On January 15, in one day, there are three things worth pondering:
Around 5 p.m., the four batches of national mining plan, which was rumored to be introduced this week, finally came to the surface.
The news broadcast at 7 p.m. reported on the executive meeting of the State Council, which called for promoting the normalization and institutionalization of centralized drug procurement.
Subsequently, the gold column "focus interview" broadcast a special report on "after the group purchase of coronary stents".
Two days later, the contents of the speech at the national health insurance work conference were circulated. The conference required all localities to focus on the centralized procurement of drugs that are not purchased by the state and top 500 in cost, explore the centralized procurement of non over evaluated chemical drugs and biological drugs, explore alliance procurement, and develop the centralized procurement of high-value consumables in layers, categories and batches. Improve the provincial platform sunshine online procurement system, standardize the online and offline rules, gradually realize the whole network procurement, and pay attention to the specific implementation, including the retention of medical insurance fund balance, payment collection and so on.
"Combination boxing" attack
2021 key year of centralized mining
After watching the dazzling series of "combination boxing", I can't help sighing that at the beginning of 2020, the author's relevant conjecture has finally become a reality: 2021 is not only the key year for the real centralized purchase of drugs, but also the real year for centralized purchase since 2015 and even since 2011!
In November 2019, a key policy that determines the centralized drug procurement for at least three years in the future has finally been implemented, that is, several policies and measures on further deepening the reform of the medical and health system by taking the centralized purchase and use of drugs as a breakthrough issued by the leading group for deepening the reform of the medical and health system of the State Council (Guo Yi Gai Fa [2019] No. 3, referred to as "measures").
The "measures" requires: from 2020 to 2022, all localities should seize the window period of reducing drug prices and canceling the addition of consumables in the pilot project, conduct price adjustment evaluation every year, adjust the prices in a safe and orderly manner if the conditions are met, increase the dynamic adjustment of medical service prices, and bring the increased costs due to price adjustment into the scope of medical insurance payment in principle.
The first reaction of the author was that these three years will be the key three years for the development of centralized drug procurement. At that time, it was understood that local procurement with volume had not yet taken shape in 2019, and 2020 was still in the initial stage of exploration. 2022 was the year of ending, and only 2021 was the main year for the national centralized drug procurement. Facts have proved that up to now, understanding is basically reliable.
The reform from "increment" to "stock" of three medical linkage
The battle to break the original interests started
Mountains are mountains, water is water. From the perspective of drug reform, the implementation effect of "three medical linkage" can only be tested and judged by the effect of the goal of medical reform. Wang Dongjin, a famous expert in the industry, once wrote an article that health care reform has short-term and long-term goals. The short-term goal is to solve the problem of "expensive and difficult to see a doctor" of the people, effectively prevent the risk of poverty caused by illness or returning to poverty due to illness, guarantee the basic medical needs of the people, and improve the people's health level and quality of life.
Under such a background, the linkage of the three hospitals under the new situation is changing from incremental reform to stock adjustment, which means that it will be an important battle to break the original pattern of interests. In 2021, just at the beginning of the fourteenth five year plan, we will open a breakthrough through the normalization of drug centralized purchase, which will not only accelerate the pharmaceutical enterprises to move closer to international standards and realize import substitution, but also further improve the pharmaceutical industry ecology and reduce the enterprises' expenditure on sales, circulation and public relations. Through centralized drug procurement, there is no doubt that the interests of most pharmaceutical and consumable manufacturing enterprises, commercial companies and some hospitals under the existing pattern will be optimized and restructured, such as the adjustment of the medical insurance catalog that has been adjusted in place, the adjustment of the national basic drug catalog that came to light in 2021, the further optimization of the drug review and approval system, and the acceleration of the quality and efficacy consistency of generic drugs So is the evaluation work, and so is the establishment of the national drug public procurement market and multi-party linkage procurement pattern.
Normalization of centralized purchasing
Provincial procurement with quantity accelerated
After looking at the situation, we can "settle down" to the centralized purchase of drugs. In 2021, the centralized purchase of drugs is still inseparable from 500 and 50. If 500 is the "upper limit" of the total amount control of national drug procurement, then 50 is the "bottom line" of local annual procurement with quantity. According to the order of purchase amount, the top 80% of drugs will be covered by about 500 drugs (the quantity will be determined by each region according to the specific situation), 250 drugs will be covered by 2021, and all drugs will be covered by 2022. What is not carried out by the State shall be organized and carried out by the provinces. In terms of category coverage, chemical drugs, biological agents and Chinese patent medicines should be included in the centralized collection. Specifically, it covers the top 80% of the purchase amount. Due to the slow pace of local promotion in 2020, the pace of procurement with volume will be significantly accelerated in 2021. On the basis of sunshine and price linkage, the provincial (inter provincial) procurement with volume will be accelerated. This was further reflected in the news report of the conference on January 15: the conference called for promoting the normalization and institutionalization of centralized drug procurement. Among them, it is emphasized that "adhere to the basic medical insurance, focus on bringing the drugs with large consumption and high purchase amount in the basic medical insurance drug catalog into the scope of centralized procurement, and gradually cover all kinds of drugs and consumables that are clinically necessary and of reliable quality. Special arrangements will be made for the procurement of orphan drugs for rare diseases.
What is the normalization of centralized drug purchase? It has become normal for the state to carry out two batches of procurement with volume in a year. Except for Jiangxi, Fujian, Guangdong, Shandong, Jiangsu, Guangxi, Hubei and other provinces, most of the provinces are still sluggish and have not formed normalization. What is the institutionalization of centralized drug purchase? In late July 2020, the general office of the State Council issued the "Notice of the general office of the State Council on printing and distributing the key tasks of deepening the reform of the medical and health system in the second half of 2020", which explicitly required "to guide local governments to comprehensively implement the procurement, distribution and use policies of selected drugs and high-value medical consumables. To formulate policy documents for the reform and improvement of drug procurement mechanism. However, due to various reasons, this policy, which is called "new No.7 document" in the industry, has not been issued. However, one month later, the guidance of the state medical security administration on the establishment of a credit evaluation system for drug price and procurement (Medicare Fa [2020] No. 34) met in advance. The measures in this document are equivalent to doing a series of basic guarantee work in advance, which creates a more favorable "environment" for the "Introduction" of the new regulations for drug centralized procurement ”。
At the level of 2021 provincial procurement with volume, from the perspective of scheme, the mainstream version can be basically divided into two. One version is based on the national procurement version, such as Fujian, Shanxi and other provinces. Another praiseworthy version is Jiangxi version, which strengthens the evaluation of quality score. On this basis, all provinces will fully understand the spirit of national mining, exchange price for quantity, and adapt and optimize the scheme in combination with the local actual situation. In the aspect of variety selection, we should focus on some common and competitive varieties as far as possible, so as to ensure that the pace of centralized mining is fast, stable and effective. It is worth mentioning that, in addition to actively participating in the inter provincial alliance, Jiangsu, Hubei and other provinces have also formed their own new way of purchasing with quantity in combination with their own drug use characteristics. This unique "local + inter provincial" new system of purchasing with quantity in one province is expected to be followed by more and more provinces for promotion.
No matter how the local procurement with quantity accelerates and changes, the introduction of the relevant guidance on national centralized drug procurement is the key policy to determine the bidding trend this year, which can be called the "sea god needle" of the drug centralized procurement policy in 2021. After the introduction of the new regulations, in 2021, the volume purchase of proprietary Chinese medicines, unreported generic drugs, biological similar drugs, insulin, and the real Wang fried variety, the national basic drug products, will surely be roaring wildly. In 2021, the medicine gathering cloud is coming with lightning and thunder!
Attached table: Catalogue of the fourth batch of centralized purchasing varieties
