Can the drug price be reduced by purchasing with quantity

Core reading recently, the pilot program for centralized drug procurement organized by the state was approved This centralized procurement is mainly to improve the method of purchasing with quantity in exchange for more favorable prices, which plays an important role in eliminating the space for "second price negotiation" in hospitals, standardizing the behavior of bid evaluation experts, and promoting the standardization of bid evaluation process In order to implement the centralized procurement with quantity organized by the state, it is necessary to coordinate the "three medical services", to simultaneously reform the compensation mechanism of supporting medical institutions, the payment method of medical insurance, and the drug distribution system, and to encourage the innovative development of drugs, to continuously improve the quality of drugs, and to promote the formation of reasonable drug prices On November 14, the fifth meeting of the Central Committee for comprehensive deepening reform deliberated and approved the pilot program of centralized drug procurement organized by the state What is the centralized drug procurement organized by the state? What is the purpose of the implementation of national centralized procurement? What are the benefits for the common people? The reporter interviewed Fu Hongpeng, a researcher of the National Health Commission's health development research center, and Wei Ziling, a medical reform expert of China Research Hospital Association What's the difference with the current centralized procurement? At present, for the basic drugs and non patent drugs with large amount of clinical use and high purchase amount, the centralized drug purchase method with province as the unit is implemented in China What is the difference between centralized procurement of national organizations and current policies? Fu Hongpeng said that the centralized procurement organized by the state this time is mainly to improve the method of volume procurement in exchange for more favorable prices Volume purchase is proposed on the basis of centralized purchase, which means that when carrying out bidding or negotiation and price negotiation in the process of centralized purchase of drugs, it is necessary to clarify the purchase quantity so that enterprises can quote for specific drug quantity This kind of purchase method with clear purchase quantity is called with quantity purchase, which is also the goal that our country has been striving to achieve for many years There are three advantages of volume purchase: first, volume purchase has certain quantity requirements, and the buyer and the seller can carry out negotiations on transaction details Compared with the centralized purchase without volume, volume can give pharmaceutical enterprises clear sales commitment and expectation, facilitate enterprises to arrange production and sales, control costs, so as to give more preferential prices, and let patients get more benefits; second, it can reduce the grey space in the process of drug purchase and sale At the same time, it means the certainty of the batch drug supply enterprise and the implementation of the procurement results At present, the centralized purchase of drugs lacks clear requirements for dosage in the bidding stage Winning the bid does not mean that there is sales volume, and the hospital still has the right to choose independently Therefore, enterprises may need "second public relations" and hospitals can "second bargaining", which will make the result of winning a bid virtually false The implementation of volume procurement means that the purchase and sale contract can be directly signed through bidding, which can realize the integration of bidding and purchase and eliminate the gray space, so it is of great significance; third, it is helpful to promote the improvement of drug procurement process In drug bidding, the subject of evaluation expert is doctor When there is "second bargaining" space, there is a subjective motivation to reserve price space for further discussion in order to seek an effective channel for hospital compensation Eliminating the space of "second bargaining" can, in turn, standardize the behavior of bid evaluation experts and promote the standardization of bid evaluation process Wei zining pointed out that volume purchase is a common international practice, and it is a common method for medical institutions to purchase drugs in some countries and regions It has been proved that the more centralized the purchasing organization is, the more obvious the transaction cost savings are, and the more obvious the effect of price reduction is This practice has been used in Hong Kong for many years and is still in its infancy in the mainland Since 2015, some regions have made beneficial attempts On November 15, with the approval of the state health insurance bureau, the document of centralized drug purchase in 4 + 7 cities (hereinafter referred to as the "4 + 7" document) was officially released on Shanghai Sunshine pharmaceutical purchase network According to the document, the purchase volume of each region is determined by the proportion of 60% - 70% in "4 + 7" region according to the purchase volume of the same variety in 2017 Wei zining believes that the promised dosage is a huge temptation for enterprises, which is conducive to improving the quality of drugs, improving the concentration of the industry, and reducing the burden of drug use for the people Can we promote the high quality and low price of drugs? The past drug bidding system has been widely criticized, the root of which is that only bidding is not adopted, bid winning does not take quantity, the space of high drug price is difficult to be effectively compressed, and it has little effect on breaking the mechanism of supplementing medicine with drugs Experts believe that the implementation of volume procurement and centralized procurement by the state will increase the bargaining power, block the gray space of drug circulation, and make the drug price return to a reasonable range, so that people are expected to use cheap and high-quality drugs Fu Hongpeng said: "there were only two options for us to use drugs, either domestic generic drugs or imported original research drugs Nowadays, with the development of the pharmaceutical industry and the implementation of the national drug consistency evaluation system, the quality of domestic drugs has gradually improved, and even some can replace imported drugs Volume procurement is conducive to the promotion and use of low-cost and high-quality drugs, and drives the innovation and orderly development of the domestic pharmaceutical industry " "For many years, the system of centralized bidding and purchase of drugs is still a basic system of drug circulation system in China From the perspective of market economy and long-term development, the role of market mechanism must be introduced The negotiation price of volume purchase is mainly affected by the purchase volume The more the purchase volume is, the lower the price is It can not only enable patients to use good drugs with good quality and low price, but also enable enterprises to recover costs as soon as possible, see economic benefits, drive the survival of the fittest in the industry, and develop more healthily " Especially for enterprises with strong R & D capability, standardized operation and management and high drug quality, said Wei At present, there are many small and medium-sized enterprises, more generic pharmaceutical enterprises, less sales amount and low industry concentration in China's pharmaceutical production enterprises Volume purchasing is a "key move" to promote the transformation and upgrading of enterprises, strengthen the reform of drug supply side structure and improve the industry concentration So how to ensure that drug quality will not be affected by price reduction? According to Wei zining's analysis, purchasing with quantity is a kind of market behavior Our country's purchasing with quantity will not and cannot be at the expense of drug quality It is understood that the production cost of domestic drugs accounts for a relatively low proportion of the actual sales price, and the difference between the factory price and the bidding price of many drugs is very large Sanming City in the process of medical reform in the drug bidding procurement method, the largest price reduction rate of 96%, the lowest is also close to 70%, which fully proves this point "Some enterprises say that in the long run, the volume procurement will promote the industry to return to the sound development track of product quality, technology, market competitiveness, etc., which will play a positive role in the integration of APIs." Wei said The application conditions proposed in the "4 + 7" document clearly indicate the varieties that must pass the consistency evaluation of quality and efficacy of generic drugs Compared with the previous method that needs to distinguish quality levels to distinguish the quality of generic drugs, the quality level of drugs has been greatly improved, and even the original drugs with high prices can be replaced with lower prices in the bidding, which is conducive to the use of low-cost and high-quality drugs by the common people What other measures are needed for landing? How to implement the centralized procurement with volume in national organizations? Experts believe that it is necessary to coordinate the "three medical services", reform the compensation mechanism of supporting medical institutions, reform the payment method of medical insurance, reform the drug circulation system, encourage the innovation and development of drugs, continuously improve the quality of drugs, and promote the formation of reasonable drug prices Volume procurement blocks the space of "second bargaining" and kickback The clearly promised market volume will be competitive, which will deeply touch the mechanism of "medical supplement with drugs" and directly touch the interests of pharmaceutical enterprises and medical institutions At present, all public hospitals across the country have cancelled the drug mark up, government subsidies must keep up, and the price of medical services must be adjusted in place The establishment of scientific compensation mechanism has a direct impact on the implementation of volume procurement From the past practice, the management ability and operation link of centralized procurement still need to be continuously improved to reduce costs and improve efficiency In the purchase process, the capital chain needs to be straightened out, and the problem of difficult payment collection needs to be solved In addition, the centralized purchase of drugs is a part of the formation of drug prices Drug price reform involves the profound adjustment of the interests of medical insurance funds, pharmaceutical enterprises, patients, medical institutions, doctors and other parties It belongs to a deep-seated system and mechanism problem, which needs comprehensive promotion to form a reasonable drug price For example, the payment method of medical insurance needs to be reformed We need to explore payment by disease, payment by disease group and other ways We need to reform the payment method to promote a reasonable compensation mechanism, but force a reasonable drug price We need to make use of information to open drug price information, as well as drug use and purchase information, and better supervise drug use and medical insurance expenses People's daily (November 19, 2018, version 13)