A large number of innovative drugs and "life-saving drugs" have entered the medical insurance drug list, which is the space saved by centralized procurement.
On December 6, 2018, the centralized procurement of drugs in "4+7" pilot cities was opened in Shanghai. This means that the long-brewing national drug centralized procurement with quantity has officially kicked off.
National centralized drug procurement with quantity, referred to as "centralized procurement" for short, means that drug procurement institutions "package" the scattered purchases of medical institutions through public bidding, and purchase a clear number of drugs from drug suppliers by "group purchase", thus reducing procurement costs.
At that time, the national medical insurance department entrusted the Shanghai Pharmaceutical Centralized Bidding and Purchasing Affairs Management Office under the Shanghai Medical Insurance Bureau to undertake the daily work of the national drug joint purchasing office (hereinafter referred to as "joint purchasing"). In the past three years, the joint procurement has organized six batches and seven rounds of national centralized procurement, and the scope of implementation has expanded from 11 cities to the whole country. The procurement content has expanded from oral dosage forms to injections, from chemical drugs to biological drugs, and the variety, quantity and degree of competition have been constantly breaking through.
Specifically, what are the breakthroughs?Let’s take a look at the changes in these three years through the data.
The original drug was greatly reduced in price, and the "patent cliff" appeared.
Among the six batches and seven rounds of centralized mining, the first five batches and six rounds are all chemical drugs. From the first batch of "4+7 quantity procurement" to the fifth batch of quantity procurement,A total of 218 varieties were covered, and the average price of the selected products decreased by 53%, which reduced the burden on patients by about 250 billion yuan.
The number of selected products shows an upward trend.In the "4+7 quantity procurement", 25 of the 31 pilot generic drugs were successfully selected, with a successful selection rate of 81%. Since then, the number of selected varieties has reached 32, 55, 45 and 61 respectively. The sixth batch of insulin special procurement is the first time that the national centralized procurement has been extended to the field of biopharmaceuticals, which is quite different from the first five batches of procurement rules, and the number of selected varieties is 16.
Except for the sixth batch of insulin special procurement, the average decline of the other five batches and six rounds of centralized procurement was above 50%, which remained stable. The fifth batch of centralized mining decreased by 56%, which was higher than other batches. It can be clearly seen that the centralized collection and extrusion of drug price moisture has played a positive role in promoting the return of drug prices to rationality.
Centralized purchasing not only reduces the burden of drug use for the masses, but also improves the efficiency of the use of medical insurance funds.After calculation, the results of each batch of bidding saved 5.8 billion yuan, 19.5 billion yuan, 9.1 billion yuan, 19.5 billion yuan, 13.2 billion yuan, 24.1 billion yuan and 9 billion yuan for the pilot areas or the whole country. Among them, the fifth batch of centralized procurement selected the most varieties, involving a total amount of 55 billion yuan, saving medicine costs to the highest in previous centralized procurement.
As a result, has the medical insurance expenditure decreased? Where did all the money saved go? In fact, to improve the efficiency of the use of medical insurance funds is not only to "cut costs", but also to spend money on the cutting edge. In recent years, a large number of innovative drugs and "life-saving drugs" have entered the medical insurance drug list, which is the space saved by centralized procurement. The continuous increase of medical insurance expenditure has prompted pharmaceutical enterprises to intensify innovation and promoted the process of high-quality development of the pharmaceutical industry.
The participation and winning bid rate of each batch of original research pharmaceutical companies have always been the focus of attention. Although the average decline of the selected original drugs in the first four batches of centralized procurement was relatively high, climbing from 71% and 79% to 82% and 84%, there were 10 foreign companies involved in 11 products in the fifth batch of centralized procurement, and their participation was significantly improved.
Foreign companies actively embrace centralized purchasing. On the one hand, the fifth batch of centralized purchasing involves many kinds of injections, and the successful result will have a great impact on the sales of enterprises in hospitals. Faced with such a big market change, foreign companies can’t "sit idly by". More importantly, it has been gradually accepted by the industry and society because the original drug is equivalent in quality and can compete on the same field. This is the embodiment of the implementation effect of the generic drug consistency evaluation policy and the embodiment of the normalization and institutionalization of centralized purchase.
More and more original drugs have been greatly reduced in price, indicating that the phenomenon of "patent cliff" has appeared.The so-called "patent cliff" means that after the patent protection of a newly developed and listed drug expires, more generic drugs will appear on the market, and the increase in supply will lead to a cliff-like decline in the price of the original drug. In the past, the prices of some original drugs in China were higher than those in neighboring countries and regions for a long time, and the phenomenon of "patent cliff" failed to happen. Now, this phenomenon has finally happened because of national centralized mining.
"Taking quantity" is the core, and promoting "exchanging quantity for price"
Six batches of centralized mining, which drug varieties have the highest decline?Based on the 457 drugs with known historical prices, the top drugs have different uses. Rivaroxaban, an anticoagulant in the fifth batch of centralized mining, dropped by as much as 99.5%, which is a veritable "price reduction king". Memantine for the treatment of Alzheimer’s Harmo’s disease and olanzapine for the treatment of schizophrenia are also in the forefront with a drop of over 97%. Taking olanzapine orally disintegrating tablets as an example, patients used to spend 849 yuan a month, but now they can save 822 yuan by using the selected varieties, which can save more than 9,000 yuan a year.
Some time ago, the "soul bargaining" in the national medical insurance drug list negotiation triggered a heated discussion. Is collective purchasing "soul bargaining"? In fact,Centralized purchasing and medical insurance negotiation are two different things.Although both of them belong to the "drug price reduction" initiative, the medical insurance negotiation is to include drugs in the catalogue, so that they can be reimbursed through medical insurance, and there is no provision for hospital dosage; Centralized procurement requires hospitals to give priority to the use of selected drugs and complete the contract dosage on time. It can be said that "with or without quantity" is the main difference between the two. In addition, the drugs selected in centralized procurement include both varieties in the medical insurance catalogue and those outside the catalogue.
"Carrying quantity" is the core of centralized purchasing, and "exchanging quantity for price" can promote enterprises to reduce prices. So,What are the ten varieties with the largest purchase volume?It can be seen from the agreed procurement volume in the first year of the country that the drugs for common diseases, such as hypertension and hyperlipidemia, are still in the greatest demand, among which metformin for treating type 2 diabetes has the largest procurement volume, with the agreed procurement volume reaching more than 5 billion tablets in the first year, and the actual procurement volume in the first year of the country exceeds 8 billion tablets. 2021 is the 100th anniversary of the discovery of insulin, and insulin has been continuously introduced in the past 100 years. At present, the second generation of recombinant human insulin and the third generation of recombinant insulin analogues are commonly used products in clinic. Relatively speaking, the third-generation insulin is safer and more effective, and the price is higher.
Just at the end of last month, the sixth batch of centralized purchase of insulin was opened in Shanghai. This collection covers the second and third generations of insulin, including 16 generic varieties. The purchasing demand of medical institutions in China in the first year is about 210 million pieces, and the purchasing amount involved is about 17 billion yuan according to the pre-centralized purchasing price. The average price reduction of the products to be selected is 48%, and it is estimated that the annual cost can be saved by 9 billion yuan.
The three years that Ji Cai has gone through are three years of challenges and achievements. The "Tenth Five-Year Plan" for National Medical Security proposes that by the end of the "Tenth Five-Year Plan", the number of drug varieties purchased by each province through national and provincial centralized quantity will reach more than 500. Practice has proved that only by holding on to the reform achievements and constantly promoting the normalization and institutionalization of centralized drug procurement can we better serve the overall situation of national medical and health reform and development and provide people with all-round and full-cycle health services.
◆ Source | Jiefang Daily/China Medical Insurance