Local collection has been implemented one after another, and clinical value, consistency evaluation and drug economy factors are still the core factors for implementation.Previously, the controversy behind the medical insurance negotiations once appeared. Can the quality of drugs be kept up? What changes will the medical insurance reimbursement of patients?The price of drug prices can not buy medicines. What are the problems that may be faced in local hospital purchases?What new ecological models will appear outside the hospital and the Internet?
On April 29, the website of the National Medical Security Bureau released news, in accordance with the spirit of the “Opinions of the People’s Republic of China Insurance Law” and the “Opinions of the Central Committee of the Communist Party of China on Deepening the Reform of the Medical Security System” (Zhongfa 2020 5) and other documentsDrafted the “Interim Measures for the Management of Basic Medical Insurance Medication (Draft for Opinions)”, and now solicit opinions from the society.
In the draft of the solicitation of the comments, the types of medical insurance directory are not included in a clear scope. At the same time, the drugs of the six cases are also called out of the “Drug Catalog”. It is worth noting that the medicines that are included in the negative list,It also emphasizes comprehensive consideration of clinical value, adverse reactions, and drug economy, and drugs that believe that risk is greater than returns.
The change and constant change of the base medicine directory
In the 2009 version of the basic medicine directory, the number of anti -tumor drugs was zero, and the 2012 version of the medicine directory was adjusted to 26 types. The 2018 version of the medicine directory adjustment added another 12 species, and the adjustment was obvious.Among them, new varieties include 12 types of tumor medication, 22 types of children’s medication urgently needed for clinical clinical.The directory will further standardize dosage forms and specifications. 685 drugs involve more than 1110 dosage forms and more than 1,810 specifications. It is of great significance for guiding basic drug production circulation, bidding procurement, reasonable medication, payment reimbursement, and full supervision.
Among the new varieties, Sodbwewa -Vajewei is the first and the only new drug in the world that is the only whole oral, pan -based, and single dose. Theoretically, about 80%of the domestic hepatitis C virus can be used. Infected people have achieved the effect of cure, and the demand for clinical treatment in my country is very high.In addition, including Gefitinib, Emantinib, Ekntinib, Riccina Mibab, Telkuzab, Permeusus, Capitetabin, etc., have also become the new anti -tumor this timePharmaceutical species.
From the perspective of clinical urgent need, the incidence and mortality rate of cancer from 2000-2011 showed a trend of rising year by year. Until the incidence of cancer in 2014, the incidence of cancer began to stabilize, and the mortality rate decreased slightly. In 2015, the cancer mortality rate was about 10,000 per day.(3.804 million/365 days) Diagnosis of cancer, calculated that about 5 people died of cancer per minute.The basic drug directory is transferred to the tumor medication. Although there were also objections before, pointing out that it would be very pressured to medical insurance, from the perspective of reducing the burden of patients, it undoubtedly brought “timely rain” and will also give the previous one to the past.The “expensive medicine” has taken the level that patients can accept, and improve the overall medicinal level of the masses as a whole.
After the reform of the base drug directory in 2018, the definition of basic medicines is no longer standing in the view of grass -roots drugs and even cheap drugs.
Related data shows that based on the 2012 national basic drug directory, the “2017 National Sample Hospital Drug Use Monitoring Report” made by the Chinese Pharmaceutical Society Science and Technology Development Center pointed out that in all chemicals and biological products13.25%, while the proportion of usage reached 33.71%.Xiao Lu, deputy director of the center, said that the small cost behind the small cost is large, indicating that in the practical drugs, the status of basic drugs has been reflected and recognized.
However, from the previous experience, those innovative drugs with higher unit prices, or varieties with restrictions on reimbursement ratios, will face an embarrassing situation after entering the base of the base medicine.If the price is not negotiated, the drug cannot be reimbursed even on the base drug directory, and it is likely to be marginalized.
As a result, the reform of the basic medicine catalog is accompanied by the test of how to make the drugs really landed, and a wave of waves staggered. On December 6, 2018, the procurement of the “4+7” city with 31 pilots involved a total of 31 pilot universities.Famous medicines, the final results show that 25 centralized procurement is to be selected with a success rate of 81%.Among them, 22 generic drugs through consistency evaluation, accounting for 88%, 3 original research drugs, accounting for 12%, which also means that the alignment drug replacement effect begins to appear.
On the surface, the “Band Procurement” replaced the “gold sales” and purified the pharmaceutical market environment.From the perspective of patients, it is encouraged to prioritize and use products that have been evaluated by the consistency of the quality and efficacy of generic drugs. From the aspects of “quality” and “price”, the people’s medication level is comprehensively improved.The market perspective promoted the replacement of generic drugs. At the same time, the price of products selected by the selected products declined sharply, which led to the decline in the price of unscaptized products, and forcing the “patented cliff” that forced the prices of original research drugs to appear.
Difficulty iterative journey
Unlike the phenomenon of inferior coins brought about by gold sales in the past, the new collection model will strictly follow the market model.The once -supply orientation of supply has gradually changed to value -oriented, and has become an inevitable trend. In the past ten years, the Chinese medical services and pharmaceutical markets have shown a rapid development and quality of quality.There are both general medical and resource shortages, but also “magic medicine” and good medicines.The invalid medical care will be worsened to the medical supply and medical supply.
For patients, it is harmful to health for patients.This is not only the issue of waste of resources and the burden of expenses. As the impact of pollution on the environment, the abuse of Chinese antibiotics in the world is probably affected by generations.
It is worth noting that the directory published in various regions in 2020 can be seen that the injection of antibiotics and proton pump inhibitors is the two types of products that are most liked to be included in each region.May face the lowest price bidding shock again.These two types of products have very few products through consistency evaluation, which means that the largest pressure reduction pressure is the products that have obtained separately pricing through the “high -quality level” in the past.
It is clear that the purchase of the reimbursement policy can be seen that the purchase of the band is only a matter of time, and the state adjustment of drug prices is not the ultimate goal. Putting value and quality first through strong measures to drive drug innovation, change medical services and past medical services and in the past.Pharmaceutical production is that the ecology of inferior coins that are generally dispelled in the effect of distorted interest mechanisms can fundamentally change the current status of Chinese medical care and let patients use good medicine.
Previously, the price of medicines was reduced, but the hospital could not buy medicines. There may be several reasons. First, the supply capacity was insufficient. In June this year, Hebei Province announced the follow -up of the country’s “4+7” drug band procurement.Sino -US Shanghai Schiuba Pharmaceutical Co., Ltd.’s previous selected variety of Fervli Billi sodium sheet abandoned the label.Subsequently, Hebei Pharmaceutical Concentrated Purchasing Network issued the “Announcement of the Office of Hebei Pharmaceutical Concentrated Procurement Leading Group on the Central Purchase of Ferun Pripi” “The company has promised to supply the price of Finding Prizen (10mg*14 tablets) in Hebei Province for centralized procurement, but the company’s production capacity can not meet the demand for procurement in Hebei Province., Reference Preparatory Production Enterprise, Production Enterprises that pass consistency evaluations, and production enterprises that meet the province’s drug consumption to participate in the centralized procurement of Finding Priley (10mg*14 tablets) to ensure the selection of drugs in centralized procurement of drugs. “
Second, there is another sound in the industry at the same time. The so -called “supply capacity” may be just a kind of resignation after Shi Guibao failed to talk about the price.With the continuous deepening of collection, the regions will be gradually opened in the next three years. The major pharmaceutical companies have seen the situation clearly.The testimony of testing the water gradually became “normal”.
In addition to pharmaceutical companies, there are also patients who have a wait -and -see attitude. Until July 2019, according to reporters, many people, including medical staff, prescription doctors, and ordinary people, said that they did not understand the consistency of imitation pharmaceuticals.Evaluation, there was no effort to promote consistency evaluation during the promotion of “4+7”, so it failed to reverse the public’s mentality.Many people and even medical staff still believe that “the quality of generic drugs is not as good as the original drug”, and some patients have clearly stated that “even if the price is cheap, they are unwilling to replace the original original drugs used to generic drugs.”
In addition, the medical insurance payment policy of the selected varieties is also slightly conservative, especially for patients with higher income and paranoia for medication, and they are even more attractive.A patient with diabetes with medication for the year has been taking the original medicine. After the “4+7” pilot, the “4+7” pilot was replaced with two generic drugs under the persuasion of the doctor.After one month of medicine, after converting the medical insurance reimbursement policy, it saved more than 200 yuan per month.The patient bluntly said: “I work very busy every day, and my salary is a lot. The savings are not enough to make me change my previous medication habits.”
In the 2019 catalog, more original research and drug negotiations have entered the national collection. Whether the phenomenon of “true incense” will appear in the future is worth seeing.For most audiences, whether it will be like an enterprise, it will gradually become an attitude of acceptance.
At the same time, the local response to the policy reflects certain flexibility. For example, the basic medicines with large local demand have not passed the consistency evaluation will also be included as appropriate, which is enough to reflect the real needs of the patient, that is, the value demand will be valued and metEssence
There is a lot of promising markets outside the hospital
As early as December 2018, major pharmaceutical companies have adopted strategies, and at the same time run two sets of price systems and expand out -of -hospital sales.In fact, pharmaceutical companies are not completely “purchased” 4+7 withdrawal, which has no power to fight. Many pharmaceutical companies have sold them outside the hospital and sold related products.The outflow mode is the retail mode of the prescription medicine. Although the gameplay is different, it gives more opportunities for the industrial end.
Although the out -of -hospital market (80%of the public hospital occupies 80%of the market), which accounts for 20%of the market share, will become the focus of development, but the drugs purchased will also be included in the medical security pharmacies. In addition to the trend of prescriptions, 20%of the market outside the hospital will be further further will be further further.extrusion.
At the same time, the volume procurement model becomes a new normal, which means that the profit margin of pharmaceutical companies in the hospital will become smaller and smaller.In contrast, the purchase of volume complies with the prescription outflow trend, and the chain retail leader is expected to benefit long -term benefits.”Bring procurement may be converged with the current trend of medical reform in the pharmaceutical separation and prescriptions. With the transfer of procurement documents from pilot to promotion, a large number of varieties will be shifted from inside to the off -hospital market in the future. Retail pharmacies are expected to become the most beneficial place to undertake.In addition, the release of the national opinion draft in the recent classification management and the pre -reform of the rectification and reform of the personal medical insurance account. It is expected that the small and medium chain pharmacies with irregular management management are expected to achieve the industry’s clearing.Preparation of space. “Earlier, the” Reform and Improvement of Improved Drug Supply and Use Policy Implementation Plan “announced by the Guangdong Provincial Government clearly stated that it allows patients to freely choose to purchase medicines in medical institutions or medical insurance fixed retail pharmacies at the same time.The pharmacy can make a good supply guarantee through consistency evaluation of generic drugs.The Kunming Medical Insurance Bureau also recently held a news notice meeting, requiring the execution of citizens to use the prescriptions of the external urban area to use the 10 pilot retail pharmacies in the main urban area of Kunming to use the medical insurance card and purchase related drugs for chronic diseases.
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This is undoubtedly a good thing for patients. On the one hand, slow disease purchase drugs save time to queue up in the hospital for registration. On the other hand, drugs that cannot be purchased during the transition period of volume procurement may be obtained from outside the hospital.The impact occurs when the buffer period.
In a short period of time, the purchase and drug price negotiations will bring some inconvenience to doctors and patients, but the place where the adaptation process will be more flexible from the interests and value -oriented of the patient.In the past ten years, the rapid development of China’s medical and health care is inseparable from the continuous trial and error and process development of medical insurance reforms.The healthy ecological development of the medical and health undertakings, the long -term profitable party will be patients and hospitals, as well as companies that have changed smoothly after shuffling.