Recently, the National Health Insurance Bureau revealed that relevant departments had held a symposium in mid July to listen to experts' opinions and suggestions on the centralized procurement of biological products (including insulin) and Chinese patent medicines, study and improve procurement policies in relevant fields, and promote the reform of procurement methods.
Industry insiders said that the signal of further expanding the scope of centralized procurement in China was clear. Although the Chinese patent medicine market had its particularity compared with chemical medicine, it should be noted that the price reduction of drugs was an inevitable trend, and Chinese patent medicine was no exception. In this context, the market of Chinese patent medicine with a scale of more than 300 billion yuan will enter the "shuffle" stage with the purchase in volume, and the performance of Chinese patent medicine enterprises will be affected accordingly, if the market is fully competitive or the varieties with large consumption are included first.
Many places have taken the lead in carrying out pilot projects
In late July, Qinghai Provincial Drug and Medical Consumables Centralized Procurement Network released the negotiated price list of drugs purchased in quantity by public medical institutions in Qinghai Province and the proposed winning results of drugs purchased in quantity by public hospitals in Qinghai Province. The results showed that Xueshuantong injection, Xuesaitong for injection (freeze-dried), Xiyanping injection Large varieties such as Xuesaitong capsules are included in the centralized purchasing drug catalog.
Prior to this, Zhejiang and Liaoning provinces have also experimented with local procurement of Chinese patent medicines in quantity. On June 8, Jinhua City, Zhejiang Province issued the Announcement on Carrying out the Second Batch of Drug Purchase in Jinhua City, which showed that the number of varieties purchased in this round was up to 274, involving a total purchase amount of 600 million yuan, including 147 Chinese patent medicines (excluding low-cost drugs) and 33 Chinese patent medicines (including low-cost drugs), including Compound Houttuynia Mixture, Niuhuang Shangqing Capsules, Qingkailing Granules Shufeng Jiedu capsule, Shenmai injection, Qiangli loquat dew, Bailing capsule, Liuwei Dihuang pill, Anshen Bunao liquid, etc.
It is worth noting that Jinhua City has made clear the payment policy for this purchase with volume at the same time. For the drugs of the same negotiating variety and the same bidding group, the actual purchase price of the selected variety shall be taken as the medical insurance payment standard. All medical institutions implement zero margin sales. All medical institutions use drugs of the same selected variety that are higher than the medical insurance payment standard, and the part that is higher than the medical insurance payment standard will not be settled by the pooling fund; If it is lower than the medical insurance payment standard, it shall still be settled according to the original medical insurance payment standard. The designated drugstore for medical insurance shall sell at the price not more than 15% higher than the selected price.
In addition, as for the purchase volume, Jinhua City has made it clear that relevant medical institutions will calculate and report the estimated purchase volume of the next year. In principle, 60% of the use of anti infective drugs in the previous year will be counted; The statistics of Chinese patent medicines shall not exceed the use amount of the previous year, and the statistics of Chinese patent medicines listed in the monitoring directory shall not exceed 80% of the use amount of the previous year.
For the drugs that have entered the purchase directory but have not been selected by enterprises, the member units of the Municipal Procurement Alliance are encouraged to choose high-quality and low-cost alternative drugs. At the same time, 50% of the amount of drugs used in the previous year will be used in accordance with the drug specifications of the enterprises that have not been selected. Each medical insurance agency shall prepay 30% of the agreed purchase amount to the medical institution as the revolving fund of the medical institution within one month after the execution of the contract. The member units of the Municipal Procurement Alliance shall improve the collection rate, settle accounts with enterprises in a timely manner according to the provisions of the agreement, and the period from acceptance of goods to payment shall not exceed 45 days.
On July 22, Liaoning issued a notice on carrying out the work of inviting public bidding for drug procurement, further reforming and improving the policy of drug production, circulation and use. Qixuekang Oral Liquid, Yunnan Baiyao Zhichuang Ointment, Xiaoer Chaiqin Qingjie Granules, Joint Analgesia Babu Ointment, Xiaozhi Ointment, etc. are all on the list of this bidding.
Price decline is the "main theme"
Price reduction is inevitable. It is specified in the purchase requirements with quantity recently issued by Qinghai Province that the price quoted by pharmaceutical enterprises shall not be higher than the current national to low purchase price, and those higher than the current national to low purchase price or the current provincial purchase price shall be regarded as invalid bids. Jinhua made it clear that anti infective drugs should be quoted separately according to the original research drugs and non original research drugs, and the price reduction should not be less than (including) 10% based on the current Zhejiang medical insurance payment standard (low price drugs should be linked (purchased)). If there are low price drugs in the same generic name, the price ceiling policy shall be adopted. On the basis of the price ceiling, the quotation shall not be reduced by less than (including) 10%.
Industry insiders said that based on the experience of several batches of centralized purchase of chemical drugs, once the centralized purchase policy is formally implemented, it will be inevitable to significantly reduce the price of drugs. He believes that once the selected varieties are at a national low price, it will lead to a series of price reductions in the market, or make the development of Chinese patent medicine enterprises more difficult.
The director of Jinhua Medical Insurance Bureau once publicly said that the first batch of purchase with quantity in Jinhua had achieved good results, 22 drugs directly reduced the burden of patients by 54 million yuan, with an average decrease of 28%, and the maximum decrease of a single drug was 73.6%.
This means that compared with chemical drugs, Chinese patent drugs with special characteristics may start with drugs with more sufficient competition. For example, enterprises that produce Xueshuantong, Xuesaitong, Shuxuening, Shenmai, Xingnaojing and other traditional Chinese medicine injections may be the first to be impacted.
According to the data of Mi Nei Wang, Chinese patent medicine covers 13 treatment categories, and drugs for cardiovascular and cerebrovascular diseases are the first selling category in the Chinese patent medicine market, accounting for 35% of the market share, 14.67% for respiratory diseases, and 8.58% for musculoskeletal diseases.
Specifically, in 2019, the total sales of the top 20 Chinese patent medicine products at the terminals of public medical institutions in China reached 60.2 billion yuan, and the sales of all kinds exceeded 2 billion yuan, of which the annual sales of Xueshuantong for injection (freeze-dried) reached 6.283 billion yuan, the sales of salvianolic acid salt for injection also reached 4.135 billion yuan, and the sales of Xuesaitong for injection (freeze-dried) reached 3.928 billion yuan Danhong injection was 3.615 billion yuan. After the implementation of purchase in quantity, the decline in drug prices will have a considerable impact on enterprises producing these Chinese patent medicines.
"Shuffle" of 100 billion level market is imminent
On the one hand, the medical insurance catalogue is adjusted, on the other hand, the expansion of procurement with volume is accelerated, and the Chinese patent medicine market may usher in a "shuffle" period.
In recent years, the overall growth of the Chinese patent medicine market has continued to slow down due to the adjustment of the medical insurance policy and the gradual refinement of the hospital's rational drug use policy. According to the data from Mi Nei Wang, in 2019, the sales of Chinese patent medicines at the terminals of public medical institutions in China, such as urban public hospitals, county public hospitals, urban community centers and township hospitals, were 283 billion yuan, and the sales of Chinese patent medicines showed a negative growth of 1.7% for the first time.
On August 17, the work plan for the adjustment of the 2020 national medical insurance drug catalog released by the National Medical Insurance Bureau showed that the drugs whose drug approval certification documents were revoked, revoked or cancelled by the national drug regulatory department would be directly excluded from the medical insurance catalog after considering the clinical value, adverse reactions, drug economy and other factors.
In addition, the negotiated drugs that are within the validity period of the agreement and need to re determine the payment standard according to the agreement are significantly higher in price/cost than other drugs in the same treatment field, and drugs that occupy more funds in recent years will adjust the payment scope, and qualified Chinese herbal pieces will be included in the adjustment scope.
At the same time, a new round of bidding will be officially opened on August 20. This procurement involves 56 varieties and more than 80 specifications.
According to the announcement of the National Centralized Drug Purchase Document (GY-YD2020-1) issued at the end of July, the agreed purchase volume of each variety in each region in the first year shall be determined according to the following rules: if the number of enterprises actually selected in the country is 1, it is 50% of the calculation base of the agreed purchase volume in the first year; The actual number of enterprises selected nationwide is 2, which is 60% of the calculation base of the agreed purchase volume in the first year; The actual number of selected enterprises nationwide is 3, which is 70% of the calculation base of the agreed purchase volume in the first year; The actual number of enterprises selected nationwide is 4 or more, which is 80% of the calculation base of the agreed purchase volume in the first year.
Relevant people said that the key work in the future is to comprehensively deepen the reform of centralized drug procurement and use, establish a standardized and normalized mode of centralized drug procurement in quantity, and further reduce the drug burden of the masses.
The above people pointed out that according to statistics, the average terminal price of drugs is usually dozens of times more than the production cost, and a large amount of price moisture is hidden in all aspects of drug circulation, many of which become gray income. Due to the lack of awareness of strict management in the past, the management could not be refined, and many seemingly ordinary "ant moving" behaviors accumulated, causing serious erosion to the medical insurance fund.
"Some Chinese patent medicines also have 'sales with money'." The above people said frankly that some Chinese patent medicines are often promoted by means of cross department, super indication and other means, and the rebate of some varieties is even as high as 50%. The purchase with volume will further curb commercial bribery and continue to squeeze out the price of drugs.
Therefore, the implementation of purchasing in quantity is both a challenge and an opportunity for Chinese patent medicine enterprises. Some insiders said that due to the price reduction and the sharp reduction of profit margin, Chinese patent medicine enterprises must have the determination to break their swords, accelerate the transformation and upgrading, develop in the direction of refined and refined operations, and increase the research and development of new drugs to further enhance the competitiveness of enterprises. Reporter Liang Qian
(Editor in charge: Zhang Hongli (intern), Wang Zhen)
