Shenyang implements the procurement with quantity: the quantity is not completed, and the scope of the pilot project is expanded

Shenyang land procurement with quantity was implemented on March 20, but the quantity was not completed and the medical insurance was deducted Before March 20, Shenyang Municipal People's Government Office issued the document "notice on printing and distributing the implementation plan of national organization drug centralized procurement and use pilot work in Shenyang" (hereinafter referred to as the "plan") According to the plan, Shenyang will officially launch the pilot work of centralized purchase and use of drugs organized by the state Simultaneously implement the payment standard of medical insurance, analyze and evaluate the pilot work of centralized purchase and use of drugs organized by the state in due time, and make provisions on the purchase, supply, payment and payment standards, which are required to be fully implemented before March 20 It is worth noting that Shenyang clearly proposed in the plan to explore and expand the pilot program While focusing on the procurement tasks of public medical institutions, it also selected some non-public medical institutions with high management level, information level and public recognition, and explored the implementation of centralized drug procurement ▍ if the amount is not enough, the industry has always been concerned about how to issue policies to ensure the amount of medical institutions In this regard, Shenyang has adopted various ways to ensure the dosage: The plan proposes that public medical institutions should unblock the channels for the selected drugs to enter the hospital, ensure that the selected drugs enter the hospital and are used preferentially, and shall not influence the purchase and use of the selected drugs on the grounds of the total cost, "drug proportion", the requirements for the specifications and quantity of the drugs used by the medical institutions, the review by the pharmaceutical Committee and the account opening of the distribution enterprises The scheme in Shenyang clearly states that medical institutions can purchase non selected drugs of the same variety, but in principle, the quantity shall not exceed the use amount of selected drugs after being converted according to the proportional relationship At the same time, formulate corresponding punishment measures The use of selected drugs is directly linked to the medical insurance, which is directly reflected in the incomplete quantity and the deduction of medical insurance settlement quota: The plan shows that for medical institutions that fail to complete the purchase and use as required and affect the patients' drug demand, the medical security department and the health and health department shall make corresponding treatment in the level review of medical institutions and the target responsibility assessment of the person in charge of medical institutions, and take measures such as notification criticism, rectification within a time limit, assessment and evaluation of unqualified medical institutions, and deduct the corresponding medical institutions as appropriate Guarantee settlement limit ▍ exclusive distribution, which is not allowed to be purchased in the scheme through a third party, is to clarify the main responsibility of supply and distribution of the selected varieties The selected drugs can be delivered directly by the selected enterprises, or according to the principle that no more than one distribution enterprise is entrusted by a selected drug in the whole city, the drug manufacturers can independently establish and change the distribution relationship in the provincial drug and medical consumables centralized purchase platform The scope of distribution of drugs shall cover all regions of the city and have the ability and conditions to distribute the selected drugs to all medical institutions in the city within 24 hours It is not allowed to purchase the selected drugs through a third party During the implementation period, if the distribution enterprise is listed in the "illegal list", the selected drug manufacturer shall timely start the emergency plan, select other distribution enterprises, and ensure the timely distribution of the selected drugs ▍ advance 45% of working capital to solve the problem of payment collection According to the plan, direct settlement of medical insurance shall be carried out on a trial basis Through the tripartite agreement signed by the medical insurance center, production enterprises and distribution enterprises, the corresponding funds shall be transferred by the medical insurance fund as the working capital The working capital shall be prepaid in batches through the special purchasing account, i.e 50% for the first time, 45% for the rest when the purchasing cycle is half or the contract volume is half implemented The last 5% of the working capital shall be used for liquidation after the completion of the contract volume As far as the northeast is concerned, the issue of payment collection has always been a problem that needs attention This time, Shenyang Municipal People's government issued a document and set up a pilot group for volume procurement, with the mayor and deputy mayor of Shenyang as the group leader and Deputy group leader, and the director of the municipal government office as the leading group member, which is powerful enough The implementation plan of national drug centralized purchase and use pilot project in Shenyang In order to actively promote the pilot work of centralized purchase and use of drugs organized by the state, according to the notice of the general office of the State Council on printing and distributing the pilot program of centralized purchase and use of drugs organized by the state (GBF [2019] No 2) and the implementation of the pilot work of centralized purchase and use of drugs organized by the state in Liaoning Province The implementation plan is formulated in accordance with the relevant spirit of the opinions on Implementation (No 2 in 2019) and the actual situation of our city 1、 General requirements (1) guiding ideology We will thoroughly implement the important directive spirit on centralized drug purchase, fully implement the decision-making and deployment of the Party Central Committee and the State Council, and make people use drugs with higher quality and lower price through centralized and volume purchase in accordance with the general idea of "national organization, alliance purchase and platform operation" （2） Basic principles We should take the people as the center, ensure the demand of clinical medication, reduce the burden of patients and ensure the quality and supply of drugs Adhere to the combination of market mechanism and government role, not only respect the market-oriented drug price formation mechanism, but also better play the role of the government in building a platform, promoting docking, ensuring supply and strengthening supervision Adhere to the comprehensive policy, improve the assessment mechanism, reward and punishment, fully mobilize the enthusiasm of medical institutions and medical personnel, improve the drug use structure, and guide the insured to use drugs reasonably Adhere to smooth transition and proper connection, handle the relationship between pilot work and existing procurement policies, and promote the reform of medical institutions by improving the policies of procurement, distribution, drug payment settlement and medical insurance payment （3） Main objectives To reduce the drug price and reduce the burden on patients; to reduce the transaction cost of enterprises, purify the circulation environment and improve the industry ecology; to guide medical institutions to regulate drug use and support the reform of public hospitals; to explore and improve the mechanism of centralized drug purchase and market-oriented drug price formation 2、 Work task (I) ensure to purchase and use with quantity 1 Clarify the main responsibility of the supply and distribution of the selected varieties In the pilot work of centralized purchase and use of drugs organized by the state, the selected drugs (hereinafter referred to as "the selected drugs") can be directly distributed by the selected enterprises, or according to the principle that no more than one distribution enterprise is entrusted by the whole city to distribute a selected drug, the drug manufacturers can independently establish and change the distribution relationship on the provincial centralized purchase platform of drugs and medical consumables The scope of distribution of drugs shall cover all regions of the city and have the ability and conditions to distribute the selected drugs to all medical institutions in the city within 24 hours It is not allowed to purchase the selected drugs through a third party In case of failure to fulfill the specified responsibilities and obligations, once confirmed, the distribution qualification shall be cancelled, and the pharmaceutical production enterprises and distribution enterprises shall be dealt with according to the relevant provisions of the state and the province During the implementation period, if the distribution enterprise is listed in the "illegal list", the selected drug manufacturer shall timely start the emergency plan, select other distribution enterprises, and ensure the timely distribution of the selected drugs 2 Define the responsibility of the procurement and use subject The public medical institutions in the administrative region of our city are the main purchasers of the selected drugs The selected drugs should be included in the drug prescription set and the basic drug supply catalogue of the medical institutions, and the requirements for prescribing according to the common name of drugs and the contract dosage of the selected drugs should be strictly implemented We should give full play to the role of clinical pharmacists, strengthen the examination and evaluation of prescriptions, and strengthen the examination of rational use of drugs Ensure timely settlement of drug payment, and the settlement shall be completed in the next month after the drug is put into storage, in principle, no more than 30 days For the situation that the use of selected drugs may lead to the adjustment of patients' drug use, each medical institution shall do a good job in clinical risk assessment, preparation of plans and material reserves, monitoring of drug use and emergency response, and explain to patients In case of any objection or breach of contract between the buyer and the seller during the performance of the contract, they can report or complain to the medical security department in time 3 Unblock the hospital procurement channels The public medical institutions shall unblock the channels for the selected drugs to enter the hospital, ensure that the selected drugs enter the hospital and are used preferentially, and shall not influence the purchase and use of the selected drugs on the grounds of the total expenses, "drug proportion", the requirements for the specifications and quantity of the drugs used by the medical institutions, the review by the pharmaceutical Committee and the account opening of the distribution enterprises; the medical institutions shall use the remaining drugs on the premise of ensuring the dosage of the selected drugs In principle, the quantity converted according to the proportional relationship shall not exceed the usage of the selected drugs 4 Explore and expand the scope of the pilot While focusing on the procurement task of public medical institutions, we should select some non-public medical institutions with high management level, information level and public recognition, and explore the implementation of centralized drug procurement （2） Ensure drug quality and supply 5 Strengthen drug quality supervision We will strengthen the supervision of selected drugs to ensure their quality and safety We will further strengthen the reporting and monitoring of adverse drug reactions, make a good plan for drug safety early warning and emergency response, and ensure the quality and reliability of selected drugs 6 Implement drug use monitoring The monitoring of the use of selected drugs shall be included in the overall monitoring of drug use, and the shortage of selected drugs shall be detected and forewarned in a timely manner, and the situation of insufficient and untimely supply shall be reported to the national, provincial and municipal pilot work leading group in a timely manner （3） Advance the working capital 7 Trial medical insurance direct settlement In order to ensure the safety of funds for centralized purchase of selected drugs, the medical insurance center, the production enterprise (or the distribution enterprise independently selected by the production enterprise) must set up a special purchase account Through the tripartite agreement signed by the medical insurance center, production enterprises and distribution enterprises, the corresponding funds will be allocated by the medical insurance fund as the working capital Through the special purchase account, the working capital will be prepaid in batches, i.e 50% for the first time, 45% for the remaining when the purchase cycle is half or the contract quantity is half implemented, and the last 5% of the working capital will be used for liquidation after the completion of the contract quantity 8 Monitor the payment collection of medical institutions As the first person responsible for drug payment settlement, medical institutions should settle accounts with enterprises in time according to the provisions of the contract to reduce the transaction cost of enterprises The health department and the medical security department shall urge the medical institutions to settle accounts with the enterprises in time according to the provisions of the contract, strictly check the problem of failing to settle drug payments in time, and take punishment measures such as interview and notification for the medical institutions and their responsible persons who fail to collect payments in time according to the requirements （4） Improve supporting policies 9 Clear payment standard For the national centralized procurement varieties, the selected price shall be taken as the payment standard of medical insurance within the scope of the medical insurance catalog In principle, the medical insurance fund shall implement the same payment standard for all designated medical institutions in the overall planning area for the original research drugs, reference preparations and generic drugs passing the consistency evaluation under the same general name If the price of drugs used by patients is higher than the payment standard, the part exceeding the payment standard shall be paid by the patients themselves If there is a big difference between the price of drugs used by patients and the centralized purchase price of selected drugs, the payment standard can be adjusted gradually and adjusted in place within three years; if the price of drugs used by patients is lower than the payment standard, the medical insurance settlement shall be conducted according to the actual price 10 Improve the balance retention mechanism Deepen the reform of medical insurance payment, establish the incentive and risk sharing mechanism of "surplus retention and reasonable over expenditure sharing" between medical insurance agencies and medical institutions, promote medical institutions to use the drugs with appropriate price, and reduce the operation cost of medical institutions Public medical institutions may, in accordance with the "two permits" (allowing medical and health institutions to break through the current wage control level of public institutions; allowing medical service income to deduct costs and withdraw various funds as required