Shenzhen drug price fight is imminent, GPO scheme is officially launched

Source: medicine local station July 5, 2016 today, the notice of Shenzhen health and Family Planning Commission on printing and distributing the pilot implementation plan of Shenzhen public hospital drug group procurement reform (hereinafter referred to as the "official draft") was published on the website of Shenzhen health and Family Planning Commission Shenzhen GPO, which has attracted much attention before, has finally been officially launched At the beginning of May, Shenzhen Municipal Office of medical reform solicited opinions on the implementation plan of drug supply and security system reform in Shenzhen public hospitals (hereinafter referred to as the "draft for comments") The draft said that since July, the group procurement reform pilot project has been launched in Shenzhen public hospitals, some of which have caused a great deal of noise in the industry First of all, the draft requires GPO to promise to reduce the average price of all drugs in the group procurement catalogue by 30% compared with 2015 Secondly, with regard to the conditions of GPO, there are four items listed in the draft, and few enterprises can basically meet these four requirements at the same time It can even be said that "tailor-made" points to the whole drug network - and the controlling shareholder behind the whole drug network, Haiwang Group, has the production and sales of drugs And in the draft, there is not too much restriction on the power of GPO The whole pharmaceutical network, or Haiwang Group, is likely to "be both a referee and an athlete" Both the production enterprises and the circulation enterprises are in the fear of "being replaced" Because of this, the draft has met with resistance from all sides However, by the end of June, the implementation plan of Shenzhen public hospital drug group procurement reform pilot (Draft for review) (hereinafter referred to as "draft for review") was still out Shenzhen GPO has taken another step forward However, compared with the draft for comments, the draft for review has changed a lot First of all, even the file name has changed! Secondly, the basis of the two documents has changed! The guidance of the general office of the State Council on promoting the healthy development of the pharmaceutical industry (GBF [2016] No 11) mentioned in the draft was deleted from the draft for examination The relevant content in the text is also deleted Therefore, the draft for review is more concentrated than the draft for comments, which directly refers to the group procurement reform As for the changes in the content of group procurement reform in the two drafts, there are also several major ones For example, the selection conditions of GPO were modified, and the Internet procurement platform was changed from pre condition to post selection construction; for example, it was proposed that "the group procurement organization shall not directly participate in the production and distribution services of drugs in the group procurement catalog", avoiding the "customized" conditions of the whole drug network that were questioned at the beginning, and Haiwang Group "to be both a referee and an athlete" Sensitive behavior More importantly, the original wording of "the average price reduction of drugs reaches 30%" was changed to "the total purchase cost of drugs reduces by more than 30%" On the one hand, the change of the wording requires higher price reduction (the total purchase cost includes drug price, distribution cost, GPO service cost, etc.), on the other hand, it makes variety replacement more reasonable and standardized However, there are still many unclear points in the draft For example, as mentioned earlier, "the group purchasing organization shall not directly participate in the production and distribution services of drugs in the Group Purchasing Directory", how to define the "group purchasing organization"? Independent legal person? Or a holding group? In addition, there are two questions left by some wording in the draft for review: one is about the drugs not included in the group procurement catalogue, which is expressed as "the public hospitals shall organize the procurement by themselves, and file on the drug management platform of Shenzhen public hospitals (hereinafter referred to as the Municipal Drug management platform)." Does the "self-organized procurement" need to be conducted on the third-party drug trading platform of Guangdong Province? Second, as for the pilot hospitals, do all public hospitals in the city participate in the pilot? If so, why does the draft propose "expanding the coverage of the group's procurement catalogue and the number of public hospitals participating in the pilot project" one year later? Today, the official draft is finally released This version is similar to the previously circulated draft for review, with only a few changes, most of which are more rigorous wording changes The changes in specific data include: for the requirements on the proportion of drugs in 2017, the official draft is 27% (25% of the draft for comments, and 30% of the draft for review); the official draft specifies the coverage of the group procurement catalogue - the top 80% of drugs purchased by public hospitals in the city In addition, when determining the supply brand and price of drugs by GPO, a sentence "and fully consult with the expert committee" was added to make some restrictions (but not strong) on the power of GPO For the decrease of drug price obtained through GPO, the draft submitted for review proposed that "50% of the drug revenue of public hospitals will be reduced year on year as the total amount control quota to increase the price of medical service items reflecting the value of technical services of medical personnel", but the formal draft did not have such a statement, just said that "to make room for adjusting the price of medical services" I wonder if the GPO in Shenzhen will continue to repeat the story of "no more birds than cages"? As for the questions left in the draft, the definition of GPO is still unclear, and there is no answer to whether the hospital can break through the third-party drug trading platform of Guangdong Province by organizing procurement by itself, but there is no longer "expanding the number of public hospitals participating in the pilot", it seems that all the public hospitals in the city have participated in the pilot It is an important content and "breakthrough" of deepening the reform of medical and health system to carry out the pilot implementation plan of drug group procurement reform in public hospitals in Shenzhen, improve the centralized procurement of drugs in public hospitals, and reduce the virtual high price of drugs In order to reduce the burden of medical expenses, curb the unhealthy trend of the medical industry and promote the healthy development of the medical industry, according to the guidance of the general office of the State Council on improving the centralized procurement of drugs in public hospitals (GBF [2015] No.7), the implementation opinions of Shenzhen Municipal people's Government on deepening the reform of the medical and health system and building a strong health city (Shenfu [2016 No 14), this plan is formulated 1、 The general requirements are to deepen the transformation of government functions in the field of pharmaceutical purchase and sale, promote the simplification of administration, decentralization, combination of management and optimization of services, adhere to government guidance and market leadership, pilot the establishment of drug group procurement mode, entrust a third-party drug group procurement organization (hereinafter referred to as the group procurement organization) to be responsible for the unified procurement of clinical commonly used drugs in public hospitals in the city, and implement it "Purchase with quantity", organize fixed-point production, fixed-point purchase, negotiation and price negotiation, reduce drug circulation link and drug purchase cost We will promote "Internet + medicine", open and transparent information on drug purchase prices and quality levels, extend the modern logistics supply chain of medicine to public hospitals, and reduce the cost of pharmaceutical services Through the pilot reform, the following four goals have been achieved: (1) drug supply prices have been significantly reduced During the pilot period, the total cost of drugs purchased in a centralized way decreased by more than 30% compared with the total cost of drugs purchased in the same quantity and specification on Guangdong Drug electronic trading platform (hereinafter referred to as the provincial platform) in 2015 （2） The level of clinical rational drug use was improved By 2017, the proportion of drug revenue in business revenue of the city's public hospitals had dropped to less than 27% （3） Malpractice in the field of medicine has been curbed The purchase, distribution and clinical use of drugs in public hospitals are more standardized and orderly, and commercial bribery in the field of medicine purchase and sale has been effectively curbed （4） The ability of drug supply guarantee has been enhanced The market-oriented, large-scale, intelligent and sunshine level of drug supply guarantee has been improved in an all-round way, and the supply guarantee capacity of commonly used low-cost drugs, women's and children's specialty drugs, first-aid and rescue drugs, and drugs in short supply in the market has been enhanced 2、 Reform measures (1) pilot the establishment of drug group procurement mode Based on the principle of "ensuring supply, quality, safety, efficiency, fairness and justice", a group of commonly used clinical drugs will be selected and centralized procurement will be carried out in public hospitals throughout the city A pharmaceutical trading enterprise shall be selected as a third-party group purchasing organization, which shall be responsible for the centralized, volume and price limited purchasing of pharmaceuticals in the city's public hospitals, and establish a collaborative mechanism for pharmaceutical purchasing and distribution with the city's public hospitals and other pharmaceutical production and trading enterprises, so as to ensure the reliable quality, reasonable price and timely supply of pharmaceuticals 1 Establish group purchasing directory management specifications The municipal administrative department of health shall take the lead in formulating the Interim Measures for the administration of drug group purchasing catalogue of Shenzhen public hospitals (hereinafter referred to as the "measures for the administration of drug catalogue") to clarify the principles, procedures and supervision and management measures for drug selection The municipal public hospital pharmacy Expert Committee (hereinafter referred to as the expert committee) is composed of hospital pharmacy, clinical medicine and other experts Based on the big data analysis and systematic evaluation of rational drug use, and combined with the clinical drug use practice, the Shenzhen Public Hospital Pharmaceutical Group procurement catalogue (hereinafter referred to as the group procurement catalogue) is prepared The "group procurement catalogue" shall cover the top 80% of drugs purchased by public hospitals in the city, as well as commonly used low-cost drugs, women's and children's specialty drugs, first-aid and rescue drugs, and drugs in short supply in the market, and specify the general name, dosage form and specification of each drug The catalogue shall be adjusted once a year The "one product, two regulations" are implemented in the group's procurement catalogue The varieties of drugs with the same general name, injection type and oral dosage form shall not exceed two respectively, and the prescription composition shall be 1-2 compound preparations with the same type, taking into account the drug needs of adults and children, except for the use of other dosage forms and dosage specifications for special diagnosis and treatment According to the pilot situation, gradually expand the variety coverage of the group procurement catalogue, and gradually achieve full coverage For drugs not included in the group procurement catalogue, public hospitals shall organize procurement by themselves and put them on the drug management platform of Shenzhen public hospitals (hereinafter referred to as the Municipal Drug Management Platform) (municipal health and Family Planning Commission, medical management center) 2 Establish group purchasing organization management standards The municipal public health administrative department shall take the lead in formulating the Interim Measures for the administration of drug group purchasing organization of Shenzhen public hospitals (hereinafter referred to as the "measures for the administration of group purchasing organization") to clarify the basic conditions, selection procedures, work responsibilities, operation specifications and supervision and management measures of group purchasing organization The purchasing organization of the group shall hold a valid drug trading license and drug GSP certificate, and have the ability to purchase all drugs in the group purchasing catalogue The health, finance, drug supervision, medical insurance fund management, hospital management and other departments shall participate in the establishment of the municipal public hospital drug group purchasing organization Selection Committee (hereinafter referred to as the selection committee) In accordance with the principles of openness, fairness and fairness, one group purchasing organization shall be selected for a one-year pilot work The purchasing organization of the group shall promise: the total cost of drugs entrusted for centralized purchase during the pilot period,