The drastic changes in circulation have given birth to the "one-vote system", and the "two-vote system" has been canceled? National Health Insurance Administration: "Two-invoice system" plays an important role!

On October 12, the National Medical Security Administration issued a group of suggestions from deputies to the National People's Congress and a reply to the proposal of members of the National Committee of the Chinese People's Political Consultative Conference, which clearly responded to the proposal
of the deputies to abolish the "two-invoice system" for the procurement of pharmaceutical consumables in medical institutions.

Although the specific content of the "abolition of the 'two-vote system'" proposed by the committee members and deputies is not clear, the National Health Insurance Bureau has a clear attitude: the "two-vote system" plays an important role
.

The purpose of promoting the "two-invoice system" is to streamline circulation links and cure the chaos in
the drug market.
At the same time, the continuous promotion of the volume procurement policy is intensifying the changes in the
pharmaceutical circulation industry.

The logic of volume-based procurement is that participating production enterprises will adopt the "quantity-for-price" access model, and after the price of drugs falls, enterprises will no longer need marketing and marketing, and the medical insurance bureau and corresponding government departments will commit to the use through
supporting policies.

With the normalization and institutionalization of volume-based procurement, the multi-level procurement pattern of national, provincial, prefectural and municipal, cross-regional alliances and county medical alliances is having a far-reaching impact on the pharmaceutical circulation industry, and pharmaceutical manufacturers, commercial circulation companies, medical insurance payment terminals, etc.
are reconstructing their respective functions and positions
.

However, taking into account the current progress of volume procurement, as pointed out by the National Health Insurance Bureau in its reply letter, the national centralized procurement of a total of 294 kinds of drugs, accounting for 35% of the annual procurement amount of chemical drugs and biological drugs in public medical institutions, and local governments have also explored the collective procurement of some varieties, but there are still a large number of varieties that have not been covered by the new collective procurement system, and some innovative varieties and exclusive varieties with insufficient competition cannot be included in centralized procurement
with quantity.

It is not difficult to see that for the commercial circulation of these varieties, it is still necessary to use the "two-invoice system" as the regulatory yardstick
for circulation channels for a period of time.

1

Take the "two-vote system" as the starting point

Heavy-handed control of the chaos in the drug market

Behind drug procurement are drug circulation channels, which are the basis for
many reforms and management.
Due to historical reasons, China's drug circulation field has been in a state of
"small and scattered" for a long time.
The long chain of drug circulation, the chaotic circulation order, the superimposed illegal money laundering, gold sales and other problems have pushed up drug prices
.

In April 2016, the executive meeting of the State Council proposed to implement the "two-invoice system" reform, the main purpose of which is to control the chaos in the field of drug circulation, reduce the links of drug circulation, prevent money laundering and unhealthy trends, reduce inflated drug prices, strengthen drug supervision, and ensure the safety
of drug use by the masses.
In December of the same year, the former Medical Reform Office of the State Council and other eight departments jointly issued the "Implementation Opinions on the Implementation of the "Two-invoice System" in the Drug Procurement of Public Medical Institutions (Trial)" to promote the implementation of the "two-invoice system"
in drug procurement by public medical institutions.

Since its implementation, the "two-invoice system" has played a role in standardizing the circulation market, accelerated the integration and large-scale development of the circulation field, was an important measure to control the chaos in the pharmaceutical market at that time, and played a positive role
in streamlining the lengthy circulation links of the pharmaceutical market.

According to the Statistical Report on Drug Supervision and Administration (Fourth Quarter of 2021) released by the State Food and Drug Administration, by the end of 2021, there were 609,700 enterprises holding "Drug Business Licenses" nationwide
.
Among them, there are
13,400 wholesale enterprises.

During the reporting period, provincial and sub-provincial regulatory authorities inspected a total of 30,700 pharmaceutical wholesale enterprises, found 6,213 enterprises that violated relevant management regulations on drug business, and completed rectification 6,271 times
.
It can be seen that under the policy of increasing the code layer by layer, there are still enterprises that do not hesitate to take risks to "step on the tightrope"
.

Daily supervision of drug operations in the fourth quarter of 2021

According to the "2022 Drug Circulation Operation Analysis Report" released by the Ministry of Commerce, the sales scale of the national drug circulation market increased steadily in 2021, and the growth rate gradually recovered to the pre-epidemic level
.
Among them, the sales of the pharmaceutical wholesale market were 2,061.
5 billion yuan, a year-on-year increase of 8.
65%
after deducting non-comparable factors.

With the promotion of the "two-invoice system", drug distributors have undergone several reshuffles, Sinopharm Group, Shanghai Pharmaceutical Group, and China Resources Pharmaceutical have basically divided most of the drug circulation, and the situation of "how small and scattered" has now been improved, and the reshuffle effect of circulation enterprises in some provinces (autonomous regions and municipalities) is obvious
.

In 2021, the main business income of pharmaceutical wholesale enterprises will be among the top 10

Comparison of data for 2021 and 2016

It is worth noting that the drug circulation chain still needs long-term continuous compliance constraints, and the behavior of seeking benefits in the medical and health field in various places in terms of consumables procurement, drug sales, project undertaking, and post adjustment is still the focus of regulatory attention and the investigation of
violations of laws and disciplines.

Just in February this year, Guangxi Wuming District Traditional Chinese Medicine Hospital, Nanning Ninth People's Hospital, and Binyang County Appointed Hospital all had problems such as drugs beyond the scope of medical insurance restrictions, inconsistent purchase, sales and inventory of some consumables, and Sichuan Suining Economic and Technological Development Zone Weigao Hemodialysis Center Co.
, Ltd.
had problems of irregular purchase, sale and inventory of pharmaceutical consumables.
.
.
At a time when relevant institutions and enterprises are still trying to bypass the rules to seek benefits, the importance of legal compliance of commercial circulation has become more and more prominent
.

2

The pattern of pharmaceutical circulation enterprises has changed

Will the "one-vote system" accelerate?

After the issuance of the "Implementation Opinions on the Implementation of the "Two-invoice System" in the Procurement of Drugs in Public Medical Institutions (Trial)", various provinces and cities have not only successively issued the policies and requirements of the "two-invoice system", but also clarified the implementation of the "two-invoice system", but also clearly encouraged the "one-invoice system"
.

There are too many links in the overall circulation of drugs in China, and the situation of inflated drug prices caused by layers of price increases has begun to improve
one after another.

Two years after the implementation of the national "two-vote system", Shandong has become the vanguard of drug policy reform, and is the first to "turn the trial opinion into a positive one"
.
In November 2019, Shandong issued the "Implementation Plan for the Implementation of the "Two-invoice System" in Drug Procurement in Public Medical Institutions", which not only requires the full implementation of the "two-invoice system", but also proposes to pilot the "one-invoice system"
in the selection of some drugs with large quantities and simple market supply channels in third-class general hospitals in the pilot cities of the medical reform.

Just after the implementation of relevant policies in Shandong, many provinces and cities across the country began intensive actions to clearly encourage the promotion of the "one-vote system", and some areas have already implemented the "one-vote system"
.

In February 2020, the "Fujian Province Centralized Procurement Document for Drugs" showed that the "two-invoice system" is strictly implemented for the procurement of selected varieties, and the implementation of the "one-vote system" is encouraged, and the selected drugs are uniformly settled by the medical insurance handling agency
.

In April of the same year, the Hunan Medical Insurance Bureau issued the "Implementation Rules for Online Payment and Settlement of Medical Payments on the Hunan Provincial Pharmaceutical Procurement Platform", which stipulates that a settlement supervision account shall be established, and the account shall be specially used to supervise the settlement of transaction payments generated by the centralized procurement of drugs and consumables by medical institutions through the centralized pharmaceutical procurement platform of the provincial trading center, and to receive and pay the advance payment
of the medical insurance fund for the purchase of drugs and consumables.

In April of the same year, the Guangdong Provincial Medical Insurance Bureau issued the "< Guiding Opinions on Promoting the Procurement of Drugs and Medical Consumables Groups> Announcement on Soliciting Opinions Again", article 6 of which clearly states: reform the payment settlement mechanism
.
Strengthen the settlement of drug payments, and prepay medical institutions in advance at a rate of not less than 30% of the purchase amount; Actively promote the medical insurance fund to directly settle payments with pharmaceutical manufacturers or circulation enterprises to improve the efficiency of
payment collection.

.
.
.
.
.
.

At the same time, with the implementation of "4+7" volume procurement in 2018, the prelude to the large price reduction of drugs, the reform of the procurement system has not only made the pharmaceutical market shift from "seller-driven" to "buyer-driven"; It also enables medical institutions to sign contracts with production companies, which select distribution companies, and encourage direct settlement of payments
with production companies.

The market believes that the production enterprise independently chooses the distribution business, and the medical institution, as the first responsible person for the settlement of the drug payment, settles the payment with the enterprise according to the contract, and encourages the implementation of direct settlement of medical insurance in areas with conditions, and these measures have been fully implemented, in fact, it is not far from the "one-invoice system"
.

Industry insiders pointed out that the practice and implementation of the "one-vote system" may be much
earlier than everyone estimated.
"After all, the prototype of the direct transaction model between hospitals and production enterprises has been established, and to achieve direct settlement is to realize the 'one-invoice system'
.
"

With the advent of the "one-invoice system", it cannot be ignored that the pharmaceutical circulation industry has undergone earth-shaking changes
.
A large number of non-standardized small and medium-sized pharmaceutical circulation institutions have been out, greatly compressing the profits between drug circulation, and the centralized procurement system has brought subvertive changes to the pharmaceutical industry and brought great changes
to the trillion-level pharmaceutical circulation market relying on pharmaceutical consumption.

Industry insiders pointed out that the pharmaceutical circulation sector has been squeezed at both ends and the gross profit is small, in the great changes in the pharmaceutical industry chain, in order to cope with the changes in the industry, the pharmaceutical circulation leader can only accelerate the adjustment and transformation in order to survive
the fittest.

In the process of transformation, some leading enterprises choose to expand their original business models, develop vertically, and broaden
the company's business scope.
For example, Jointown, while promoting the digital and platform-based transformation of the pharmaceutical circulation supply chain, relies on the industry's leading logistics system to accelerate the coverage of upstream and downstream customers; On the one hand, it expands general agency sales and self-production of drugs, merges into upstream pharmaceutical enterprises and downstream terminal retail pharmacies, opens the M&A and franchise model, walks out of the "batch and zero integration" and digital business model, and covers the industry deeper to improve the ability to
resist the risk of industry changes.

The medical insurance fund directly settles the payment with the pharmaceutical company, and the circulation link can only charge warehousing and distribution fees, and the distribution price difference income completely disappears.
.
.
With the increasing call for the "one-invoice system", the revenue scale of the pharmaceutical circulation industry will shrink
significantly.
At the same time, with the rise of Internet platforms and pharmaceutical e-commerce, the entry of third-party social logistics has brought more unknown variables to the industry, further aggravating the transformation of
the industry.

Leading pharmaceutical circulation enterprises are no longer traditional distributors, and it is urgent to stand out in the competition of industry changes and restructure their positioning between upstream pharmaceutical enterprises and terminal sales platforms such as downstream hospitals and retail pharmacies
.