up to date! "4+7" expansion message spread

Up to now, according to statistics, about 19 provinces have issued formal implementation plans or drafts for the implementation of the pilot program for the centralized procurement and use of drugs in national organizations.
4+7 national expansion has gradually entered the stage of landing. According to previous official news, the national expansion of centralized drug procurement will be completed before the end of this year.
With the official expansion of the 4+7 national expansion, how will the margin market in the coalition procurement area agree on the purchase volume? The discussion of issues such as the payment standards for 25 selected varieties has also entered the industry's field of vision.
▍4+7 expansion, how to deal with the remaining market
On the afternoon of November 2, at the "National Drug Centralized Purchasing and Enlargement Implementation Policy Symposium" hosted by the Policy Research Institute of the China Medical Materials Association, industry experts and scholars on 4+7 market and 4+7 medical insurance Issues such as payment standards have expressed their views.
According to the centralized procurement documents of the alliance area, the first-year agreed purchase amount of the 4+7 expansion area accounts for 70% of the first-year agreed purchase amount, of which the actual selected enterprise is one, and the agreed purchase amount is 50% of the first-year agreed purchase amount. That is to say, 25 4+7 varieties still have a margin market ranging from 30% to 50%.
According to the feedback from the participating pharmaceutical companies, some public hospitals have been conservative in the process of participating in the national drug concentration and procurement pilot. Some 4+7 varieties also have other sales channels other than public hospitals. From the point of view, the space in the margin market is still very impressive.
For the arrangement of the surplus market, according to the “National Medical Insurance Bureau and other nine departments, the State Administration of Health Protection issued the “Opinions on Expanding the Regional Implementation of the Centralized Procurement and Use of Drugs in the National Organization” on the 30th of September, within one to three years, The remaining amount of the purchase amount other than the agreed purchase amount, the platform can purchase other types of nets with suitable prices, but the number of production enterprises that have passed the consistency evaluation of the same variety of drugs reaches more than three, and the centralized procurement of drugs no longer selects the varieties that have not passed the consistency evaluation.
▍ surplus market, handed over to the appropriate price
It can be seen that for the margin market, the state only proposes to purchase the appropriate net-hanging varieties, and what the margin market should handle, leaving a lot of room for the place.
Chen Hao, a professor at Huazhong University of Science and Technology, said at the meeting that 4+7 nationwide expansion has partially narrowed the regional gap, effectively reducing the price of medicines and reducing the burden on medical insurance funds, and the gray space in the sales process has also been greatly reduced.
For the margin market, Chen Wei proposed that the selection of the varieties in the remaining markets requires certain principles, one is clinical demand; the second is the price formation mechanism; the third is the sustainability of supply security.
A representative of the participating companies said that the drugs that meet the clinical needs must be reliable, affordable, and cost-effective drugs.
He further stated that according to national documents, the margin market should be handed over to products of appropriate price. Based on the spirit of the contract, it is necessary to ensure the completion of the selection of the selected enterprises; for the margin market, it is necessary to ensure the fair competition between the selected enterprises and the non-selected enterprises. On the basis of the consistency evaluation, under the premise of ensuring quality and supply, hope The purchaser can choose low-cost drugs to save medical insurance funds and reduce the burden on patients.
▍Quality and low-priced drugs should get the market
Zhang Lan, director of the Pharmacy Department of Xuanwu Hospital, said at the meeting that the reason why the policy arrangement will retain 30% of the procurement margin is to leave some flexibility for the implementation of the policy.
Representatives of participating enterprises also believe that according to the principle of 4+7 expansion, all provinces are selected by pharmaceutical companies. In the margin market, the provincial medical insurance departments and patients should have the right to choose independently.
Niu Zhenggan, executive vice president of the China Pharmaceutical Enterprise Management Association, also expressed his views at the meeting. He said that under the realistic environment with large differences across China, a one-size-fits-all policy is not desirable, and the national procurement policy has The regulation of market share is to consider the diversity and imbalance of market demand, giving hospitals, doctors and patients a modest freedom of choice, but how to use free choice is the key.
Niu Zhenggan further pointed out that the distribution of the remaining market share should follow the market mechanism, and the high cost performance should be the primary factor to consider, and the sustainability of supply is also very important.
The health protection of patients, in terms of medicines, is first of all a medicine, followed by a cost-effective medicine. It should be noted that if the drug of the enterprise has no profit at all, the accessibility of the drug will have certain risks. The policy arrangement should consider both the inclusiveness of price reduction and the sustainability of drug supply. It should be fully respected. market.
He further said that in theory, both doctors and patients hope to choose cost-effective drugs. Under the measure of consistency evaluation, the low-cost drugs with consistent consistency and the quality of the original drug are undoubtedly cost-effective. of.
Chang Lirong, director of the Strategic Support Forces Special Medical Center (formerly the 306th Hospital of the People's Liberation Army), further stated that the 4+7 national expansion of the surplus market should be reserved for enterprises that have passed the consistency evaluation and low drug prices.
For the processing of the margin market, Liu Junshuai, deputy director of the Pharmaceutical Policy Committee of the China Association for the Advancement of Medicine, added that the problem of the margin market is actually a question of patient choice. The question now is how patients choose and how the policy guides patients to choose. .
For example, he said that in Japan, in order to complete the substitution of generic drugs, it has been a 10-year generic education alternative education work. This is an ecologically-created problem, and patient education must be carried out.
▍Use the medium price as the medical insurance payment standard
On the day's meeting, in addition to discussing the 4+7 national expansion of the margin market, many experts and scholars also expressed their views on the standard of medical insurance payment.
Liu Junshuai believes that the choice of drugs for patients is not a price issue but a payment issue. It is a question of the price paid by medical insurance. The selection and use of drugs by patients will be guided by the standard of medical insurance reimbursement.
For example, he said that the practice of Qingdao medical insurance reform proves that under the premise that the same type of drugs for the same indication are consistent (the default), the medical insurance department, after considering the savings of medical insurance funds, sets the medical insurance payment standard at the lowest price. Domestically produced drugs of consistent quality account for nearly two-thirds of the market.
He further pointed out that under the premise of consistent drug quality, the medical insurance department needs to consider cost management, and the medical insurance department can introduce drugs as much as possible, but the lowest price can be used as the medical insurance payment standard.
Indeed, on the payment standard for medical insurance, on January 17, 2019, the State Council’s officially issued “National Organizational Drug Centralized Procurement and Use Pilot Program” and the September 30th National Health Insurance Bureau issued the “National Organizational Drugs” Both documents on the Centralized Procurement and Use of Pilots to Expand Regional Implementation Opinions are clear, and explore the synergy between the centralized procurement of medical insurance payment standards and purchase prices.
The opinion stipulates that the centralized purchase price is used as the medical insurance payment standard. In principle, the original research drug, the reference preparation under the same generic name, the generic drug that passed the consistency evaluation, and the medical insurance fund are settled according to the same payment standard.
For drugs that are higher than the payment standard, the part that exceeds the payment standard is paid by the patient. If the price of the drug used by the patient differs greatly from the centralized purchase price of the selected drug, the payment standard may be gradually adjusted and adjusted in 2-3 years; the price is lower than For the payment of standard drugs, the savings will be paid at the actual price.
As far as the standard of medical insurance payment is concerned, since the adjustment period of 2-3 years is given, in fact, various places have given different treatment methods when issuing corresponding documents - for example, some provinces require the original research drugs to be hung. On the basis of the price of the net, the medical insurance will pay a reduction of about 10%.
In response, some representatives of the enterprises pointed out that since the generic drug has passed the consistency evaluation and then reserved the separate payment standard for the original drug, it is obviously unfair. The medical insurance fund emphasizes mutual benefit and fairness, and all localities should formulate the same drug as soon as possible. The unified medical insurance payment standard.
Business representatives also called on local governments to consider factors such as medical insurance funds and patient burdens in the process of policy implementation and improvement.
The relevant representatives of the China Pharmaceutical Materials Association, which organized this symposium, said in the summary speech of the meeting that a number of experts put forward corresponding rationalization suggestions for the use of “balance”, encouraging, advocating and guiding the use of quality through consensus evaluation. Good and cheap products are everyone's opinions, which is a good thing for the country, society and patients.