Should purchasing with volume be carried out comprehensively or prudently?

Today (May 27), a PDF document signed by 14 pharmaceutical industry associations was forwarded in wechat group The report (hereinafter referred to as the report) submitted to the National Health Insurance Bureau suggested that the new round of pilot drug centralized purchase should be promoted prudently 14 industry associations, including pharmaceutical industry associations in 13 provinces and cities including Zhejiang, Jiangsu, Shanghai, Shandong, Anhui, Jiangxi, Fujian, Tianjin, Shaanxi, Guizhou, Sichuan, Chongqing and Henan (Jiangsu includes pharmaceutical industry associations and pharmaceutical business associations) It is confirmed that the report was jointly issued by 14 industry associations in the 13 provinces and cities mentioned above The report puts forward the problems existing in the 4 + 7 centralized purchase The report believes that the centralized purchase of drugs is a complex system engineering, which should not only bear the impact of the long-standing institutional and institutional defects in the field of medical and health reform, but also take into account the impact of the healthy development of the pharmaceutical industry on the drug supply and security system According to the reports of many local enterprises, the lowest price bid winning and exclusive bid winning adopted by 4 + 7 centralized mining, as well as the bidding mode named "only low price is taking" in fact, have brought about an undeniable negative impact on the pharmaceutical industry, hit the advanced enterprises, weakened the industry's R & D innovation and long-term innovation ability, dampened the enthusiasm of carrying out consistency evaluation, and even led to listed enterprises The market value has shrunk by 500 billion, triggering a rapid spread of pessimism Although the clinical use of 25 products in 11 pilot cities has achieved the expected results, to some extent, it is the result of administrative intervention There are many specific problems in the implementation, which affect the durability and replicability of the 4 + 7 model In this regard, the report makes several suggestions Among them, it is suggested that "it should be carried out prudently on the basis of summing up experience", and that on the basis of systematic summary and report, the opinions of industry associations or enterprises should be listened to, and then the progress should be carried out in an orderly manner in grades, batches and classifications It is suggested that "all provinces and cities should not blindly compare the 4 + 7 centralized mining mode" and that non pilot areas should put an end to the bidding and mining behavior without considering the preconditions such as volume price linkage We should firmly abandon the guidance of "only low price is to take" such as "winning the bid at the lowest price", "winning the bid exclusively" The bid winning price should be reasonable rather than the lowest, and the winning enterprises should be several rather than exclusive It is suggested to refuse the lowest price seriously deviated from the international price level and to open up the independent purchase of drug purchase and sale platform For the collection of varieties, anti-tumor, diabetes, antibiotics and other fields should be selected In addition, the report suggests that we should severely punish the dishonest default of payment To speed up the reform of medical insurance payment, the payment standard of medical insurance should stipulate that the same general name should implement the same payment standard, not simply adopt the lowest price as the standard Timely adjust the price of winning products, etc Since the implementation of 4 + 7 centralized purchase in March, according to the relevant news reports, it has achieved better than expected results On April 16, Chen Jinfu, deputy director of the state health insurance bureau, said at a regular briefing on the State Council's policies that on April 1, 11 pilot cities had launched the national drug centralized procurement in an all-round way As of 24:00 on the 14th, the total purchase amount of 25 selected varieties in 11 pilot areas reached 438 million pieces, with a total amount of 533 million yuan, 27.31% of the total agreed purchase amount While 11 pilot cities have been implemented successively, whether non-4 + 7 areas follow up or not is also a topic that the industry has been highly concerned about For this, the repeated statements of senior officials, as well as the attitude of provinces and cities, are worth pondering The shock brought by 4 + 7 centralized mining to the industry has not been dissipated In fact, the purchase of the second tire volume has begun to brew and is on the way! On April 3, Premier Li presided over the executive meeting of the State Council, at which he listened to reports on centralized drug procurement, drug shortage supply and medical assistance, and demanded that more people benefit from drug use and medical treatment It has been proposed that the volume procurement should be fully promoted On May 17, news came from the national teleconference of medical reform work The next step of medical reform work will timely improve and comprehensively push forward the centralized drug purchase system organized by the state, and promote the reduction of the virtual high price of drugs and high-value medical consumables In non-4 + 7 regions, provinces and cities are also ready to move On May 20, Fujian Province issued relevant documents and interpreted them to make it clear that the province fully followed up the pilot work of centralized drug purchase and use organized by the state, and planned to purchase and use 4 + 7 selected drugs uniformly by public medical institutions in the province from June 1 This is the first province in China to fully follow up the pilot of centralized purchase and use of drugs (only Xiamen is a 4 + 7 pilot city in Fujian Province) May 22, Wuxi City, Jiangsu Province The key points of health work of the whole city in 2019 were printed and distributed, in which it was mentioned to strengthen the guarantee of drug supply, to cooperate with the medical insurance department to deepen the sunshine procurement of drugs and medical consumables, to implement the provisions of online procurement of drugs in public hospitals, to link with the "4 + 7" volume procurement price of national products, and to do a good job of lowering the price of drugs into hospitals To explore the volume procurement, unify the coding of drugs, medical consumables and equipment, establish an information platform for online procurement and use monitoring of drugs, medical consumables and inspection and testing reagents in medical institutions, and continuously reduce the price and water content of drug consumables In the middle of April, it was also reported that Tangshan City, Qinhuangdao City, Handan city and Wuhan city of Hubei Province intended to link 4 + 7 centralized purchase price or carry out volume purchase Jiangxi Province and Taiyuan city of Shanxi Province have also issued documents to report the use of 4 + 7 selected varieties, so as to prepare for the next related work In this context, non-4 + 7 regions have the intention of following up, linkage and even specialized volume procurement If according to the instructions of the high-level meeting, it is only a matter of time before the national comprehensive promotion of centralized procurement Therefore, it is also understandable that relevant pharmaceutical enterprises put forward their own demands through industry associations However, with the implementation of 4 + 7 centralized mining in pilot cities, the industry mentality is gradually changing Before 4 + 7 centralized mining, the general psychology of the industry was that this was just a new procurement method, and price reduction was inevitable, but it was "impossible" to reduce price by 96% After the results of centralized mining were selected, this expectation was shattered by the tragic price and decline, and the industry turned from wait-and-see to pessimism It is said that on the night of December 7, some projects with consistency evaluation were suspended or terminated by the entrusting party, even at the cost of paying liquidated damages and undertaking early investment Therefore, there is a saying that "only the evaluation is equal to death, and if the evaluation is excessive, it is death seeking" Many people think that under the sharp drop in price, all the inherent marketing models have failed In the future, enterprises should not marketing? Is the collective "holiday" in the pharmaceutical industry? However, with the implementation of 4 + 7 centralized mining, pessimism has gradually turned into an instinctive response to survival Trauma is objective, and enterprises also need to survive and develop The expectation and result of the policy implementation, the development trend of the next step policy and the intense market competition all force the pharmaceutical enterprises to face the reality So, we saw that the selected enterprises were destroying the city and pulling out the villages A selected enterprise revealed to us that the antidepressant drugs of the enterprise were sold only in parts of Sichuan before 4 + 7 After the selection, the company "developed 20-30 hospitals on average every day" in 11 cities, "no need to sell at all, just business." After the failure of 4 + 7 centralized purchase, some unsuccessful enterprises will see the opportunity and enter the market decisively at or below the selected price through "record purchase" and "direct online" in various provinces and cities However, some of the original non selected varieties failed to pass the consistency evaluation, or failed to catch up with the 4 + 7 centralized purchase opportunity At this time, 11 pilot cities faced the situation of volume and price falling together In order to ensure the purchase and use of the selected varieties, the price and purchase quantity of the non selected varieties were suppressed Different opinions on the "proposal report" of the pharmaceutical industry association since the 4 + 7 centralized purchase price has been formed and the base plate of the quotations of the enterprises not selected has been shown, even if the next step of centralized purchase is postponed, the price rate will be low or not high The consistency evaluation policy is also irreversible Even if we choose to wait and see now, we still need to pass it in the future to keep the approval Smart and powerful pharmaceutical companies have been working on their own for a long time, and the consistency evaluation has entered 2019 From the data point of view, the progress of work has accelerated significantly Therefore, when the report of 14 pharmaceutical industry associations was spread in the circle of friends, the opinions of the insiders on the demands of the association were also different Many people think that we should put an end to the vicious competition that only low price is the price Only in this way can the pharmaceutical industry have the power of innovation Especially in the context of trade friction between China and the United States, how can domestic enterprises compete with each other? The trade association should have put forward such a demand! Some people expressed different views They believed that the 4 + 7 centralized purchase in the domestic and international background is the inevitable product of the development of policy and market to a certain stage The price of expired patent drugs must be reduced, and the price of generic drugs must be reduced if they want to participate in the competition, which is the way of global generic drugs 4 + 7 centralized purchase can not only purchase drugs at a lower cost, but also clean up drugs with low level of repeated construction and homogenization on the supply side, indirectly cut corners on long-term gold sales Opposing 4 + 7 centralized purchase is opposing backwardness itself! However, some friends also hold a more eclectic view In their view, volume purchase is to be carried out, but it is still in the observation and inspection stage Whether 4 + 7 is successful and whether it can guarantee the purchase volume and timely payment remains to be tested in time Blindly following the trend all over the country will only create problems for policy makers and make the next step of policy formulation difficult It is understandable that entrepreneurs take into account the interests of their own enterprises, but it also requires wisdom to transmit these appeals through the association! Of course, we also see that the joint meeting of 14 pharmaceutical industry associations was held on May 8, 20 days from now In these 20 days, not only the national medical reform teleconference was held (it is required to timely improve and comprehensively implement the volume procurement), but also Fujian issued the notice of the provincial linkage 4 + 7 centralized procurement At the same time, all provinces and cities are in full swing through the work of consistency evaluation and record procurement, and all major pharmaceutical companies are also taking the opportunity to enter the market From this point of view, the game among policy, market and pharmaceutical enterprises persists, and how to balance "political correctness" with the so-called correct policy? Let's do a little research