Clopidogrel bisulfate, brand name Plavix, was originally purchased at 108.29 yuan per box in Jiangxi. After the state organized centralized procurement of medicines, it dropped to 17.81 yuan per box, a decrease of 83.55%; acarbose, brand name Baie Tang Ping, the original purchase price in Jiangxi was 56.6 yuan per box, and after the state organized centralized procurement of medicines, it dropped to 5.42 yuan per box, a decrease of 90.42%. The centralized procurement and use of drugs organized by the state has made these imported original research drugs, which have occupied a huge market share for many years but have remained high in price, finally "diving" and benefiting more patients.
In order to explore and improve the centralized drug procurement mechanism and the market-led drug price formation mechanism, reduce the burden on the masses of drugs, standardize the order of drug distribution, and improve the safety of drug use by the masses, the state initiated the implementation of the pilot centralized drug procurement at the end of 2018. Public medical institutions in 4 municipalities including Beijing and 7 cities including Shenyang and Guangzhou, as the main body of centralized procurement, formed a procurement alliance to carry out centralized procurement of medicines, clarified quantity procurement and linkage of quantity and price, which were called "4+7" pilot projects. In April 2019, 11 cities began to implement the results of the “4+7” selection. The average price of 25 selected drugs dropped by 52%, with the largest drop of 96%; in September 2019, the pilot project was expanded to the whole country, and 25 drugs were expanded. Afterwards, the average price will be reduced by 25% compared with the “4+7” pilot; in January 2020, the second batch of countries will organize the centralized procurement and use of medicines. The average price drop of 32 medicines will be 53%, with the highest drop of 93%; 2020 In August 2008, the third batch of countries organized the centralized procurement and use of drugs. 55 drugs were selected in 191 specifications, and the average price fell by 53%.
The centralized procurement of medicines organized by the state has greatly reduced the prices of high-priced imported drugs such as Polivier and Baitang Ping. The "patent cliff" of expired patent drugs has appeared for the first time in my country. The "patent cliff" refers to the phenomenon that after the patent period of an innovative drug has passed, the sales revenue of a generic drug with the same or similar curative effect drops sharply. In my country, a large number of original research drugs still maintain high prices for many years after the patent period. One of the important reasons is that the quality level cannot be distinguished, so it is difficult to achieve price reduction with the advantage of mass procurement while ensuring quality. In the centralized procurement and use of drugs organized by the state, only original research drugs and generic drugs that have passed the consistency evaluation are eligible to participate, and the quality standards are clearly defined. The purchase amount of each drug is agreed, and the purchase price formation mechanism is smoothed, so the price of each batch of drugs selected has fallen by more than half. At the same time, the direct settlement between medical insurance funds and pharmaceutical companies was promoted, and the time for drug collection to be reduced to less than one month, and corporate marketing and production costs were greatly reduced. Purchasing, payment, use, incentives and other supporting policies are linked, drug prices can be reduced, and drugs can be supplied, bidding farewell to the phenomenon of "only low prices are taken", "winning bids, and seeing the end". For the pharmaceutical industry, the state has come forward to organize "super group purchases", so that pharmaceutical companies can no longer "enclose gold and race", improve the ecological environment of the pharmaceutical industry, and facilitate the transformation of the pharmaceutical industry from marketing-driven to innovation-driven.
Let the small cuts of "4+7" volume procurement play a major role in promoting the "three-medicine linkage" reform of medical, medical insurance, and medicine. It is also necessary to continue to complete policies, handle several relationships, and actively promote centralized procurement to normalize.
Deal with the relationship between price reduction and quality assurance. On the one hand, scientifically evaluate the production cost of drugs, and on the basis of ensuring safety and effectiveness, purchase the most cost-effective drugs to ensure that "low-price bidding" does not move toward "low-price theory"; on the other hand, strengthen supervision services to ensure bidding Product market expansion and capacity expansion will reduce prices without degrading quality, and the consistency evaluation of generic drugs must not be turned into a "one-off evaluation" prepared by companies for passing the evaluation.
handle the relationship between market competition and industry promotion. It is necessary to improve the selection rules, increase the number of selected companies, force domestic pharmaceutical companies to transform, upgrade, and innovate by guiding companies to compete in a fair and orderly manner, encourage the promotion of generic drug consistency evaluation, and force the realization of the "patent cliff" of expired patent drugs. Agreed on the market procurement volume of winning drugs, and reserved market "vents" to avoid "instant suffocation" caused by 100% of the procurement volume. At the same time, for drugs that are not included in the scope of centralized procurement by the country, we will further improve the procurement of provincial platforms with the direction of volume procurement, and orderly guide and release corporate market expectations.
Deal with the relationship between "cage" and "bird exchange". Concentrated purchases made the "cage" free up, and the "birds" had to sing happily to achieve "free cages for birds". For the saved medical insurance fund, it is recommended that a certain percentage be awarded to the hospital to mobilize the enthusiasm of medical staff. At present, the National Medical Insurance Bureau and the Ministry of Finance have issued the "Guiding Opinions on the Retention of Chinese Medical Insurance Surplus Funds for Centralized Drug Purchase by the State," which clarifies the incentive policy for the retention of surplus and hopes to implement it as soon as possible.
Deal with the relationship between meeting the expectations of the masses and scientific and rational drug use. At present, there are 112 kinds of drugs purchased by the country in three batches, accounting for only 4.24% of the 2,643 kinds of drugs in the National Medical Insurance Catalog. On the one hand, we should comply with people’s expectations for good medicines, step up efforts to promote the consistency evaluation of generic drugs, and promote the expansion of national centralized procurement from over-rated drugs to non-under-rated drugs, from Western medicines to Chinese patent medicines, and from drugs to medicines. Medical consumables; on the other hand, strengthen publicity and guidance to let the masses know what is the consistency evaluation of generic drugs, dispel the masses' worries that generic drugs are inferior to the original research drugs, and create a social atmosphere conducive to reform.
Pharmaceutical procurement is related to the interests of thousands of households. We look forward to the continuous improvement of the national drug centralized procurement and use policy, to achieve normalized development, and to enhance the people's sense of gain, happiness and security.
(The author is a member of the Standing Committee of the Chinese People's Political Consultative Conference and Vice Chairman of the Jiangxi Provincial Committee of the Chinese People's Political Consultative Conference)