Official interpretation of the National Health and Planning Commission: two-vote implementation of the opinion!

, why should the "two-vote system" be introduced in the procurement of medicines by public medical institutions? What's the significance?
: In the public medical institutions in the procurement of drugs to implement the "two-vote system", mainly in response to the current drug purchase and sale process in the process of more links and multi-level agents and other outstanding issues to take a reform measure, the purpose is to compress the drug circulation link, so that the intermediate price increase transparent, and further promote the reduction of drug inflated prices, reduce the burden of drug use.
Due to historical reasons, the situation of "many small scattered messes" in the field of drug circulation has not been fundamentally improved, the drug circulation chain is long, the circulation order is more chaotic, hanging on to the operation, money laundering, short selling, with gold sales and other issues prominent, pharmaceutical commercial bribery occurs from time to time. The interaction and interaction of these disorders in the field of drug circulation have pushed up drug prices, contributed to corruption in the purchase and sale of medicines, restricted the reform of the medical and health system to develop in depth, and caused great losses to the government, society and individuals. To solve these long-standing problems, it is difficult to achieve tangible results in the short term by spontaneous market regulation alone, and we must make a heavy-handed effort to speed up the pace of the fight against disorder through the reform of medical care, medical insurance and medicine linkage. The "two-vote system" is an important measure to deal with the chaos in the pharmaceutical market at this stage, and we should unswervingly implement the "two-vote system" from the height of safeguarding the interests of the country and the people, and from the overall situation of promoting the healthy development of the pharmaceutical industry.
the implementation of the "two-vote system" in the procurement of medicines in public medical institutions is of great significance. First, it is conducive to reducing the circulation of drugs, regulating the circulation order, improving the efficiency of circulation and reducing the inflated price of drugs; For example, to crack down on illegal activities such as illegal association, commercial bribery and tax evasion in accordance with the law; fourth, it is conducive to deepening the reform of the pharmaceutical sector, promoting the transformation and upgrading of pharmaceutical enterprises, being bigger and stronger, improving the concentration of the industry, promoting the healthy development of the pharmaceutical industry, and realizing the reform of the "three-medical linkage".the "two-vote system" is defined?
: "Two-vote system" refers to the pharmaceutical production enterprises to the circulation enterprises to open an invoice, the circulation enterprises to the medical institutions to issue an invoice. Public medical institutions and pharmaceutical production enterprises are encouraged to settle directly the purchase price of drugs, drug production enterprises and circulation enterprises to settle distribution costs.
Taking into account that in recent years pharmaceutical production enterprises have accelerated the transformation to a group-type enterprise integrated with science, industry and trade, it has become a trend of enterprise development for enterprises to expand their scale, reduce operating costs and refine their professional division of labor, and to set up commercial companies to sell their own drugs. In addition, imported drugs domestic manufacturers, only the domestic general agent. Therefore, the Notice on the Implementation opinion (Trial) on the Implementation of the "Two-Vote System" in drug procurement in public medical institutions, referred to as the Notice, stipulates that a who-owned or controlled commercial company (nationally limited to one commercial company) and a domestic general agent for imported drugs (only one domestic general agent) established by a pharmaceutical production enterprise or a group-type enterprise integrated by science, industry and trade may be considered as a production enterprise.
addition, in recent years, some drug distribution enterprises have accelerated the pace of mergers and reorganizations, set up subsidiaries in the national layout, accelerate the development of group-type enterprises, improve the concentration of drug distribution and distribution capacity. In order to properly solve the problem of "two-vote system" for group-type drug distribution enterprises, to meet the needs of enterprises to grow and strengthen, to further improve the concentration of drug distribution, but also to take into account the reality of local supervision and management of group-type enterprise subsidiaries, the Notice stipulates that the transfer of drugs between pharmaceutical distribution group-type enterprises and wholly-owned (controlled) subsidiaries or wholly-owned (controlled) subsidiaries for business needs may not be regarded as a vote, but at most allowed to issue an invoice. Pharmaceutical production and circulation enterprises shall reasonably determine the level of price increases in accordance with the principles of fairness, legality and good credit.the scope of implementation of the "two-vote system" is stipulated?
: Public medical institutions in pilot provinces (districts, cities) and public hospital reform pilot cities should take the lead in implementing the "two-vote system" and encourage other regions to implement the "two-vote system". In 2017, the implementation of the "two-vote system" will be further expanded, with the aim of being pushed across the country in 2018.the current implementation of the "two-vote system" is eligible?
: The implementation of the "two-vote system" in the procurement of medicines in public medical institutions has been carefully studied and demonstrated. At present, the implementation of the "two-vote system" has many favorable conditions: First, some enterprises have spontaneously formed a "two-vote system." With the development of modern pharmaceutical enterprises, some pharmaceutical production enterprises set up their own marketing network, direct sales or commissioned distribution in key cities, part of the realization of the "two-vote system." Second, the rapid development of some large circulation enterprises for the implementation of the "two-vote system" provides conditions. In recent years, a number of large-scale drug distribution enterprises through mergers and reorganization, circulation network further improved, basically covering the national municipal level and part of the county level. In the course of the research, some enterprises said that in the information flow and logistics so developed today, the implementation of the "two-vote system" has no obstacles. Third, in line with international practice. Foreign experience shows that after the cost of medicine becomes a medical institution, through market competition and government regulation, the circulation chain is usually compressed into a "two-vote" mode. Most governments in Europe and the United States will limit the profit margins of drug circulation, make enterprises develop in the competition, and promote the formation of the "two-vote system" and direct marketing pattern. Fourth, Sanming City and Fujian Province have been implementing the "two-vote system" in the city and the province for many years, the middle link of drug circulation gradually compressed, the circulation market has been purified, the inflated price of drugs has been decreasing, resulting in good results, and achieved successful practical experience. Fifth, with this year's reform and increase (business tax reform value-added tax) of the comprehensive push, bill management more standardized, for the implementation of the "two-vote system" to create favorable conditions.and risks that may be encountered in the implementation of the "two-vote system"?
: First, the "two-vote system" in the initial implementation of only cover some areas, but also can not completely solve the problem of drug marketing agents, drugs "with gold sales" problem may not disappear soon. However, with the continuous expansion of the scope of implementation of the "two-vote system", multi-level agents, illegal hanging, money laundering space will be further squeezed, until completely disappeared, and thus in order to achieve the reduction of inflated drug prices, purify the drug circulation environment to provide favorable conditions, promote the three-doctor linkage, deepen the reform of the medical and health system. Second, during the transition period of the "two-vote system", it may have some impact on the supply of some low-cost drugs and small quantities of medicines. Because these pharmaceutical manufacturers do not want to sell sporadically, distribution enterprises after a large number of procurement due to limited sales volume, facing expiration, economic losses and other issues, may affect the supply. To this end, we require circulation enterprises in accordance with the principle of near and far integration, urban-rural linkage, to achieve regional drug distribution urban-rural integration, through the rural drug distribution "last kilometer." Local also through the requirements of circulation enterprises in the distribution of large quantities, high profits of drugs at the same time, the distribution of those small quantities, low prices of drugs, in order to ensure overall profit balance and market supply. Third, the implementation of the "two-vote system" may be opposed and obstructed by some enterprises with agents, over-votes and so on as their main business. But the reform is to move the "cheese" of these enterprises, regulate the behavior of enterprises, cut off the gray interest chain, purify the drug circulation market, accelerate the formation of large-scale backbone enterprises as the main body, small and medium-sized enterprises as a supporting complement to the urban and rural drug circulation network, to promote the healthy development of the industry., how to ensure that the "two-vote system" is effectively implemented?
: the implementation of the "two-vote system" landing four requirements: First, strict implementation of drug purchase and sale bill management regulations. The key to the implementation of the "two-vote system" is to strictly implement the relevant provisions on the management of drug purchase and sale invoices, starting with invoices, controlling from the source, to ensure the implementation of the "two-vote system". To this end, respectively, pharmaceutical production enterprises, circulation enterprises, medical institutions on the implementation of the "two-vote system" put forward clear requirements. Second, create conditions to support the implementation of the "two-vote system". We will support the construction of national and regional drug logistics parks and distribution centers, promote coordinated distribution of multiple warehouses, allow pharmaceutical operators to open warehouses off-site, and use qualified drug warehouses of their enterprises across provinces and regions. Third, we should effectively strengthen the supervision and inspection of the implementation of the "two-vote system". Drug centralized procurement agencies should take the implementation of the "two-vote system" as a necessary condition for the bidding, winning bid and distribution qualifications of pharmaceutical enterprises; the administrative departments of health planning and traditional Chinese medicine should strengthen supervision and inspection of the implementation of the "two-vote system" in medical institutions; the drug regulatory departments should incorporate the implementation of the "two-vote system" of pharmaceutical enterprises into the scope of daily inspection; and the tax department should strengthen the inspection of drug purchase and sale invoices and tax evasion. All departments should do their part, strengthen cooperation and jointly promote the implementation of the "two-vote system". Fourth, strengthen the interpretation of policy publicity and create a good atmosphere of public opinion. Widely publicize the "two-vote system" for the national and people-friendly enterprises, and mobilize the understanding, support and cooperation of all parties on the "two-vote system" reform measures., pharmaceutical production, distribution enterprises and medical institutions should implement the "two-vote system"?
: In order to promote the implementation of the "two-vote system", we have made clear what tasks pharmaceutical production, circulation enterprises and public medical institutions undertake in the implementation. When selling drugs, pharmaceutical production and circulation enterprises shall issue special vat invoices or free invoices (collectively, "invoices") in accordance with the relevant provisions on invoice management. The drugs sold shall also be accompanied by a list of accompanying peers in accordance with the requirements of the Drug Business Quality Management Code (Drug GSP), and the name of the purchase and seller of the invoice shall be consistent with the accompanying counterpart list, the flow of payment and the amount of the same. When a drug distribution enterprise buys a drug, it shall take the initiative to ask the pharmaceutical production enterprise for an invoice, which must be issued by the pharmaceutical production enterprise. Upon delivery acceptance, the invoice, the supplier's accompanying counterpart list and the actual purchase of drugs varieties, specifications, quantity and so on. Check the agreement and establish the acceptance record of the purchase of drugs, so that the tickets, goods, accounts are in line. If the invoice and the accompanying companion list do not meet the requirements of the relevant provisions of the State, or if the contents between the tickets and goods do not conform, the revenue bank shall not be verified. Invoices and related bills that occur in the purchase and sale of drugs shall be kept in accordance with the relevant provisions.
Public medical institutions in the drug inspection revenue bank, must verify the ticket, goods, accounts of the three consistent to enter the warehouse, use, not only to the distribution of drugs circulation enterprises to request, verify invoices, but also should require the circulation enterprises to issue stamped copies of the purchase invoices provided by the production enterprises, two invoices of the drug circulation enterprise name, drug batch number and other related content mutually confirmed, and as a public medical institutions to pay for drugs, into the financial file management. A copy of the purchase invoice for each drug variety is provided at least once. Conditional areas are encouraged to use electronic invoices to verify the "two-vote system" through information technology., how to ensure the remote, inconvenient rural and village drug supply?
: The implementation of the "two-vote system" is a major reform initiative, will lead to a series of changes and adjustments in the field of drug circulation. In order to ensure the smooth progress of reform and an orderly transition, especially to ensure the supply of medicines to primary health care institutions, the Notice stipulates that drug distribution enterprises distribute medicines for particularly remote and inconvenient townships (towns) and village medical and health institutions, allowing for another invoice for the purchase and sale of medicines on the basis of the "two-vote system", but only in particular remote and inconvenient townships (towns) and village-level primary health care institutions., for special drugs and special circumstances, how to deal with drug procurement?
: In order to respond to natural disasters, major outbreaks, major emergencies and emergency (rescue) of patients and other special circumstances, emergency procurement of drugs or national medical reserves of drugs, special treatment may be implemented to ensure the supply of drugs. At the same time, the circulation and operation of narcotic drugs and psychotic drugs in category I shall still be carried out in accordance with the provisions in force of the State. (National Health and Planning Commission)