The latest development of volume purchasing! The transformation track of drug bidding and purchasing reveals four signals!

Provincial limited price and renegotiated purchase let the front-line medical insurance designated institutions directly participate in the price negotiation of pharmaceutical enterprises On November 16, Ningde, the pilot city of limited price sunshine purchase in Fujian Province, released the second round of selected drugs in the joint negotiation On November 15, the notice on further promoting the experience of deepening the reform of the medical and health system in Fujian Province and Sanming City was released, which was the same one before and one after On November 16, Ningde City, Fujian Province announced the second round of joint negotiation on drugs to be selected According to rough statistics, there are about 190 catalogue varieties, including 11 Traditional Chinese medicine varieties and 179 western medicine varieties Except for gefitinib and montelukast sodium, they are basically non "4 + 7" varieties, including injection and oral administration From the catalog, in addition to commonly used drugs such as aspirin, antihypertensive drugs and hypoglycemic drugs have become the two major fields selected by drug companies, followed by cardio cerebrovascular drugs and mental drugs Catalog data shows that at present, metformin, one of the most commonly used oral hypoglycemic drugs, has been shortlisted in 106 dosage forms of 65 enterprises The situation of gliclazide, glimepiride and other diabetes drugs is similar The same is true of valsartan, nifedipine and other compression drugs The pressure of competition can be imagined In addition, five anticancer drugs, including trastuzumab, anastrozole, gefitinib, lenalidomide, and tegio, were shortlisted The indications were breast cancer, non-small cell lung cancer, multiple myeloma, gastric cancer, as well as the rare disease "blue lips", such as enrisontan Most of these drugs were selected by only two companies, the original research drug company and the first domestic drug imitator Geofitini, which is listed in the list of 25 varieties of centralized procurement, was selected as three winning enterprises As one of the two pilot cities of limited price sunshine procurement in Fujian Province, Ningde's pilot procurement rules are different from the previous "4 + 7" procurement and expansion procurement From the perspective of quotation rules, there are also differences The way of "price limit + price negotiation" is adopted to let the more sinking medical insurance designated medical institutions directly participate in the price negotiation as members of the "drug Consortium" The purchase of Ningde district is divided into two rounds of quotation: the lowest price of the first round of joint negotiation of Ningde district and all districts in the province is limited, and the first round of quotation is not higher than the provincial medical insurance maximum sales price and provincial online purchase price; in the second round, according to the first round of quotation, 50% from the low to the high, enter the second round, and the second round of quotation should be lower than the first round In terms of selection criteria, it is also different from centralized expansion procurement, and the number of winning bidders is not specified For competitive drugs, according to the principle of "single source, low price shortlist", they are grouped according to the provincial catalogue, and the lowest price in each group is directly shortlisted, and the next lowest price in the upper order is the alternative For non competitive drugs, according to the principle of "low price shortlisted + differential selection", they are divided into groups according to the provincial catalogue, with the lowest price in each group and the direct shortlisted ones meeting the differential selection conditions, and the next lowest price in the upper order as the alternative The distribution mechanism after procurement is also clear, which makes medical institutions more motivated to participate in negotiations and improve efficiency After the negotiation, the regional drug consortium will readjust the sales price of the corresponding drugs of the regional medical institutions In principle, under the provincial sales ceiling, 50% of the difference between the new negotiated price and the original negotiated price of the same group of drugs shall be transferred to the medical masses, and the remaining 50% shall be transferred to the medical institutions participating in the joint negotiation According to industry insiders, drug bidding and procurement started from 4 + 7 in 2018, showing signs of transformation Until 2019, joint procurement and expansion, drug bidding transformation is imminent The sunshine purchase in Ningde District of Fujian Province is just one direction of transformation On the basis of provincial price limit, the price negotiation purchase is carried out again The "drug consortia" participated by medical insurance designated medical institutions seems to be more "local" than the centralized purchase, especially in the distribution of subsequent drug price differences, it is more market-oriented There are three other signals of transformation: From the national level, through the 4 + 7 pilot and joint mining expansion, the bidding policy "mix" is implemented on the basis of "Fujian Sanming alliance procurement + Shanghai volume procurement" The group carries out strong price negotiation, volume price integration, full competition, centralized procurement, policy coordination, activate the use of medical insurance funds, adjust the drug structure, de channelize, and implement real volume procurement From the provincial level, the large-scale bidding procurement with the province as the unit is gradually weakened More likely, the provincial level further formulates the upper limit price through dynamic adjustment, and formulates the unified procurement demand catalog On the basis of the national 4 + 7 and the combined mining expansion policy, for the non evaluated varieties with high procurement amount and large consumption, the prefecture level cities or medical consortia implement the procurement with quantity, and implement the procurement share and medium The number of bid enterprises is linked, such as the draft of bidding scheme recently issued in Jiangxi Another possibility is to entrust a third party to lead and "let go" the medical institutions and enterprises to negotiate For example, Hainan just released the draft of bidding and procurement plan for comments Finally, GPO group began to expand from prefecture level city to provincial level On November 15, the Department of system reform of the health care Commission issued the notice on further promoting the experience of deepening the reform of the medical and health system in Fujian Province and Sanming City issued by the leading group of medical reform of the State Council Chen Qiulin, deputy director of the Research Center for health industry development of the Chinese Academy of Social Sciences, said that the impression was that in 2016, it was the notice on further promoting and deepening the reform of the medical and health system issued by the leading group of deepening the reform of the medical and health system of the State Council Several opinions on the experience of health system reform "is followed by another document to promote the experience Of course, this time it is more accurate to Fujian Province and Sanming City According to the document, in 2020, according to the unified deployment of the state, we will expand the scope of centralized procurement and use of drugs by national organizations Comprehensive medical reform pilot provinces should take the lead in promoting medical insurance agencies to directly settle payments with drug production or circulation enterprises, and other provinces should also actively explore All localities should explore centralized procurement by category for high-value medical consumables with large clinical dosage, high purchase amount, mature clinical use and produced by multiple enterprises Before the end of September 2020, comprehensive medical reform pilot provinces should take the lead in exploring.