What is the crux of the difficulty of "negotiating drug price"?

Source: Liao Haijin, August 4, 2016, needless to say, "national drug price negotiation" is a pioneering work for China, and also a win-win and meaningful exploration Its original intention is to allow specific drugs to enter the list of medical insurance, in exchange for the benefits of price reduction and profit sharing of relevant pharmaceutical enterprises, that is, "market for drug price" Generally speaking, it means "your enterprise will reduce the drug price, and my government will give the market scale" For the government, the use of national resources to increase negotiating power and greatly reduce the price of new drugs; for pharmaceutical enterprises, price for market is a long-term interest exchange In the past, if a new drug wants to enter the medical insurance, it can only wait for the medical insurance catalog to be updated, usually for several years However, through drug price negotiation, the time for a new drug to enter the medical insurance is much earlier in theory It is gratifying that, after more than half a year's hard work of relevant government departments, the first negotiation has achieved remarkable results The price of three expensive patent drugs has dropped by more than 50%, and the price of strong antiviral drugs for hepatitis B has dropped by as much as 2 / 3 However, it has been more than two months since the results of the national drug price negotiation were announced More than half of the provinces that are so popular for benefiting the people have not yet implemented the price negotiation, which is not a small gap with the ardent expectations of all sectors of society and many patients It is not difficult to find out that, in the current situation, the reasons why the national negotiated drugs are difficult to be included in the medical insurance are as follows: first, the original drugs in the local medical insurance list are enough to replace the newly included negotiated drugs, because the price is not too high, some provinces may feel that it is not necessary to introduce the negotiated drugs into the medical insurance list Second, it still takes time for the agreement to come into force after the negotiation, and the inventory purchased according to the previous price still needs to be shipped according to the past price, so there is a certain time difference between the national negotiated drug price and the final drug price Third, the medical insurance department is worried about the risk that the medical insurance fund will not be enough after the negotiation of drugs into the medical insurance In addition, this time, the government departments came to the negotiation to lock in three kinds of drugs for price reduction The government did not force all regions to be included in the list of Medicare drugs simultaneously Each province should measure the pressure on the Medicare fund according to local conditions, and according to their respective tolerance But most importantly, in addition to the local interests of the medical system, it is also largely due to the diversification of the medical insurance management system In the provinces where urban and rural medical insurance has not yet been integrated, the new rural cooperative medical system is the medical insurance fund in charge of the health and family planning commission system, while the management right of urban employees and urban residents lies in the human society system It can be seen that the real reason for the resistance in drug price negotiation lies in that the person responsible for price negotiation and the person responsible for paying the bill are not the same Specifically speaking, the health and Family Planning Commission is responsible for bargaining, but the human resources and social security department is responsible for paying the bill It is true that patented drugs and exclusively produced drugs are all hardliners in the drug procurement of various countries It is the responsibility of the government to carry out national drug price negotiations and make the prices of these hardliners return to the bearing range In fact, it has become an important means for many countries to organize price negotiation between relevant government departments and drug manufacturers on behalf of national interests, while it is a common practice for countries to organize price negotiation by medical insurance fund management department as the investor For example, in the United States, pharmaceutical companies negotiate with pharmaceutical wholesalers, insurance companies and other institutions to determine drug prices respectively, using scale effect to reduce prices, and at the same time, through patent protection system to ensure the profits of pharmaceutical companies National drug price negotiation has never been an isolated event What it involves is the coordination of functions of different competent departments, and even the redistribution of interests among different public groups In view of the current special period of health insurance integration of urban and rural residents, in this special period and reality, it is particularly important for different departments to strengthen coordination and complement each other, and promote the implementation of relevant medical reform policies through "three medical linkage", which can also better reflect the will and determination of the country to promote reform Drug price is closely related to people's livelihood It is expected that all relevant departments around the country will focus on people's livelihood interests, improve this system as soon as possible, break through the policy "obstruction", and take root and blossom the "negotiated drug price" as a "benefit to people"