Adjustment of bidding and purchasing policies for essential drugs in Zhejiang Province

Source: 21st century economic report 2014-10-14 China's basic drug system, which started in 2009, has entered its fifth year Among them, the bidding and purchasing policy for basic drugs, which has attracted high attention of the pharmaceutical industry, has quietly entered the adjustment period "The basic drug system is a very good system, but it has been implemented for several years It's time to look back and review the situation of the basic drug system to further improve, enrich and upgrade it." Wu Chaohui, director of the drug policy and basic drug system Department of Zhejiang health and Family Planning Commission, told reporters that based on the consideration of solving the problem that "good drugs can't be matched, and cheap drugs can't be matched", the latest round of bidding in 2014 in Zhejiang province needs to solve the most urgent drug demand of these two people from the overall design On September 15, the health and Family Planning Commission of Zhejiang Province issued the implementation plan for 2014 drug centralized procurement (the first batch), marking the launch of the latest round of new policies for drug centralized procurement in Zhejiang Province Compared with the last round of bidding and purchasing policies for essential drugs in Zhejiang Province, Wu Zhaohui further analyzed that this bidding has three characteristics: "first, adopting a new concept of cost performance suitability, that is, not pursuing high and low, but worthless; second, classified management and classified procurement; third, in terms of price control, no longer one size fits all, to support the weak and prevent the strong." In fact, the national level has adjusted the basic drug system and drug price control thinking On August 21, 2014, the health and Family Planning Commission issued the opinions on Further Strengthening the management of drug allocation and use in primary medical and health institutions (hereinafter referred to as the "opinions") The opinion clearly states: "consolidate and improve the basic drug system and the new mechanism of grass-roots operation" It can be seen from the opinions that there is a clear trend of policy adjustment, that is, to release the restrictions that primary medical institutions can only be equipped with basic drugs, and allow urban community health service centers and rural township health centers to temporarily use a certain amount or proportion of drugs from the catalogue of drugs for medical insurance (New Rural Cooperative Medical System) according to the regulations and requirements of provincial health management departments In addition, the notice on improving the price management of low-cost drugs issued by the national development and Reform Commission in April this year allowed the price of low-cost drugs to be increased for the first time, changed the way of unilateral price reduction in the past, and reflected the idea of policy adjustment of drug structure Both the basic drug system and the drug price management system are concentrated in the design of bidding and purchasing policies at the local level In the past five years, Anhui model, Guangdong model, Fujian model and so on have appeared, which has caused the continuous controversy and the game among all parties in the pharmaceutical industry We should not only "squeeze" the water content of drug price, but also guarantee the quality Around the price and quality, we fully consider the balance ability of policy makers in different regions As an economically developed region, Zhejiang Province has a large annual drug purchase volume (about 50 billion yuan), and the adjustment of its bidding policy is particularly concerned According to the analysis of the insiders, Zhejiang is the first province to carry out classified procurement comprehensively, which conforms to the development direction of centralized drug procurement in the medical reform and promotes the rationality of the development of bidding mode "To explore a way of drug purchase in Zhejiang And it will give full play to the subjective initiative of each medical institution, and may allow medical institutions to purchase by themselves, but only if there are enough systems to restrict it " Wu Zhaohui said The "two expansion" of basic drugs in combination with the use of basic drugs for hierarchical diagnosis and treatment has also been "upward" expansion During the five years since the implementation of basic drugs, it has always been the core concern to supplement the list of basic drugs "Zhejiang's list of essential drugs has increased by 292, which we don't think is much." Wu Zhaohui analyzed the 21st century economic report, saying that the average level in the last round of China was 220, excluding this supplement The increase of 292 kinds of regular drugs is in line with the economic development level of Zhejiang Province There are 520 new versions of the national essential drugs catalogue, which will be implemented as of May 1, 2013 In 2009, 307 varieties of the first edition of the national essential drugs catalogue were established What is the scope of the essential drug catalogue suitable for different regions? There are two different views on the provincial supplement of the essential drug catalogue First, the supplement is limited to local protection, and if not standardized, the "rent-seeking space" will be increased; however, some experts have questioned the issue of meeting the accessibility of essential drugs, that is, the basic drug system should be a "floor policy", aiming to achieve the most basic drug use guarantee, rather than a "ceiling policy" "The list of comments on a place is more or less, which can not be measured by a single scale It should match the level of local economic and social development and the level of new rural cooperative fund-raising." In response, Wu Zhaohui said that 520 kinds of national version of the basic drugs catalogue were calculated according to the financing level of 300 yuan of the new rural cooperative medical system, that is, 520 kinds of basic drugs matched in expenditure and drug level But the financing level of Zhejiang NCMS is 649 yuan "Insurance is not public medical treatment, public medical treatment is fair, insurance is to pay attention to different financing levels to obtain different security treatment." Wu Zhaohui said that if the base drug catalogue is determined according to the financing level of 300 yuan, in fact, for the participants of Zhejiang new rural cooperative medical system, it does not reach the guarantee corresponding to the financing level Although 292 "supplementary" drugs were selected according to the basic drug standard, Zhejiang did not manage them according to the basic drugs It is called "the list of commonly used drugs out of the list of essential drugs" It is purchased together with the essential drugs through bidding and required to be used by medical institutions In addition to the catalogue expansion, in the new policy of Zhejiang bidding, the allocation and use of essential drugs have also been expanded "upward" That is to say, the purchase amount of basic drugs and commonly used drugs of level II General Hospital and TCM hospital shall not be less than 50% of the total purchase amount of drugs of the medical institution; the purchase amount of level III class B hospital shall not be less than 30%; the purchase amount of level III class a hospital shall not be less than 25%; all kinds of medical institutions at all levels shall be gradually equipped with and give priority to the use of basic drugs This means that Zhejiang province puts forward quantitative requirements for the use of basic drugs (520 kinds and 292 kinds) in non basic medical institutions, namely large-scale public hospitals in cities "We will strengthen the leading role of the allocation and use of essential drugs, and encourage public hospitals at and above the county level to give priority to the use of essential drugs and commonly used drugs." Wu Zhaohui said that it is necessary to put forward requirements for "superior" hospitals, public hospitals at or above the county level If everyone chooses drugs by themselves, there will be a lack of concentration, which is not conducive to the promotion of the basic drug system In fact, for the decision-makers and executors of local basic medicine, the expansion of the above two levels of basic medicine system is to adapt to the other new policy of deep medical reform - hierarchical diagnosis and treatment In May 2014, the general office of the people's Government of Zhejiang Province made a pilot opinion on carrying out hierarchical diagnosis and treatment to promote reasonable and orderly medical treatment According to the document, eight counties and districts in Zhejiang, namely Chun'an County, Beilun District, Ninghai County, Wencheng County, Yongjia County, Yueqing City, Pingyang County and Haiyan County, will be the first to launch pilot projects On October 9, the national health and Family Planning Commission said at a regular press conference that it had recently sorted out the establishment and implementation of the national hierarchical diagnosis and treatment system and was studying and drafting relevant documents The so-called hierarchical diagnosis and treatment refers to the classification according to the light, heavy, slow, urgent and easy degree of treatment Different levels of medical institutions undertake the treatment of different diseases, have their own strengths, and gradually achieve specialization Divide the general outpatient service, rehabilitation and nursing undertaken by large and medium-sized hospitals into basic medical institutions "Zhejiang proposes that high-quality medical resources sink, that is, human resources must sink to the grass-roots level, and it's definitely not good if people go to medicine without going with them." Wu Zhaohui said that hierarchical diagnosis and treatment, two-way referral and basic management of chronic diseases are all related to drugs We are encouraged to use commonly used drugs instead of those out of the way drugs, which in itself is improving and upgrading the basic drug system The habit of drug use must be formed through long-term accumulation 292 kinds of regular drugs have been selected in Zhejiang Province It is not that we have to use so much, but that we need to achieve the goal of centralization, docking and cohesion In fact, the practice of using non essential drugs in primary medical institutions has started in some provinces Half a year after the implementation of the basic drug system in Anhui Province, it was clear that a certain proportion of non-basic drugs could be increased in primary medical institutions; the way of Shandong Province is that the varieties of non-basic drugs and the purchase amount should not exceed 20% of the basic drugs It is an original term of Zhejiang Province to explore the non mainstream varieties of classified procurement In addition to the "two expansion", the first "three bids" in one (bidding for basic drugs, non basic drugs and low-cost drugs together), and classified procurement and management according to different drug catalogs are the most important points of this centralized drug procurement program in Zhejiang "Three bids in one bidding can be considered as a whole to avoid two skins." Wu Zhaohui told the 21st century economic report that before, because the basic drugs and non-basic drugs were bidding according to different standards, there were incidents of social criticism such as "clindamycin phosphate ester", and there were also problems of different prices of the same product in the same city As for the classified procurement method, other provinces are also trying it out to varying degrees, but it is not comprehensive From the perspective of this bidding plan, Zhejiang is the first province to conduct classified procurement comprehensively That is to say, according to the catalogue of basic drugs, the catalogue of centralized purchase of low-cost drugs in Zhejiang Province (I), the catalogue of drugs in short clinical supply in Zhejiang Province, and non mainstream drugs, different evaluation methods such as "double envelope" comprehensive evaluation, separate technical bid evaluation, direct online purchase, invitation to bid and so on are adopted respectively The specific classification is: basic drugs, commonly used drugs, low-cost drugs, supply of tension drugs, large infusion, non mainstream varieties "The so-called non mainstream is a term that we have created, that is, the dosage forms and specifications that are not included in the basic drugs, because to protect the main status of the basic drugs, we must limit the non mainstream, and now the society has accepted this term." Wu Zhaohui said Whether we want to recruit quality or price for priority purchase of generic drugs that reach the international level? Price is always the core issue of centralized purchase of drugs, and there are endless disputes around it Some places are called "only low price" bidding mode "We also think about the price, that is, price reduction is the general trend, because at present, it is an indisputable fact that the drug price is inflated, but what can't be ignored is that the drug price is also inflated, so are we bidding for quality or price?" Wu Zhaohui said, now everyone's requirements are that the quality is better, the price should be low, and the supply guarantee should be in place Who can do it all? This is a difficult problem, how to solve it? In this regard, Wu Chaohui believes that the principle for the formulation of this Zhejiang drug bidding plan is "cost performance is appropriate", that is, "do not evaluate whether the bidding is high or low, and should first ask whether it is worth it or not." This requires the introduction of a pharmacoeconomic evaluation mechanism and the implementation of this mechanism " The main purpose of pharmacoeconomics is to apply the principles and methods of economics to the evaluation of clinical drug treatment process, and to guide clinicians to formulate the most reasonable prescription of potency ratio Pharmacoeconomic research can be used for clinical rational drug use, optimal allocation of drug resources, research and development of new drugs, and clinical drugs