"Red envelope" policy of preferred lead in basic drug market

Since the national basic drug catalogue (2018 version) was published by the national health and Health Commission in 2018, the basic drugs have been continuously supported by policies In recent years, the basic medicine has ushered in double benefits First, the general office of the State Council issued documents to promote medical institutions at all levels to form a "1 + X" drug use mode dominated by essential drugs, optimize and standardize the drug use structure; then, the Ministry of finance, the national health and Health Commission, the National Health Insurance Bureau and the state Administration of traditional Chinese medicine jointly issued documents to clarify the "how to pay" of basic drug-based institutions Under the influence of the two policies, the market of basic drugs will accelerate to expand, and the enthusiasm of basic drug use in primary medical institutions will also be enhanced Enterprises that have entered the basic drug catalog should seize the opportunity of "1" and improve the level of academic promotion; enterprises that have not entered the basic drug catalog should not only compete for "X", but also vigorously develop the market outside the Institute and strive for a share On October 11, the general office of the State Council issued the opinions on further ensuring the supply and price stability of drugs in short supply (hereinafter referred to as the opinions), which not only made arrangements for ensuring the supply and price stability of drugs in short supply, but also put forward requirements for the use of basic drugs The opinion points out that by strengthening the supervision and assessment of drug use, guiding and urging medical institutions to optimize drug use catalogue and drug formulary and other measures, we will promote the priority of the use of essential drugs, increase the proportion of the use of essential drugs, and timely adjust the national essential drugs catalogue, so as to gradually realize the allocation of essential drugs in primary medical and health institutions, secondary public hospitals and tertiary public hospitals run by the government In principle, the proportion of varieties shall not be less than 90%, 80% and 60% respectively In fact, many departments, including the health and Health Commission, have issued relevant support policies for the shortage of drugs and basic drugs This time, in the name of the general office of the State Council, the opinions are obviously of different significance Chu Shitao, deputy director of the Basic Medical Research Institute of China Pharmaceutical Materials Association and general manager of Baiyun pharmaceutical marketing of Xiangju group, said: "the unit issuing this document is the general office of the State Council, which is higher than other ministries and agencies, and can directly coordinate the connection between multiple ministries and commissions The implementation of basic medicine is led by the national health and Health Commission The health and Health Commission and the administration of traditional Chinese medicine work together to promote the use and rational use of basic medicine We can see the determination of the state to this round of medical reform, but we need to pay attention to the cooperation degree of medical institutions If the compensation mechanism of medical institutions is improved after the addition of drugs, the opinions can fall smoothly It's in place " According to the opinion that "the proportion of basic drugs in government run primary medical and health institutions, secondary public hospitals and tertiary public hospitals shall not be less than 90%, 80% and 60% respectively in principle", Zhang shanguo, general manager of Henan Yingguo Enterprise Management Consulting Co., Ltd., analyzed and recognized that: first, it is to ensure the comprehensiveness and rationality of primary medical drugs, especially to solve the basic problems Second, to ensure the coverage of secondary hospitals to the county-level market, non major diseases can be diagnosed and treated nearby; third, to further alleviate the diagnosis and treatment pressure of tertiary public hospitals through the adjustment of basic drugs and self funded drugs The opinion also said that it is necessary to promote medical institutions at all levels to form a "1 + X" drug use model with basic drugs as the leading factor (1 is the national basic drug catalog, X is non basic drugs, which shall be determined by each region according to the actual situation) According to Chu Shitao, the implementation of "1 + X" drug use mode means that the drug use structure of public hospitals at all levels in China will change dramatically He said that if the list of basic drugs is still 685, and the hospitals do not add new basic drugs, the hospitals should achieve the target of basic drug allocation proportion In addition to the primary hospitals, the secondary and tertiary hospitals should remove a large number of non basic drugs If you don't want to eliminate non base drugs and the hospital wants to achieve the proportion of base drugs, you need to increase the number of base drugs The list of base drugs may be readjusted to add some varieties But no matter which way above, the structural adjustment of hospital medication is inevitable Zhang also said that for primary medical institutions, the first thing to consider is the availability of drugs, followed by the use of good drugs Basic medicine as "1" is to solve the problem of available medicine; "X" is to use better medicine The former can be reimbursed, while the latter cannot How about the effect? How do consumers choose? There may be hospital induced factors, but the final decision is still the patients and their families In my opinion, for hospitals, there are two points: first, "1" refers to non profitable products and "X" refers to profitable products; second, in order to increase the share of "X", we have to constantly refresh the sales volume of "1", but the proportion of "1" has been set by the state through policies, and the "X" products of hospitals can not grow unrestricted In this case, how to ensure that the "1 + X" medication mode is implemented? Chu Shitao said that we can do it from the following aspects: 1 Improve the sensitivity and timeliness of monitoring response; 2 Strengthen the allocation and use of basic drugs in medical institutions and the standardized management of drug use; 3 Improve the procurement of short drugs; 4 Increase the supervision and enforcement of drug prices; 5 Improve the multi-level drug supply system; 6 Effectively strengthen the organization and implementation After the implementation of "1 + X" drug use mode, it is bound to have an impact on drug bidding and purchase In fact, "1" is basically limited by the policy, and almost every action is guided by the policy The key lies in "X" No matter the existing bidding method or the upcoming method, it can not limit the details of "X" and will be used by the hospital For example, Zhang shanguo said: "for example, a three-level public hospital has an annual sales volume of 2 billion yuan, and the proportion of basic drugs is 60%, that is, 1.2 billion yuan, so the" X "is 800 million yuan There are many articles to do, even can carry the demand of the whole hospital for profit In short, in the future, "1" bidding rules and regulations, "X" darkbox operation, the implementation of many years of "medicine division" cycle will be infinitely prolonged " Chu Shitao believes that after the implementation of "1 + X" mode, it is beyond reproach to include the new version of the national basic drug catalogue in the future drug bidding procurement, and the whole bidding structure will be based on basic drugs From the perspective of bidding trend, price reduction and cost control will be the main theme, the status of basic drugs will be improved, and the supply will not be short Based on the influence of "1 + X" drug use mode on hospital drug use structure and drug bidding and purchase, Zhang said that market development of pharmaceutical enterprises will establish an operation strategy based on four "changes": 1 Changes in product classification: basic drug products and non-basic drug products; 2 Changes in market classification: basic drug market and non-basic drug market; 3 Changes in public hospitals: basic drug market and non-basic drug market Base drug unit and non base drug unit; 4 Change of operation mode: divided into base drug operation mode and non base drug operation mode Correspondingly, enterprises should establish corresponding basic medicine operation team and non basic medicine operation team, and the backstage personnel should match with them Chu Shitao gives specific suggestions for the strategic layout of pharmaceutical enterprises in market development: first, for the enterprises whose varieties enter the base drug catalog and pass the consistency evaluation, it is a great advantage, and such enterprises must seize the opportunity to improve the level of academic promotion; second, for the enterprises whose varieties do not enter the base drug catalog, in addition to the competition of "X", they must vigorously develop Develop the market outside the hospital, and strive for a share; finally, actively prepare for the next opportunity of base drug catalog adjustment On October 16 after the release of the opinions, the Ministry of finance, the state health and Health Commission, the state health insurance bureau and the State Administration of traditional Chinese medicine jointly issued the notice on the issuance of five measures for the administration of subsidy funds for basic public health services, mainly covering the distribution, use and management of subsidy funds for the implementation of the national basic drug system in grass-roots medical and health institutions supported by the central government The relevant measures for the administration of subsidies for the basic drug system (hereinafter referred to as the measures) have made clear the "how to pay" of the basic drug implementing institutions The measures pointed out that the basic drug system subsidy fund refers to the transfer payment fund used to support the grass-roots medical and health institutions to implement the national basic drug system and promote the comprehensive reform of the grass-roots medical and health institutions through the arrangement of the transfer payment method of the common financial power Transfer payment funds are distributed by factor method In the allocation, the subsidy standard, the number of service population and the local financial situation are mainly considered, and the results of performance evaluation are taken into account as a whole for settlement (in principle, the weight of performance factors shall not be less than 5%) For community health service centers (stations) and township health centers, transfer payment funds shall be verified in accordance with the method of "verification of tasks, verification of revenues and expenditures, and performance evaluation subsidies" For village clinics, transfer payment funds shall be determined according to the number of rural doctors serving population and per capita standard The funds to be allocated in a province (District, city) shall be equal to the number of serving population × per capita standard × central and local share proportion + performance factor allocation funds According to Zhang shanguo, at present, the implementation of the basic drug system is basically in place in the medical institutions at and below the county level, but there are three things that often happen: 1 Many businesses distributing for the county level are often in arrears with the medical insurance payment; 2 The poor management of the medical insurance, the rapid payment of the annual medical insurance payment, and the situation that "only x yuan can be purchased at a time"; 3 There are often doctors from hand In the operation room, the head came out to ask the family: "this one is reimbursed, but the effect is not good; this one is not reimbursed, the effect is good, which one is used in the end?" This means that there are three major problems: incomplete drug-based supporting system, poor medical insurance management and "X" being magnified If these three problems are not solved, it will affect the implementation of the basic drug system Zhang also said that according to the new measures, grassroots medical institutions' enthusiasm for the use of basic drugs will be increased accordingly As mentioned above, even if the hospital is painstaking in "X", the proportion between "1" and "X" should be maintained After all, the provisions of "approved task, approved revenue and expenditure, and performance appraisal subsidy" constrain the behavior of the hospital and doctors Although "excessive medical treatment" and excessive attention to "X" may occur, the use of "1" with subsidy is also a traction The two policies mentioned above are undoubtedly beneficial to the use of base drugs, and the use of base drugs continues to increase under the support of the policies According to the monitoring report on hospital medication in 2018 issued by China Pharmaceutical Association, the quantity of drug base catalogue and regulations of sample hospitals increased steadily in 2018 On the whole, how far is the base drug market from the explosive development stage? In response, Chu Shitao said that the base drug market is still a certain distance from the explosion, which will take about two years Before that, we need to do the following: first, we need to set aside adjustment time to gradually promote and guide the replacement of drugs; second, we need to straighten out the interests of all aspects; third, we need to develop a sound financial compensation mechanism for primary medical institutions and the assessment incentive mechanism for doctors.