The State Health Insurance Administration issued guidance on the establishment of a system of evaluation of pharmaceutical prices and credit

On September 16th, the State Health Insurance Administration issued guidance on the establishment of a credit evaluation system for pharmaceutical prices and recruitment, aimed at combating the inflated prices of medicines and medical supplies caused by kickbacks and monopoly controls in the pharmaceutical sector, the excessive growth of medical expenses and the massive loss of medical insurance funds.
The full text is as follows: The Guidance of the State Medical Security Administration on the Establishment of a Medical Price and Credit Evaluation System For Medical Insurance (2020) No. 34 Provinces, Autonomous Regions, Municipalities directly under the Central Government and Xinjiang Production and Construction Corps Medical Security Bureau, Pharmaceuticals and Medical Supplies Centralized Procurement Agencies: The practice of giving rebates in the field of medicine, monopoly control and marketing results in inflated prices of medicines and medical supplies, excessive growth of medical expenses, large loss of medical insurance funds, and increasing the burden of medical treatment.
In order to implement the Opinions of the State Council of the CPC Central Committee on Deepening the Reform of the Medical Security System, promote the improvement of the market-oriented mechanism for the formation of pharmaceutical prices, promote pharmaceutical enterprises to set prices in accordance with the principles of fairness, reasonableness and good faith, and conformity with quality prices, and put forward the following guidance on the establishment of a system of evaluation of pharmaceutical prices and credit.
1. Guided by Xi Jinping's thought of socialism with Chinese characteristics in the new era, the guiding ideology fully implements the spirit of the Second, Third and Fourth Plenary Sessions of the 19th National Congress of the Communist Party of China, adheres to the innovation of drug price management, and relies on the bidding and procurement platform for pharmaceuticals and medical supplies, systematically integrates trustworthy commitments and credits. Rating, graded disposal, credit repair and other mechanisms, the establishment of recidies and responsibilities, coordination of the linked medical prices and credit evaluation system, promote honesty and trustworthiness of all parties, and jointly create a fair and standardized, clean circulation order and trading environment, and effectively protect the interests of the masses and the safety of health insurance funds, so that the people have more sense of access, happiness, security.
2. Establish a list of credit evaluation catalogues The State Medical Security Administration shall establish a list of medical prices and the list of matters of breach of trust, carry out dynamic adjustments, and the misinreliation items included in the catalogue include, among others, the granting of kickbacks or other improper benefits in the purchase and sale of medicines (hereinafter referred to as "pharmaceutical commercial bribery"), tax-related violations, the implementation of monopoly acts, improper price behavior, disturbing the centralized procurement order, malicious breach of contract agreements and other acts contrary to good faith.
From the date of issuance of this Opinion, pharmaceutical enterprises (including pharmaceutical production license holders, pharmaceutical and medical supplies production enterprises, distribution enterprises with a principal-agent relationship with the production enterprises, and distribution enterprises, the same below) shall be included in the scope of pharmaceutical prices and credit evaluation in the course of pricing, bidding, performance, marketing, etc., through the misconceptions listed in the catalogue.
Three, the implementation of the pharmaceutical enterprises actively committed pharmaceutical enterprises to participate in or entrusted to participate in the centralized procurement of pharmaceutical and medical supplies, platform network, as well as public medical institutions and medical insurance fixed-point non-public medical institutions (collectively, "medical institutions") for the record procurement, should be in the name of an independent legal person to the relevant drugs and medical supplies centralized The purchasing agency (hereinafter referred to as the "centralized purchasing agency") submits a written commitment, which includes establishing a compliance review system, eliminating misrepentation, regulating the sale of their own medicines or medical supplies by its employees (including employment relations) or distribution enterprises with a principal-agent relationship, assuming corresponding responsibility for failure of trust, accepting disposal measures, etc.
Fourth, the establishment of the loss of trust information reporting channels through the enterprise report and platform records combined way, timely, comprehensive and complete standardized collection of pharmaceutical enterprises in the loss of trust behavior information, the establishment of the loss of trust information bank.
pharmaceutical enterprises should take the initiative to report the information of the loss of trust to the provincial centralized purchasing agencies in the place where the loss of trust occurred.
Under the framework of cooperation between the State Administration of Medical Security and relevant departments, provincial centralized procurement agencies regularly comb through and summarize the judicial documents and administrative penalty decision documents disclosed or shared by the relevant departments, collect and record information on the failure of medical enterprises.
the daily operation of provincial centralized procurement agencies through monitoring, receiving reports and other means, grasp the pharmaceutical enterprises pricing, bidding, performance, marketing and other aspects of the misconduct information and record.
5. The provincial centralized purchasing agencies that carry out the credit rating of pharmaceutical enterprises shall implement the credit rating according to the requirements of reliable source, clear conditions, procedural norms and strict operation, and shall, according to the nature, circumstances, limitations, influence and other factors of the mis-trusting behavior, assess the disrelieverability of pharmaceutical enterprises in the local bidding and procurement market as general, medium-, serious and particularly serious, and update them dynamically on a quarterly basis.
the facts on which the breach of trust or credit rating is based on the violation of the law shall be determined by a court decision or administrative penalty decision.
The State Administration of Medical Security authorizes and guides the guidance center for supervising pharmaceutical prices and tendering and procurement to formulate operational norms for credit evaluation and discretionary benchmarks for credit ratings, and standardizes the work of credit evaluation ratings in various regions.
provinces (districts and cities) can explore the credit rating method of quantitative scoring and raise the standardized level of credit rating on the basis of the operational norms and discretionary benchmarks formulated and issued by the state.
6. According to the credit rating of pharmaceutical enterprises, the provincial centralized purchasing institutions shall, in accordance with the credit rating of pharmaceutical enterprises, take written reminders and warnings, rely on centralized procurement platforms to prompt the purchaser of risk information, restrict or suspend the relevant drug or medical supplies hanging network, restrict or suspend the procurement of related drugs or medical supplies, disclose the breach of trust information and other disposal measures.
the supply structure of related drugs or medical supplies is single and the supply and demand situation is tight, graded disposal measures are taken on the basis of ensuring supply.
, encourage pharmaceutical enterprises to repair credit to establish credit repair mechanism for pharmaceutical enterprises.
the act of misreponsment has been confirmed for more than a certain period of time, and if the relevant judicial judgment or administrative penalty decision has been revoked or changed in accordance with the law, the record shall be retained but shall no longer be included in the credit rating.
provincial centralized purchasing institutions shall remind pharmaceutical enterprises before the disposal measures take effect, and shall, depending on the circumstances, give certain complaints and rectification periods, and allow enterprises to supplement the corrective information and statement of complaints.
Encourage enterprises to take practical measures to take the initiative to repair credit, including terminating the relevant unconscionable acts, disposing of those responsible for the failure of trust, submitting compliance rectification reports and accepting compliance checks, publicly issued apology statements to eliminate adverse effects, eliminating the false high space in the prices of drugs or medical supplies involved, returning or public welfare donations of unreasonable income, effective proof of the actual control subject of the misconduct.
8. The correct use of pharmaceutical prices and recruitment credit evaluation of provincial centralized procurement agencies to implement pharmaceutical prices and credit evaluation, should accept the guidance and supervision of provincial medical security departments, adhere to the objective facts as the basis, laws and regulations as the criterion, market mechanism as the guide, based on the relationship between the sale and purchase of contracts, to ensure that pharmaceutical enterprises enjoy independent pricing, independent management rights in accordance with the law, not in the name of pharmaceutical prices and credit evaluation system, the implementation of local protection and destruction of fair competition.
9th, jointly promote the construction of credit evaluation system provincial medical security departments should, by the end of 2020, guide and supervise the province's centralized procurement agencies to establish and implement the medical price and credit evaluation system.
Adhere to the principle of co-construction and sharing, promote the active participation of pharmaceutical enterprises and medical institutions, guide pharmaceutical enterprises to conscientiously fulfill their obligations to abide by price rules and operate in good faith, and guide medical institutions to give priority to the selection of pharmaceutical enterprises with better credit ratings as supply or distribution units under the same conditions.
centralized procurement agencies should further promote the standardization and standardization of construction, improve bidding and procurement services, make full use of information technology, for pharmaceutical enterprises to submit commitments, record information, repair credit and other convenient and efficient services and support.
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