标签： 杭州龙凤网

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

　　Preface:

　　Today is March 8th International Women’s Day, which coincides with the National People’s Congress and the National People’s Congress. Although it is a holiday, the female delegates stick to their respective posts. Every year, the female delegates and members of the two sessions spend their holidays in the busy process of performing their duties and participating in the discussion of state affairs.

　　It is said that "women hold up half the sky". How do the female delegates and committee members in Beijing play the role of "holding up half the sky"? What good suggestions have you made? Outside the venue, they are mothers, wives and daughters; In the meeting place, they are "counselors" who offer advice and suggestions for the country, showing the charm of women. Busy, they are the most beautiful scenery at the two sessions.

　　To this end, Yang Guangwang interviewed five women deputies to the National People’s Congress. Let us follow their eyes, pay attention to people’s livelihood, education and other fields, and listen to their proposals and suggestions.

　　Viewpoint: Increase the intensity of precision poverty alleviation in the old revolutionary areas.

　　A red shirt and a black suit. As for being called "the most beautiful rural female branch secretary", she smiled and said that this is trust and respect, as well as responsibility and responsibility. It’s not that I’m beautiful, it’s that I do practical things for the masses.

　　From Gansu to Beijing, Ma Yinping was both honored and nervous when she was elected to the National People’s Congress for the first time.

　　Ma Yinping attended the opening meeting of the first session of the 13th National People’s Congress in the morning and participated in a panel discussion in the afternoon. The day’s itinerary is tight and full. The reporter noticed that there was a pile of draft paper on Ma Yinping’s desk, which was full of words. Ma Yinping said that for the first time, I was worried that I couldn’t remember the figures and I was well prepared.

　　Ma Yinping’s suggestion this year is to increase the intensity of precision poverty alleviation in the old revolutionary areas. She said that according to local conditions, she is "confident in helping the poor accurately" in her village. The report of the 19th National Congress of the Communist Party of China proposed to implement the rural revitalization strategy. She said that the next step is to build beautiful countryside, develop tourism resources, and broaden the channels to get rid of poverty and become rich.

　　When it comes to the topic of poverty alleviation, Ma Yinping opened a chatterbox. There are many happy things on the road to poverty alleviation, big and small. She told reporters the story of many poor households getting rid of poverty, and she could feel that she knew everything about each situation. She said that a seemingly trivial matter is "a big deal" for poor households. When their problems were understood and solved, Ma Yinping said, "My heart is full of joy and a sense of accomplishment."

　　Ma Yinping also introduced the "one household, one policy" program for accurate poverty alleviation to reporters. That is, adhere to the policy of households, vary from person to person, project to household, and policy to people. Ma Yinping said, find out the causes of poverty, formulate a poverty alleviation menu, "don’t rush headlong into it" and formulate a policy of "grounding gas".

　　After listening to this year’s government work report, Ma Yinping said that there were many bright spots and she was very touched. She said, especially in the renovation of dilapidated houses of poor households, there has been a great improvement, "feeling particularly obvious." In poverty alleviation work, "more precise" and "more grounded" will bring back the spirit of the meeting and implement it. (Reporter Du Jing Ma Yuan Li Xuenan)

　　Viewpoint: increase the investment in mass sports and suggest setting up a national Wuqinxi promotion center.

　　Wuqinxi originated in Bozhou, Anhui Province, and was created by Hua Tuo, a physician at the end of the Eastern Han Dynasty. It has a history of more than 1,800 years and is an excellent traditional fitness culture of the Chinese nation. In recent years, with the rise of the national fitness campaign, people’s attention to Wuqinxi has obviously increased.

　　However, Chen Jing, who has more than 30 years’ experience in spreading and learning Wuqinxi, found that Wuqinxi is very popular abroad, and its love and promotion are increasing day by day. However, the popularity in China and the province is still lacking, which belongs to "flowers in the wall and fragrance outside the wall".

　　Therefore, Chen Jing suggested setting up a national Wuqinxi promotion center to promote the development of national fitness.

　　In order to adapt to the development of the national fitness campaign, Chen Jing proposed to revise and promulgate the Sports Law, which has been implemented for more than 20 years. The current "Sports Law" does not clearly define and express citizens and their sports rights, and the right protection mechanism is seriously lacking; There are more and more sports disputes, but the dispute resolution mechanism is obviously absent.

　　Chen Jing suggested that relevant legislation should be improved. At the same time, in the form of legislation, the "National Fitness Day" on August 8 will be established as a national sports festival. It is also suggested that the whole people should have a holiday on this day, so that the people of the whole country can take various kinds of physical exercises, so as to drive the people to remember the glorious history, carry forward the Olympic spirit and promote national fitness, thus realizing the new sports rejuvenation of the Chinese nation. (Reporter: Wang Li)

　　Person: [Fang Min, deputy of the National People’s Congress and senior engineer in charge of thermal control of Yinchuan Thermal Power Co., Ltd., Ningxia Hui Autonomous Region]

　　Viewpoint: Promote the reform of energy structure in the east and west by using the west-to-east power transmission channel.

　　"When you are a representative, you have to do something and solve some problems better." In his first year in office, Fang Min, a representative of the 13th National People’s Congress, set himself a goal. This year, she focused on the problem of overcapacity in the power industry, using the West-to-East Power Transmission Channel and big data to promote the reform of energy structure in the east and west, and achieve energy conservation and emission reduction.

　　Fang Min, a senior engineer in charge of thermal control in Yinchuan Thermal Power Co., Ltd., Ningxia Hui Autonomous Region, has participated in the innovation and transformation of thermal control system for more than 20 times, and is a veritable technical backbone of the company. As a newly elected deputy to the National People’s Congress, Fang Min actively prepares for the two sessions of the National People’s Congress and earnestly performs her duties with her consistent craftsman spirit.

　　In recent years, Ningxia has built a positive and negative 660 kV DC transmission project from Ningdong to Shandong and a positive and negative 800 kV HVDC transmission project from Ningdong to Zhejiang, and a large power transmission channel from west to east has been completed. In view of the relatively backward development in the western region and the strong demand for electricity in the eastern region, she suggested that three power plants with a total scale of 5.32 million kilowatts should be put into operation in 2018, effectively promoting the adjustment of energy structure in the east and west.

　　One month after being elected as a deputy to the National People’s Congress, Fang Min also consulted experts extensively, collected data and compared experiments. She found that there was a waste of resources in the usual power grid dispatching. If the national power grid needs a 500,000-kilowatt adjustment range, and more than two small thermal power units with 300,000 kilowatts participate in peak shaving, the coal consumption will be greater than that of a 600,000-kilowatt unit. In short, the coal consumption of two small units is higher than that of one large unit. Nowadays, more and more new energy power, such as wind power, photoelectricity, etc., are incorporated into the national power grid, and the peak shaving and dispatching of the power grid will become more frequent, and the waste of resources will become more serious. Fang Min hopes that relevant departments should organize power grid dispatching departments and thermal power generation enterprises to set up a project to jointly discuss the scientific dispatching scheme of thermal power units supported by big data, rationally dispatch power plants with different energy levels, and introduce corresponding incentive and subsidy policies to achieve the effect of energy saving and emission reduction. (Reporter: Xu Sheng)

　　Viewpoint: "Make way for ambulances" depends on the system rather than praise.

　　Whenever I drive on the road, whenever I see an ambulance passing by, Li Yan, deputy of the National People’s Congress and president of Qilu Pharmaceutical Co., Ltd., always lets the ambulance go first, and at the same time, I feel a sweat for the patient in my heart, even a little worried. "Because the 120 ambulances that perform the task are racing against time, once some vehicles are blocked on the road, it will cause a waste of ambulance time." Therefore, during the two sessions this year, Li Yan brought a proposal on "unblocking the ambulance" life channel ".

　　In an interview with a reporter from the Central Broadcasting Network, Li Yan appealed that it is suggested to install a camera on the ambulance to take pictures of private cars that refuse to let go, and the behavior of not avoiding the ambulance must be clearly stipulated and severely punished. She seems a little urgent to implement the above suggestions. This year, she also plans to shoot a public service advertisement about comity ambulances.

　　Li Yan said: "In real life, there are some car owners who refuse to give way when they meet 120 ambulances to perform emergency tasks, and even occupy the emergency passage. I usually feel very angry when I meet such car owners. This is a disregard for life. We are in the pharmaceutical industry, and we have a strong desire in ourselves: there will be a strong rescue complex in our hearts. Therefore, when I heard that I died because of time delay, not because of medical skills or medicine, I couldn’t accept it. "

　　It is understood that at present, in Shenzhen, Fuzhou, Fujian, Nanjing, Jiangsu and other places in China, attempts have been made to establish relevant systems on ambulance avoidance. For example, Shenzhen has launched a "worry-free avoidance" penalty-free system, but those who fail to avoid it for more than the set time will be entered into the law enforcement database as illegal information, and 300 yuan will be fined and deducted 3 points according to law. For another example, on October 17th last year, Jinan City, Shandong Province launched the "Fearing for Life and Avoiding Worry" campaign, and the newly-developed "Intelligent Driving Recorder" was put into use in 75 ambulances under the Jinan Emergency Center ….. and so on, which are all worth learning.

　　For unblocking the ambulance "life channel", Li Yan suggested that a camera should be installed in front of every 120 ambulance to collect evidence for vehicles that cut in line, cut off or give way to ambulances, and relevant data should be shared with the traffic control department as evidence of punishment. In addition, Li Yan also suggested that the unimpeded ambulance "life channel" should be included in the evaluation index system of civilized cities (units). From the system to the concept, the fundamental solution to this problem is to make the ambulance become everyone’s conscious action. (Reporter: Jing Wong)

　　Person: [Chen Jianyin, deputy to the National People’s Congress, chairman of the trade union of Chuzhou RT Mart Commercial Co., Ltd. and director of the human resources department]

　　Viewpoint: It is suggested that every city or public place should set up a maternal and child room reasonably according to its size, and incorporate it into relevant laws and regulations.

　　"Being elected as a deputy to the National People’s Congress is very exciting on the one hand and a heavy responsibility on the other. This time, I pay more attention to the content of setting up a maternal and child room in public places. " Chen Jianyin, deputy to the National People’s Congress, chairman of the trade union of Chuzhou RT Mart Commercial Co., Ltd. and director of the human resources department, suggested that every city or public place should reasonably set up a maternity room according to its size and incorporate it into relevant laws and regulations.

　　According to Chen Jianyin, in her previous research, she found that although the construction of maternal and child nursing rooms in some cities has been relatively perfect, the construction progress of maternal and child nursing rooms in public places such as expressway service areas, railway stations and bus stations is still unsatisfactory.

　　Chen Jianyin believes that this phenomenon is incompatible with the pace of social civilization and progress since the reform and opening up. "Society is constantly improving, especially women need more private privacy."

　　Therefore, Chen Jianyin suggested that the establishment of maternal and child rooms should be rationally allocated according to the size of each city or place. At the same time, she also hopes to incorporate this content into laws and regulations to better protect the rights and interests of women and children. (Reporter: Xu Peng)