaceutical industry chain, middle and lower reaches will be greatly affected, and the previous price strategy may have to be adjusted Special guests: Yang zeyouyu, special observer of this newspaper and marketing consultant of pharmaceutical enterprises, Huang Bing, co-founder of blockchain thinking pharmaceutical sharing platform Shi lichen, special observer of this newspaper and founder of the third-party medical service platform Li Congxuan, general manager of OTC Business Department of Kangmei pharmaceutical Hu Xiaochun, special observer and senior medical person of this newspaper The unprecedented effect of "hard core" price reduction remains to be fully reflected Medical Observer: in terms of linking up and improving the current drug prices, the opinion said that medical insurance should play a leading role in drug prices Since the establishment of the medical insurance bureau, various measures have been taken to guide "drug price reduction" In your opinion, how effective are these measures? Is it against the direction of "market regulation"? What are the advantages and disadvantages of medical insurance guiding "drug price"? Shi lichen: at present, the effect is very good However, the "market regulation" is not perfect, and the drug price is still a policy regulation At present, the medical insurance bureau has not established a drug monitoring system or system for medical institutions or designated institutions, so the whole supervision of the price level of the medical insurance bureau is still in the initial stage, but also plays a control role The medical insurance bureau focuses on the price of drugs and the cost control, rather than the overall procurement mechanism, so price negotiation and price management have become the main tasks of the medical insurance bureau at present This is not good for the industry as a whole Only focusing on the price, not the later purchase, payment collection, and the construction of the overall drug purchase structure will highlight the problem of drug bidding At the same time, the drug price is not reflected in DRGs and rational drug use, and the price and cost control are not related to DRGs and rational drug use The phenomenon that the health care Commission and the medical insurance bureau perform their respective duties is still prominent, which makes the enterprise at a loss Li Congxuan: the price reduction guided by medical insurance has indeed achieved good results, effectively reducing the price, but it is only part of government procurement, not pure market behavior It is indeed a helpless move of the government to guide the drug price with medical insurance, which is good for the pharmaceutical enterprises, but good for the people of the whole country It can also play a role in guiding competition, eliminating backward production capacity, reducing costs and improving efficiency At the same time, it can also force foreign original drug manufacturers to reduce prices, which is its advantage But it also has its disadvantages, that is, when the price is reduced to the "underpants price", many enterprises will not survive or have no money to research and develop again As a result, new drugs will always be foreign, and we can only eat cheap generic drugs In addition, when the original research drugs are greatly reduced in price, consumers still choose the original research drugs with better curative effect, and the generic drug enterprises will "die faster" Huang Bing: after the establishment of the National Health Insurance Bureau, 17 kinds of anti-cancer drugs were negotiated and incorporated into the medical insurance and other measures were introduced and implemented In particular, the national pilot procurement with volume not only shows in the sharp reduction of the price of related drugs, but also has a far-reaching impact on the drug market The government is hoping to lead the drug price drop in the market through "tangible hand", so as to realize the point by point adjustment This is indeed a "hard core" operation in some specific varieties, and the price reduction is unprecedented But at present, it is only reflected in some specific varieties, and due to the rapid change, pharmacies in some regions now take a very cautious attitude towards "4 + 7" varieties, and even reject purchase or sales From this point of view, it is time to fully reflect the effect of price reduction, and more measures are needed to mobilize the enthusiasm of each link Yang Ze: I think the cooperation of medical insurance in winning the bid is better From the point of view of the country, "4 + 7" plus medical insurance linkage has been effective in promoting drug price reduction From the perspective of "4 + 7" as a whole, there is a way for the state to reduce drug prices First of all, all products have been evaluated for consistency and become a level of quality Then, the enterprise will make its own quotation Once the lowest bidder wins the bid, all similar products that have been evaluated for consistency will be in accordance with this standard Therefore, this kind of linkage effect of the state can be achieved With this benchmark and foundation, the payment price of medical insurance will be determined Hu Xiaochun: obviously, since its establishment, the medical insurance bureau has taken a series of drastic measures to reduce the drug price, which can be expressed by its outstanding achievements But I still have some puzzles After all, the medical insurance bureau represents the will of the state Although the first one or two articles of the first major item in the document clearly stated that "adhere to the overall direction of market regulation of drug prices" and "play the guiding role of medical insurance in drug prices", in fact, we see that the leading rather than guiding national forces are playing a positive role 。 Here, I can only understand that it is a kind of "serious illness, powerful medicine" and "chaotic times, severe code" to set things right I hope this will have more advantages than disadvantages in the future drug price management, and really play a role in balancing the interests of the state, industry and the people Medical Observer: for the differences in dosage forms, specifications and packaging of the same kind of drugs, the opinion points out that a reasonable price difference relationship should be maintained Excuse me, what are the reasons for maintaining a reasonable price difference relationship? How can this relationship be defined as a reasonable range? Huang Bing: is the price difference relationship reasonable? This is a problem faced by production enterprises, circulation enterprises and sales enterprises It is also a problem caused by many years of market-oriented sales, channel competition and uneven management level of production enterprises To actively guide orderly marketing, governments at all levels have already made efforts in pricing, purchasing and payment, involving the conversion of drug price difference relationship! In my opinion, if there are differences in dosage forms, specifications and packaging of the same kind of drugs, we can judge whether the price difference relationship is reasonable according to the daily consumption amount of patients Li Congxuan: you can't raise the price by changing a vest or specification Reasonable means that the specification is doubled, and the price is doubled or slightly lower For example, the large specification is 2 times lower than the small specification price by 5%; otherwise, if the specification is doubled, the small package is slightly more expensive, about 5% is reasonable Of course, this 5% is only a reasonable range in my opinion, mainly the gap between packaging specifications and labor costs Hu Xiaochun: it should be necessary to maintain a reasonable price difference relationship Although the external performance is the difference of dosage form, specification and packaging, in fact, it involves the similarities and differences of many factors, such as the production process, the route of administration, the content of effective ingredients and so on Under normal circumstances, scientific understanding, these differences will directly affect the clinical efficacy of drugs, so we should maintain a reasonable price difference ratio However, it is difficult to make a reasonable decision However, it has been some years since the country implemented the calculation of drug price difference ratio, and has accumulated some experience I believe that the relationship between them will be handled well in general Personal point of view should be from the drug potency, preparation process, future development direction of dosage form, pharmacoeconomic evaluation, as well as favorable to reduce the drug price to develop the corresponding comprehensive calculation coefficient Medical Observer: the second main content of the opinion is to establish and improve the regulatory mechanism for the normalization of drug prices Based on the current policies related to drug prices, do you think that the conditions for the normalization of drug price supervision in China are mature? Are there any problems that need to be solved? Shi lichen: the conditions are not mature In fact, there are three directions of price supervision: 1 The price is too high; 2 The price is too low, resulting in the shortage of goods; 3 The price is unbalanced, high and low Price supervision can be done at any time, but now there is a problem Provinces, regions or purchasing consortia have all conducted price negotiations independently, which has resulted in the disorder of domestic drug price system and the frequent occurrence of the situation that pharmaceutical enterprises are at a loss Which is more important, a regional market or a national market? This causes the trouble of price management for enterprises The formation of a good price system should be based on the national unity No matter the provinces, regions, or purchasing consortia conduct price negotiations, they should form a national linkage and joint procurement At the same time, reasonable price differences (differences in transportation distance, packaging, etc.) are allowed In this way, pharmaceutical enterprises can focus on reducing costs on the premise of ensuring quality Reduce the transaction price In drug price negotiation, all drugs should be classified into category, quantity, or other categories, and then each province, region, or purchasing alliance should negotiate the price separately After the price is determined, the national market linkage should be carried out This will not only avoid the formation of low-lying drug prices, but also be conducive to the rational price balance of pharmaceutical enterprises across the country Huang Bing: on the basis of respecting the market law and the operator's independent pricing power, we should comprehensively use monitoring and early warning, inquiry and interview, warning and warning, cost investigation, credit evaluation, information disclosure and other means to establish and improve the regulatory mechanism of drug price normalization, and promote the operator to strengthen price self-discipline At present, it is just the beginning, and the road behind is still very long, after all, it involves all aspects of benefits The benefit relationship is too many and too complex It is not mature to solve the problem by means of monitoring, credit system and self-discipline at some points Yang Ze: the normal regulation of drug prices is now gradually starting In fact, if there is no innovation in drugs of the same kind, the price cannot be high Under the guidance of national policies, many large enterprises have begun to strengthen R & D investment Therefore, the relevant policies issued by the state are all related, which is also the process of industry shuffling Hu Xiaochun: obviously, at present, the conditions for the normalization of drug price supervision in China are mature Just hope, as a well-developed drug price system, we can not only monitor whether the drug price is rising, but also comprehensively monitor whether the drug price really reflects the drug value and other factors in line with the objective laws A scientific and reasonable price system that can promote the healthy development of drug research, development, production and circulation is the right way Medical Observer: according to the opinion, we will rely on provincial drug bidding and purchasing institutions to promote the construction of regional and national drug alliance purchasing mechanism, unify coding, standards and functional specifications, and promote information interconnection, resource sharing and policy linkage What is the significance of this measure for the normalization of drug regulation? Shi lichen: relying on the provincial drug bidding procurement agency, but the bidding agency is under the management of the health care Commission Now there are two price forming departments, one is the price negotiation of the bidding office, which is under the management of the health care Commission; the other is the medical insurance bureau