It Is Related To The Centralized Procurement Of Drugs, And The Price Of Drugs May Be More Reasonable

1. Diversified centralized procurement, standardized guidance for diversified procurement

Recently, the National Health Insurance Administration mentioned in the "Letter on the Response to the Proposal No. 04081 (Medical and Health No. 377) of the Fifth Meeting of the 13th National Committee of the Chinese People's Political Consultative Conference" that it is necessary to standardize and guide diversified procurement.

"Provincial and inter-provincial alliances collectively collect drugs other than national centralized procurement varieties. For drugs other than national and local centralized procurement, the provincial pharmaceutical procurement platform is implemented for online procurement, and for such drugs, under the guidance of the medical insurance department, medical institutions can carry out joint procurement, special procurement or entrust a third party to carry out group procurement, forming diversified procurement. ”

Xu Yucai, former deputy director of the Shanyang City Health Bureau in Shaanxi Province, told Cyboran that there may be four diversified procurement methods, namely national centralized procurement; Provincial/inter-provincial alliance collective procurement; In the form of medical alliances, medical communities, specialty alliances, etc., the alliance of medical institutions shall carry out collective procurement by itself, and limit the varieties purchased; Entrusting a third-party institution for centralized procurement may be through some market transactions and procurement on social platforms, especially for specialized drugs.

Previously, drugs were purchased by public medical institutions, mainly at the prefecture level, and later at the county level, in order to reduce the shortcomings in the circulation link, but the rules were very different in different places. After the reform of the original health commission, a provincial-level centralized procurement model was gradually formed, and the bidding and procurement of public medical institutions in a province were concentrated on the provincial-level platform.

It is worth noting that whether it is centralized procurement carried out by public medical institutions, national procurement, provincial/inter-provincial alliance centralized procurement, etc., a single form of centralized procurement mode is difficult to meet all the clinical drug needs of medical institutions.

In February this year, at the State Council's regular briefing on the progress of the State Council's policy on deepening the reform of centralized procurement of drugs and high-value medical consumables, Chen Jinfu, former deputy director of the National Health Insurance Administration, said, "A large number of procurement should be carried out through provincial alliances, and even some need to have third-party procurement, such as small consumables, including some procurement by hospitals." ”

In fact, there are precedents for public medical institutions themselves to take the lead in collective procurement.

On May 28, 2021, Quanyao.com issued the Notice on Carrying out the Procurement Registration of Pharmaceutical Groups in 2021 (Part I) of the Procurement Catalogue of Shenzhen Public Hospital Pharmaceutical Group (Second Batch). The market of Shenzhen GPO is not only Shenzhen, but also includes Guangxi, Jilin, Heilongjiang, Xinjiang and other places, forming a cross-regional alliance of 22 cities, involving 2,531 medical institutions;

On August 31, 2021, Henan Province decided to establish the Henan Provincial Public Medical Institutions Drug and Medical Consumables Procurement Alliance; On August 11, 2022, Ningxia announced the formation of a procurement alliance by 82 public medical and health institutions.

At present, whether it is Henan Province or Ningxia Hui Autonomous Region, it has been stipulated that the purchase price of the public hospital procurement alliance will be the price of the subsequent listing of their respective provinces, which further clarifies the significance of centralized procurement by public medical institutions.

The above experts pointed out that although the national procurement and provincial/inter-provincial alliance centralized procurement have been carried out many times, there are still some situations that are difficult to meet the needs of medical institutions, so the National Health Insurance Administration may consider other procurement models. Medical institutions are allowed to independently negotiate prices for limited varieties, and centralized procurement guided by public medical institutions will be more in line with the needs of clinical drugs.

For a long time, public medical institutions have been the main institutions for clinical medicine, and there is still the freedom to use drugs. Although public medical institutions may continue to take the lead in centralized procurement in the future, it is very different from before. In terms of procurement varieties, restrictions will be imposed, and the National Health Insurance Administration has clarified that the varieties collected are drugs other than national and local centralized procurement. This also avoids the situation of drug bargaining layer by layer, as low as the "floor price", and thus avoids reducing the enthusiasm of enterprises to participate in collective procurement.

Dong Zecheng, marketing director of a domestic pharmaceutical company, believes that public medical institutions need a unified platform to organize drug procurement on their own, and multiple medical institutions can better control drug prices by centralized procurement and information disclosure.

 

2. Full coverage of centralized procurement? Drug prices may be more reasonable

From the reply of the National Health Insurance Administration, it can be understood that varieties other than national procurement and provincial/inter-provincial alliance collective procurement may still face centralized procurement later, and the coverage of centralized procurement will become wider and wider.

This can also be seen in the first part (I) of the procurement catalogue of Shenzhen Public Hospital Drug Group (second batch), Shenzhen GPO (second batch) involves 140 varieties and 154 product specifications.

The above-mentioned experts said that although corporate profits will face a decline in corporate profits for centralized procurement, the "floor price" of drugs may decrease after becoming more and more inclined to market-guided prices in the later stage.

From the perspective of specific price reduction effects, in July 2016, in order to solve the problems of inflated drug prices, "medicine to support doctors" and "large prescriptions", Shenzhen launched the pilot work of procurement reform of public hospital drug groups. According to CCTV News, the reduction rate of commonly used drugs for some major and chronic diseases exceeded 50%, the reduction rate of tumor drugs reached 70%, and the comprehensive reduction rate was 21.99%. In 2018 alone, Shenzhen saved 1.516 billion yuan in medical expenses.

After the successful implementation of the GPO model in Shenzhen, it has caused imitation and promotion in various places.

In 2019, the Jilin Provincial Medical Insurance Bureau publicly listed the "Jilin Province Guiding Opinions on Carrying out the Pilot Work of Cross-regional Alliance Procurement of Drugs (Proxy Draft)" to solicit comments, pointing out that on the basis of the pilot cities implementing the results of centralized procurement of drugs organized by the state, the state will make unified deployment, expand the scope of procurement regions, organize relevant regions to form alliances, and carry out cross-regional alliance centralized procurement of drugs.

At present, the state has carried out seven batches of centralized procurement, purchasing a total of 294 kinds of drugs, mainly concentrated in the field of chemical drugs and biological drugs, accounting for 35% of the procurement amount of chemical drugs and biological drugs in public medical institutions, and the average price of selected drugs has been reduced by more than 50%. Proprietary Chinese medicines have also been collected and procured in the form of provincial and inter-provincial alliances.