Prospect: drug and consumables collection in 2020

With the novel coronavirus pneumonia epidemic becoming more stable, orderly return to work in all industries has been put on the agenda Health insurance will continue to do a good job in the relevant epidemic prevention and control work, and continue to carry out various reforms As some places began to issue papers one after another, in 2019, the national organization of drug collection, which made the whole pharmaceutical industry ups and downs, returned to our attention On January 10 this year, the national medical security working conference was held in Beijing to study and deploy the key tasks of medical security in 2020 Among them, for the centralized procurement of drugs and consumables, it is clearly proposed that "vigorously promote the reform of centralized procurement and use of drugs organized by the state, break the barriers of interest, and realize the normal operation", and "do a good job in the implementation of centralized procurement of drugs and medical consumables" However, to do a good job in the national centralized procurement reform is the most important work in the centralized procurement of drugs and consumables, but it is not all In fact, at the end of 2019, the leading group for deepening the reform of the medical and health system of the State Council adopted several policies and measures on further deepening the reform of the medical and health system with centralized purchase and use of drugs as a breakthrough (hereinafter referred to as the measures) On the basis of comprehensively deepening the national centralized procurement, relying on the provincial platform for centralized procurement of drugs, we need to build the national public procurement market and multi-party linkage procurement pattern, so as to promote the "three medical linkage" reform So, in this unknown and variable 2020, what direction will the centralized procurement of drugs and consumables continue to develop? Combined with the key points of medical security work in 2020 issued by the state health insurance bureau, let's sort it out Direction 1: do a good job in the implementation of centralized procurement of national organization drugs Establish a normalized centralized procurement mechanism of national organization drugs On the eve of the Spring Festival in 2020, on January 17, the second batch of centralized procurement of national organization drugs was carried out in Shanghai, and the results of the proposed selection were officially announced that night A total of 32 varieties and 100 products were successfully purchased, involving 77 enterprises to be selected According to the work plan put forward by the joint procurement office, in the next step, all regions will focus on the implementation of the results of the selection, and ensure that patients start to use high-quality and affordable drugs from April 2020 At present, affected by the epidemic situation, the landing of the second batch of national collection varieties has not been fully started, but some areas with a relatively light epidemic situation have begun to prepare for the relevant work For example, on February 14, Hainan Province issued the implementation plan for the comprehensive implementation of the second batch of national drug centralized procurement and use in Hainan Province (Draft for comments), which made detailed provisions on the implementation scope, tasks and steps for the implementation of the second batch of centralized procurement varieties in Hainan Province, and made it clear that the centralized procurement results and supporting policies will be formally implemented from April 10, 2020 Subsequently, with the gradual stabilization of the national epidemic situation, medical insurance departments around the country will also successively issue implementation plans to strive for the second batch of intensively collected varieties to be put into use in the country on schedule In addition, it should be noted that the renewal of 25 procurement varieties in the "4 + 7" pilot cities will also be completed in the first half of this year At present, under the condition that the nationwide expansion of national centralized mining has been basically stable, "4 + 7" pilot cities will directly implement the "alliance area" centralized mining mode after the expiration of the procurement contract Liaoning Province has taken the lead in launching this work On February 25, the notice on Issuing and implementing the results of centralized drug procurement in alliance areas (Shenyang and Dalian, Liaoning Province) was issued, which made it clear that After the completion of the "4 + 7" pilot project in Shenyang and Dalian, it will be transformed into the centralized drug purchase mode in the alliance region (Liaoning Province), and the new procurement results will be implemented on March 20 Of course, while implementing the specific procurement work, the more important work is to establish a new procurement mechanism In this regard, the joint procurement pointed out that it is necessary to "establish a normalized centralized procurement mechanism for drugs organized by the state" In this regard, the measures issued by the Shenzhen reform office also made clear instructions On the one hand, it is necessary to expand the scope of national centralized procurement in an orderly manner, give priority to such varieties as the price of the original research drug is higher than that of the world's major countries and surrounding areas, the price difference between the original research drug and the generic drug is large, as well as the basic drugs through the consistency evaluation of the quality and efficacy of generic drugs, etc into the scope of centralized procurement On the other hand, we should study and issue policy documents to reform and improve the drug procurement mechanism, and promote new procurement mode, marketing mode and industry ecology to become the leading force Direction 2: organize the alliance region to carry out the pilot procurement of high-value medical consumables, and start to carry out the price monitoring of high-value medical consumables Since the central deep reform commission deliberated and approved the reform plan for high-value medical consumables in May 2019, the reform in the field of high-value consumables has been greatly accelerated In the aspect of procurement mode reform, the reform plan of high-value medical consumables governance proposed that: for high-value medical consumables produced by multiple enterprises with large clinical consumption, high procurement amount, mature clinical use, medical institutions should be encouraged to jointly carry out negotiation and procurement with volume, and actively explore cross provincial alliance procurement In terms of volume negotiation and procurement, the state health insurance bureau has actively implemented the relevant deployment of the Party Central Committee and the State Council, formed a pilot scheme of volume procurement of high-value consumables, and guided and promoted the exploration of centralized volume procurement of high-value consumables in Anhui, Jiangsu, Fujian, Shandong, Shaanxi, Shanxi and other places For example, in the second half of 2019, Anhui Province, together with 18 provincial public medical institutions, negotiated and negotiated the volume purchase of high-value consumables such as spinal implants and ophthalmic intraocular lenses; Jiangsu Province, together with 55 top three public hospitals, attempted to purchase the volume of high-value consumables such as cardiac stents and pacemakers In the aspect of cross provincial alliance procurement, in recent years, many related exploration practices have been carried out, and the feasibility is better from the results For example, the "Beijing Tianjin Hebei" alliance, as the first Trans provincial regional alliance for medical consumables procurement, has been expanding in terms of the scale of the alliance and the range of procurement varieties since the water test in 2017 Heilongjiang, Jilin, Liaoning, Inner Mongolia, Shanxi and Shandong provinces have successively added the alliance, which has formed the largest Procurement Alliance in the country It will be clear in the beginning of 2020 Division of intraocular lens consumables began to carry out joint procurement of nine provinces It can be seen from this that for the next development direction of high-value consumables centralized procurement, whether it is to further expand the provincial level of alliance procurement, or to test the national level of centralized procurement with volume, it has met more mature conditions In the past few years, drugs have taken on too many responsibilities to leverage the "three medical linkage" reform In 2020, consumables will begin to take on this task Direction 3: encourage and standardize all regions to carry out volume procurement for non evaluated varieties It has been four years since the State Office issued opinions on the consistency evaluation of quality and efficacy of generic drugs in February 2016 Although at present, the state and local governments have basically followed the principle of "more than 3 varieties of evaluated enterprises, and no more varieties without evaluation will be selected during centralized purchase", considering the progress rate of consistency evaluation, it is still the normal situation for most varieties to have less than 3 evaluated enterprises for quite a period of time The relevant person in charge of the state health insurance bureau has previously said that the procurement with volume will be carried out normally At this stage, the procurement of the evaluated varieties can be organized by the state level, while for a large number of the non evaluated varieties, the provinces can organize the procurement according to their own actual situation and drawing on the national experience However, this idea is further clarified in the "key points of medical security work in 2020": encourage and standardize the high-value medical consumables with large consumption, high purchase amount and full competition in all regions In fact, since the second half of 2019, there have been places to start the exploration and practice of centralized procurement of non evaluated varieties On November 13, 2019, Jiangxi Province announced the implementation plan of drug volume purchase and use, and proposed to select some generic drugs corresponding to generic drugs that have never passed the consistency evaluation of quality and efficacy, with large clinical dosage, high purchase amount and sufficient competition It is considered to use the "double envelope" comprehensive scoring method to organize the implementation of volume purchase On November 20, Hebei provincial drug procurement center issued a notice that it will carry out centralized procurement of outpatient drugs for "two diseases" (hypertension and diabetes), involving 15 varieties, of which 9 varieties are selected by drug companies that have not passed the consistency evaluation (less than 3 evaluated manufacturers), but the price to be selected needs to be more than 20% lower than that of drugs that have passed the consistency evaluation On December 24, Anhui Province issued the implementation plan of negotiation and price negotiation (pilot) for partial commonly used drugs and the second batch of anti-cancer drugs in public medical institutions of Anhui Province in 2019, which proposed to carry out negotiation and price negotiation pilot for the non evaluated varieties, and completed the negotiation on December 27, involving 29 antibiotic drugs and 6 anti-tumor drugs, with an average decrease of 35.16% On February 26, 2020, Fujian Medical Insurance Bureau issued the document of centralized drug volume purchase in Fujian Province, which announced that 14 varieties and 22 products including esmeralazole and moxifloxacin (including moxifloxacin sodium chloride) were included in the centralized drug volume purchase at the provincial level, all of which were drugs with large purchase amount, full competition, and the same generic name had not yet passed the consistency evaluation of generic drugs Direction 4: strengthen the construction of provincial drug centralized procurement platform, and build a unified and open national drug public procurement market The centralized procurement of national organizations is only a part of the centralized procurement of drugs and consumables Its more significance is to play the leading and demonstration effect For China, which has a vast territory and unbalanced development in various regions The centralized procurement organized by the province is the main procurement mode with higher feasibility after long-term practice test, and it is also an important part of carrying out drug price monitoring and analysis and promoting the formation of a new pattern of procurement work promoted by the state and local governments For example, in the prevention and control of the pneumonia epidemic, the provincial procurement platform plays an important role in the supply of medical equipment At the novel coronavirus pneumonia joint defense joint control mechanism press conference held in February 20th, Xiong Xianjun, director of the national health insurance administration, said: local provincial drug centralized procurement agencies should actively play the platform of purchasing information release and centralized matching transactions, and help to provide supplies for protective materials Cheng For the next development direction of provincial-level centralized mining platform, some guiding opinions are also given in the measures, which can be summarized into the following three aspects: First, unify the coding, standards and functional specifications, promote the interconnection and resource sharing of drug prices and other related information, and promote the construction of a unified and open drug public procurement market across the country; second, for the varieties not included in the national centralized procurement, learn from the national centralized procurement experience, adopt the single or cross regional alliance and other ways to purchase drugs in the scope, shortlisted standards, centralized procurement forms, etc Third, we should explore more efficient ways to pay for drugs through the provincial centralized purchase platform, and encourage local governments to explore drug payment when conditions permit