＂Group buying＂ is strong, and the drug price ＂squeezes water＂! Expansion of national centralized drug procurement pilot

　　Pharmacists in the outpatient pharmacy of Shanghai Chest Hospital distribute medicines at the medicine collection window. Xinhua News Agency reporter Liu Yingshe

　　The nationwide "group purchase" of drugs has reduced the price of drugs a lot.

　　A few days ago, the state organized a pilot project of centralized drug procurement and use (hereinafter referred to as the "4+7" pilot project) to expand the scope and announce the successful results. Compared with the lowest purchase price in 2018 in the expanded area, the average price of drugs to be selected dropped by 59%; Compared with the selected price in the "4+7" pilot area, the selected drug price dropped by 25% on average.

　　Drug prices are related to people’s livelihood and affect people’s hearts. The expansion of the "4+7" pilot project is expected to bring benefits to patients in more areas and lay the foundation for a wider range of "group buying". Under the background of frequent policy "combination boxing" and upgrading generic drugs, drug prices are expected to enter a new round of decline.

　　Low bid price and high enthusiasm of foreign companies.

　　Where did the "expansion" come from? In fact, this centralized procurement is based on the pilot projects in 11 cities including Beijing, Tianjin, Shanghai and Guangzhou in 2018. In order to expand the effect of the reform, except the above 11 cities and Hebei and Fujian provinces, the other 25 provinces and Xinjiang Production and Construction Corps participated in the expansion. This also means that the pilot program of centralized drug procurement and use organized by the state has been extended to the whole country.

　　77 companies participated in the bidding, and 25 drugs were squeezed out again — — After fierce competition, the price of the drugs to be selected has bottomed out again on the basis of the "4+7" pilot project, which is not higher than the price of the last selection.

　　For example, after bidding, the single price of amlodipine besylate tablets has dropped to less than 7 cents; For entecavir used to treat hepatitis B, the winning bid price of the "4+7" pilot was 0.62 yuan/tablet, which was 95% lower than that in 2017. After expanding the bidding, the lowest winning bid price was reduced to 0.182 yuan/tablet, a drop of up to 70%.

　　Why can centrally purchased drugs break through the "floor price"? Experts said that compared with the previous "4+7" pilot, the scope of this centralized procurement is wider. On the basis of national heavy volume, enterprises have sufficient confidence in "exchanging price for quantity". With the advancement of medical reform and the change of medical insurance payment methods, the era of maintaining high drug prices for a long time has changed.

　　Bao Haizhong, vice president of Qilu Pharmaceutical Group, said that although the winning bid price has been significantly reduced, the company has retained a reasonable profit margin. The marketing cost of domestic pharmaceutical market is relatively high, and it is the general trend to return to a relatively reasonable level, and price reduction is a normal process.

　　It is worth noting that in this procurement, many foreign-funded original drug research enterprises and generic drug companies have also joined the competition, and the quotations of some original drug research enterprises are even lower than those of generic drugs. Well-known pharmaceutical companies, such as AstraZeneca, Sanofi, Lilly and Merck, all made some gains in the bidding.

　　In addition, the Indian generic drugs that made their debut have also entered the list of candidates — — Olanzapine tablets, a psychotropic drug produced by Dr. Reddy’s laboratory in India, was successfully shortlisted at the price of 123.8 yuan/box, and will be supplied to the markets of 8 provinces and cities such as Shanxi and Zhejiang in the future.

　　Regarding the positive attitude of pharmaceutical companies, Fu Hongpeng, a researcher at National Health Commission Health Development Research Center, said that the mode of purchasing with quantity will not only bring economic benefits to pharmaceutical companies, but also create more "intangible benefits". The attraction of centralized procurement and large volume will also attract more foreign pharmaceutical companies to participate.

　　"Group purchase" effect is strong, and the supply of drugs is stable

　　With the expansion of the pilot, the "group purchase" effect of centralized drug procurement organized by the state has once again appeared.

　　Due to the combination of quantity procurement and recruitment, the centralized procurement of drugs organized by the state is conducive to truly exerting the role of the market in allocating resources, reducing unreasonable expenses in circulation, and thus greatly reducing drug prices.

　　The "4+7" pilot launched last year reduced the average price of 25 selected drugs by 52%. The data shows that by the end of August this year, the purchase volume of selected drugs has reached 1.7 billion tablets, and the burden of drug expenses for patients has been reduced, especially for patients with chronic diseases and serious illnesses. At the same time, people in non-pilot areas hope to expand the scope of the pilot and use related drugs with high quality and low price as soon as possible.

　　Compared with the "4+7" pilot project, in order to ensure the supply of selected drugs, the expansion of this pilot project allows more than one variety to win the bid and expand the supply sources of drugs. For varieties with less than three selected enterprises, the proportion of agreed purchases is appropriately reduced to reduce the supply risk. At the same time, the production enterprises are required to supply enough according to the purchase agreement to ensure stable supply.

　　Shi Luwen, a professor at Peking University College of Pharmacy and director of the International Research Center for Pharmaceutical Management in Peking University, said that centralized procurement and use expansion can continue to expand the economic effect of quantity procurement, use market mechanism to promote drugs to return to a reasonable market price, allow more patients to use high-quality and low-cost drugs, and further improve people’s access to drugs.

　　Ensure the price reduction and quality improvement of drugs

　　The rapid implementation of the pilot expansion responded to the voice of the broad masses looking forward to using low-priced drugs as soon as possible. However, people still have many concerns about the supply and quality of drugs.

　　First, when can patients from all over the world enjoy the selected drugs with high quality and low price?

　　According to reports, in the next step, all localities will focus on the implementation of the selected results to ensure that patients can use low-priced drugs before the end of the year. According to the relevant person in charge of the pilot office, ensuring that the selected drugs enter the hospital and get priority use is the key to the success or failure of the pilot expansion. The medical security department will, together with the health department, improve the incentive and restraint mechanism of public hospitals, and escort the successful results.

　　Second, how to ensure that the selected drugs can reduce the price and improve the quality?

　　Experts believe that 25 kinds of drugs in the "4+7" pilot project have been tested for a period of time, and there is no problem in clinical substitution or drug quality and supply guarantee.

　　The person in charge of the pilot office said that the relevant departments will take effective measures to ensure the quality of the selected drugs, urge the selected enterprises to implement the main responsibility of drug quality and safety, strengthen the quality supervision of the production, circulation and use of the selected drugs, increase the frequency of sampling inspection, strengthen the monitoring of adverse reactions, and increase the accountability of illegal enterprises.

　　Third, when will more varieties of drugs join the pilot scope?

　　Experts said that the 25 varieties purchased in the "4+7" pilot are only limited varieties in clinical use at present. In addition to the 25 varieties, there must be more room for price reduction and efficiency improvement in the future.

　　According to Shi Luwen’s analysis, the expansion of the region on the basis of the original 25 varieties can test whether the pilot policy can play a good role in the government and the market and truly realize the "quantity-price linkage". After clarifying the relevant issues, we can consider further expanding the variety range. At the same time, he stressed that the drugs selected by centralized procurement must be drugs with high clinical acceptance, wide population or high social concern, and can be used well in most medical institutions.

　　Guide pharmaceutical companies to innovate and upgrade.

　　In this pilot expansion, "passing the consistency evaluation" is still regarded as the shortlisted standard for generic drugs, so as to promote enterprises to speed up the consistency evaluation and guide the upgrading of product structure. Judging from the results of quasi-selection, the effect of generic drugs replacing the original drugs is obvious.

　　The person in charge of the pilot office said that after the expansion of the pilot, the procurement of 25 drugs with quantity will cover the whole country, and the requirements for product quality, capacity supply and cost control of enterprises will be higher, and enterprises will face greater competitive pressure, which will help promote the optimization and restructuring of the industry, gradually change the situation of small scale and low quality of the industry, and promote the scale, intensification and modernization of the industry.

　　A person in charge of a pharmaceutical company said that ordinary generic drugs will enter the era of low profit. With the implementation of the "4+7" pilot and other related policies, ordinary generic drugs without barriers will gradually return to the profit level of manufacturing. This will promote the survival of the fittest of pharmaceutical enterprises and encourage more enterprises to tap the market potential and embark on the road of innovation and development.

　　At the same time of pilot expansion, a policy document has recently attracted attention — — The list of the first batch of encouraged generic drugs was officially released, and 33 kinds of drugs that are clinically necessary, effective and in short supply were among them.

　　Generic drugs are an important part of the global pharmaceutical market, and the future prospects of the industry are very broad. Experts said that the publication of this catalogue pointed out the development direction for domestic pharmaceutical companies. Whoever can lead Mr. Wang to produce generic drugs with stable quality and reliable curative effect will occupy the current market.