Behind the strengthening of administration of auxiliary drugs: rectifying irrational drugs

Source: medical economic report 2015-11-17 recently, five departments including the national health and Family Planning Commission, the national development and Reform Commission, the Ministry of finance, the Ministry of human resources and social security and the State Administration of traditional Chinese medicine jointly issued the notice of several opinions on controlling the unreasonable growth of medical expenses in public hospitals, proposing to implement the product management system such as auxiliary drugs and the tracking and monitoring system On November 10, Anhui issued the circular on the publication of the province's key drug monitoring catalogue from April to October 2015 A total of 50 drugs were listed in the key monitoring scope, and part of them were "auxiliary drugs" Before that, Suzhou, an important pilot city of national medical reform, also issued a list of key drugs for monitoring, such as high price, large dosage and non treatment assistance, and implemented an early warning management system 60 drugs were included in the first batch of monitoring directories Auxiliary drugs, a product category that has existed for many years at home and abroad, but has been difficult to clearly define the boundaries, have been discussed and heated in the media and industry recently, with the focus on how to manage and limit the use of "auxiliary drugs" However, as the discussion heats up, more scholars and enterprises in the industry are conducting more reflection tests: can the competent department clearly define what is adjuvant? Will the competent authority issue a similar catalogue to restrict the use of adjuvants? What is the real intention of the competent authority? The definition of adjuvant is confused If the government wants to open an operation on adjuvant, first of all, what is adjuvant? For this problem, the director of the Pharmaceutical Department of a top three hospital in Beijing told reporters: "there is no clear definition of auxiliary drugs in foreign countries, which is a relative concept." Why is it difficult for famous pharmaceutical experts in China to use two simple sentences to understand what is real adjuvant? Pharmaceutical experts told reporters that the basic reason for the complexity of the definition of auxiliary drugs is that under different conditions of use, the functions and meanings of each drug are different Some products are auxiliary in some departments or disease treatment, while others are necessary In addition, even if some products have certain clinical data, the clinical data is actually worth thinking about Because from a global perspective, only 60% of the diseases that have been clearly named can be effectively controlled or cured through drug treatment, and the other 30% of the diseases are not very good drugs to treat Some drugs show some efficacy in some diseases, but for many diseases, the efficacy of placebo itself is 50% Is this type of drug not an adjuvant? However, through the treatment of some drugs, such as many chemotherapy drugs for tumor treatment, the current effect is to extend the median survival time for several months, or to improve the quality of life of patients Are similar drugs classified as adjuvants? Or from another point of view, some clinical experts point out from a humanitarian point of view, for example, for patients with advanced cancer, doctors know that they have no therapeutic value, nor can they carry out radiotherapy, chemotherapy or surgery, so long as the drug has no major adverse reactions, it is still necessary to give patients some treatment drugs similar to placebo Should the use of such drugs be classified as supplementary drugs? What's more, compared with the global drug use, the existence of Chinese traditional medicine makes the definition of auxiliary drug use more complicated "For example, in some places, traditional Chinese medicine injections are listed as auxiliary drugs, but traditional Chinese medicine doctors do not agree with it, because many traditional Chinese medicine injections are even included in the directory of emergency rescue drugs in traditional Chinese medicine hospitals Traditional Chinese medicine believes that western medicine doctors may use traditional Chinese Medicine injections as auxiliary drugs according to the western medicine theory, but according to the dialectical treatment theory of traditional Chinese medicine, they are therapeutic products." The vice president of a third class hospital in Guangzhou pointed out "In a broad sense, it is almost difficult to define the auxiliary drugs comprehensively, but in a specific disease or department, it is less difficult." Experts pointed out that "if we put it at the hospital level to manage the rational use of drugs, the operability and scientificity of drug abuse control will be greatly improved The hospital can formulate the internal prescription set and use requirements The pharmaceutical management committee will discuss and decide which drugs can enter the hospital, and clearly define how to use certain varieties and which departments can use them under certain circumstances " Anti abuse is the real intention From the perspective of the country, why does it require that some products be monitored? In fact, from a macro point of view, under the pressure of the basic medical insurance fund, the health and Family Planning Commission and the medical insurance department have been grasping the drug catalog and doctor's prescription for a long time According to the relevant principles, the health and Family Planning Commission mainly from the perspective of rational drug use, not to use products that can be used and whose efficacy is not exact; the competent medical insurance department mainly focuses on drug abuse from the perspective of cost control, starting from the benefits of drugs to patients, to improve the utilization efficiency of medical insurance funds Experts believe that it is difficult to clearly define the auxiliary drugs themselves, so the basic idea at the national or local government level is to issue a guiding document, whose fundamental significance is to make medical institutions and doctors pay more attention to the necessity of use when choosing drugs What the country really needs to pay attention to is the abuse of products People close to the national health and Family Planning Commission also revealed that the national health and Family Planning Commission has never required local governments to develop a catalogue of auxiliary drugs At the national level, it is still mainly concerned about the abuse of auxiliary drugs in the process of tumor treatment In fact, it is exactly the same No matter the Beijing version circulated in the market, or the Yunnan, Anhui and Suzhou versions that have been documented, the competent departments of the government emphasize the key monitoring and prescription review of the relevant varieties The real meaning lies in the rectification of unreasonable drug use Chen Xiaokang, deputy director of Suzhou health and Family Planning Commission, also pointed out in an interview with the media that the key drug early warning and supervision mechanism is to monitor the "uncertain curative effect" drugs with high price on the basis of ensuring the patients' necessary drugs, because the excessive use of these drugs will cause the increase of medical expenses and increase the burden of medical expenses of patients "Local governments, medical institutions and people from all walks of life need to see very clearly that the state expects clinical needs to guide drug use At present, the policies of several pilot cities of medical reform also adhere to this principle, leaving the real decision-making power of drug use to hospitals and clinicians, while retaining the power of supervision and punishment." Said the vice president of a third class hospital in Guangzhou Pharmaceutical experts also further pointed out that for some products with a large amount of drug use, the state has established various databases in recent years, and the use of drugs has also been reported through various channels In fact, it is not far away to evaluate the effect of some drugs through the analysis and application of big data   Pharmaceutical experts stressed that from the perspective of China's actual situation, we still have a certain gap with the international advanced countries and regions in multi-dimensional and multi-level aspects, such as drug use level, public hospital management mechanism and system At the same time, under the condition of limited funds, to promote the rational use of drugs, we need to be cautious and slow to advance under the condition of ensuring scientific and reasonable, and it is not suitable to make a one size fits all.