Will the "Anhui model" collapse and the two envelope bidding still make pharmaceutical companies miserable?

Source: the formulation of Ames 2015-11-05 China's drug bidding policy has always blossomed, but the core goal has always been to reduce prices After all, there has never been a long-term universal ointment for controlling medical expenses Although there are many disputes about bidding, in the end, everyone can return to you and find a balance between the stability of interests and the flexibility of policies The only way to cause great controversy in China is the "Anhui model" The most important tool of Anhui model bidding is the "two envelope" system, which does not know where it comes from The double envelope itself even surpasses the Anhui model and occupies an important position in the drug bidding nowadays In fact, the policy tool of two envelopes is imported In order to purchase high-quality and high price drugs with guaranteed supply, Delhi implemented "two envelope selective tender system (tests) Tests means that the technical bid and the price bid are placed in two envelopes respectively, and the price bid will not be released until the 9 standards set by the special procurement committee are met Compared with the bidding tool invented in China, the "double envelope" has a positive significance, and the bidding for essential drugs led by the former Ministry of health has become a test field of double envelope The double envelope became a single envelope and double envelope On January 17, 2009, the Ministry of health and other six departments jointly issued the "opinions on further standardizing the centralized drug procurement in medical institutions", commonly known as "No.7 document", which set the bidding target as "quality first, reasonable price" According to the new regulations, it is required to reasonably divide the categories of drugs, increase the weight of quality, and comprehensively evaluate the quality, price, service and reputation of drugs, taking into account the clinical efficacy, quality standards, scientific and technological level and other factors However, in the actual operation process, the combination of local and foreign countries has brought different changes, which makes the commercial bidding become the competitive price reduction of enterprises, the technical bidding is virtual, and the quality of drugs is difficult to be guaranteed After the implementation of double envelope in the whole country, this phenomenon quickly became a common phenomenon Many provinces and cities are concerned about access factors such as drug quality type, sales scale and drug expiry date However, these factors are qualifications that almost all countries need to have for approval of drugs However, for the critical clinical efficacy of drugs, its weight position has not been reflected in the evaluation of bidding scores, and many indicators are scored by experts, so the subjective factors are large Finally, no matter which province or city, it is the same as Anhui, which makes the technical bid in the double envelope too simple, and the key elements of quality bid evaluation are not well reflected, leading to the focus of bidding to the competition of commercial bid, and the core of bid evaluation is still the price In terms of the political wind direction, at that time, the national model of learning from Anhui made the double envelope useless and became a competition field for low prices in various provinces and cities In particular, the single source commitment under the Anhui model makes the quality risk increasingly high At that time, it would be a great challenge for suppliers to implement the single source commitment with the province as the unit In China, the current situation of pharmaceutical industry is that the same medicine and the same specification are produced by many pharmaceutical enterprises The enterprises that implement the single source commitment may not guarantee the supply, which may easily lead to the absence of commonly used drugs However, in Anhui Province, all aspects of the survey show that the single source commitment makes the drug shortage a normal situation The single source commitment directly intensifies the competition of price bid in two envelopes For example, Liu Guoen, a famous medical reform expert, once gave an example when studying two envelopes If some enterprises have passed the commercial bid, but in the price link, an enterprise wins, and its price is the cheapest, then if the unsuccessful enterprises want to be Lei Feng, they are willing to sell at the same price as the winning enterprises, should we allow it? I think we should allow it, so as to make the two envelopes double Envelopes have a meaning This logic can be simplified as: if only one enterprise wins the bid, then everyone must try their best to offer a low price, but if more than one enterprise wins the bid, then in addition to the lowest price, the second lowest price and the third lowest price can win the bid, and the intensity of competition is greatly reduced Quality crisis makes "double envelope" encounter crisis When Anhui mode is most popular, there is a popular saying that the price is unreasonably low in the industry, that is, the bid winning of ultra-low price makes it difficult for enterprises to recover the cost of production according to the standard, or give up the market and do not produce at all At the same time, it is also difficult to avoid the lack of social responsibility of pharmaceutical enterprises, Jerry building, shoddy, low limit feeding, etc The "apple peel" event, represented by an enterprise in Sichuan, highlights that under the commitment of a single source of goods, in order to win the bid, the enterprise must take risks, so that the phenomenon of replacing apple peel appears, so that it can produce cheap and qualified fake drugs As a result, the Anhui model was soon distorted by various changes For example, a single source of goods commitment, although many provinces and cities explicitly said that they wanted a single source of goods, has started to "release water" secretly In 2014, Anhui Province publicly abandoned the requirement of single source of goods, which greatly reduced the competition between two envelopes As a result, other provinces and cities turned to it, and the dispute over the low price also subsided In 2015, the State Council issued the guiding opinions of the general office of the State Council on improving the centralized drug procurement in public hospitals, with the prominent feature of classified bidding Many drugs with fierce price competition are often in short supply, which has become the norm in recent years Such drugs will be purchased separately at designated points or directly on the official website, and will no longer participate in price competition For special drugs with high prices, a new negotiation mechanism should be adopted for procurement There has been a big change in the way public hospitals bid, and the once beautiful double envelope has not disappeared The new drug bidding system will still adhere to the two envelope bidding system According to the technical requirements of generic drugs and quality consistency evaluation, the production enterprises directly bid, select the winning enterprises and candidate winning enterprises from low to high, and scientifically set the bidding groups to promote effective competition It can be seen that the pattern of low price competition will not change in the short term Although the Anhui model has collapsed, there are still many voices defending the double envelope In late November, a new round of drug bidding will start again Whether the double envelope can achieve high quality and low price is about to be tested again.