Medical Week Talk: Reflecting on the Price Pressure Wave of Drug Tenders

　　Caixin.com (Reporter Zhou Tian) At the beginning of 2015, Zhejiang, Hunan and other provinces launched a new round of drug bidding, "price reduction" has become a common tone, to ferocious, causing controversy Among them, Zhejiang Province in the pre-set "10%" threshold, and chinese medicine injections, antibacterial drugs and distribution amount of the top 200 varieties again reduced prices Hunan is the country's lowest drug tender on the basis of the lowest price, continue to reduce prices, and Shanxi's drug tender price, but also a new round of the national lowest bid price as the average price.　　More provinces are also moving On February 1, the Liaoning Provincial Government Procurement Center officially launched the province's basic drug tender procurement work Liaoning clearly proposed that the drug winning price management to implement the price "left and right linkage" system, that is, during the implementation of centralized procurement results, if the newly announced price of drugs in other provinces is lower than the winning bid price of the province, will take the latest announced winning price announced by other provinces to implement;　　This is the second province after Beijing to propose a price "left-right linkage" Liaoning Province Drug Procurement Leading Group Office also made it clear that the price-to-right linkage "will refer to Hunan quotes." Hunan Province's approach has caused the biggest controversy in the wave of drug bidding in the provinces On January 28th, more than 200 companies protested, with some workers gathering at the gate of the Hunan provincial government to "walk" in front of the hunan provincial government.　　Controversial "human-machine dialogue" comes after the China Pharmaceutical Innovation Promotion Association (cED) wrote to the Hunan Provincial Office for Drug Central Procurement Management, saying that "Hunan Province's approach to bargaining seriously violates the law of fair competition in the market".　　In Hunan, more than 60 experts took the "human-machine dialogue" negotiation mechanism to review drug prices The specific method of operation is that the experts each input the price of each drug on the computer to reduce the degree, and then by the computer system to deduct high and low extreme values, the average price reduction recommended by the experts But the FDA believes that when experts make proposals through computers, there is no scientific, clear, fair and open basis, only to reduce prices as the ultimate goal, "subjective random color is more intense." Some of the first-round experts' suggested prices were cut by 50% directly from the bid guide price, while others offered a lower second-round offer after the first round of experts' suggested price was announced The FDA believes that this approach not only completely negates the maximum retail price of drugs set by the national price authorities and the bidding prices set by other provinces referenced by Hunan Province, but also overturns the bidding guidance prices set by Hunan Province.　　The agency said it violated basic market rules by allowing computers, experts and companies to negotiate prices and require them to immediately set the price of a deal on a computer without allowing the buyers and sellers to negotiate directly The absence of equal rights, equal opportunities and equal rules for enterprises, the absence of reasons and grounds for determining prices, is in essence the government through the hands of experts, the drug trade to carry out improper administrative intervention, artificial barriers to market transactions The Drug Society also questioned: "Through the mysterious way to bring experts together, in a short period of time on the subjective feeling of the price of 10,000 product specifications, how can this practice be scientific, and how can it be accepted by all parties?" After the differences between the two sides, according to the description of the Drug Promotion Association, Hu Zhushan, deputy director of the Hunan Provincial Drug Tendering Office, called the Drug Promotion Association on the afternoon of February 3, 2015, claiming to "prosecute the Drug Promotion Association" Hu Zhushan believes that the awareness of the Pharmaceutical Promotion Association is not accurate, most of the enterprises are supporting the results of the Hunan tender, in the bargaining process, individual enterprises also think that experts cut the price too little, enterprises can even give a lower price In addition, many of the original abandoned enterprises (including the protesting enterprises) to the Hunan Drug Tender Office to admit the mistake, asked to re-bid.　　Hu Zhushan also said that "human-machine dialogue" is one of the ways of expert bargaining, is that some provinces have implemented a mature practice of open sunshine;　　The Fdaboard retorted, "What is the basis for clinical experts to determine drug prices?" How do clinical experts understand the true price of a company's products? This is precisely the important link in the need for openness and transparency "At one point, the two sides were at war and were ready to go to court Subsequently, the tug-of-war to Hunan bid office officials to apologize, the two sides to reconcile and temporarily ended.　　The original intention of "new medical reform" should include the reform of "medical care, medical insurance, medicine" in three major areas However, in other aspects of the reform slowly, the alienation of medical reform has become a simple "drug reform", only into the drug price reduction competition The FDA believes that the government expects to quickly demonstrate the results of the reform by lowering drug prices, and that the drug tendering department has assumed the responsibility of showing the results of the reform But in reality, this is an unaffordable burden.　　In some areas, the principle of drug bidding work is gradually evolving into "price priority, up-down linkage, left-right linkage" as stipulated by the state In the tender scheme and the specific link of the implementation of the tender, the comparison is "who can lower the price of drugs", resulting in medical reform only drug reform, drug reform is bidding, bidding on the pressure on the price of the atmosphere In the short term, substantial, mandatory drug price reductions may count as a political achievement of the Government But it leaves the losses to companies, leaving the risk of drug safety to patients.　　Niu Zhengqian, vice president of the China Pharmaceutical Enterprise Management Association, also believes that centralized drug procurement is a common international practice to reduce drug prices However, because the tender office does not control the procurement power, China's current government-led, arranged drug tender procurement control policy, it has become the world's only "secondary administrative control" of the entry of drugs into the market In essence, this is the normal market behavior of entering the drug into the use option of medical institutions, which becomes a disguised administrative control approval, and even in different provinces, the competent department of drug tendering and procurement becomes the institution with the largest authority for approval in the field of medicines.　　Niu Zhengqian also pointed out that the government-led drug centralized bidding procurement control policy has been implemented for more than a decade, resulting in a series of serious problems, including: drug prices are inflated and falsely low, many drugs are inflated several times or even dozens of times;　　A report by the Ministry of Finance's Office of the Financial Ombudsman in Guizhou also pointed out that "investigations have found that there is an objective existence of the phenomenon of inflated drug prices in China" In the pharmaceutical industry multi-head management, classification pricing, public hospitals "drug-based medicine" under the current system, hospitals and doctors formed a "double monopoly" on pharmaceutical companies and patients Inflated drug pricing, to the circulation of rebates, discounts and various market fees to reserve price space; At the same time, through health insurance reimbursement, so that the country's health care spending is increasingly high.　　The report by the Guizhou Commissioner of the Ministry of Finance points out that the unified tender price of the state-directed price and the provincial centralized drug procurement service center is much higher than the cost price of the drug, so that the drug price supervision has not played its due role For example, a major hospital channel softgel, in terms of its four varieties, the provincial price bureau guide price, is the cost of production of drugs 3.51 times - 3.68 times, higher than the ex-factory price of drugs 37%-57%, 18% to 37% higher than the unified bid price And a major pharmacy channel, the main cure of cold capsules, which has two varieties, the provincial price bureau's guide price is 3.96 times the cost of production of drugs and 4.81 times, respectively, higher than the ex-factory price of drugs 65% and 139%, higher than the unified bid price 35% and 64% It is clear that the figures for government-directed prices are grossly inflated.　　In addition, the survey also showed that the main hospital channel products sales cost rate, significantly higher than non-hospital channel products, the distance is the largest is more than twice And in the case of the ex-factory price of drugs, the increase rate of dealers entering the hospital to sell drugs is also higher than the sale of drugs in non-hospital channels.