With the centralized purchasing of drugs in quantity and the decrease of drug prices, will the quality of drugs be unsafe? Will pharmaceutical companies make rude products and stop spending money on R&D?
Industry insiders and experts said that, on the premise of guaranteeing drug consumption and reimbursement, pharmaceutical enterprises are willing to trade in quantity at a price and still have profit margin; the winning drug should be evaluated by national consistency, which means that quality is controlled; the lowering of drug price, mainly through purchasing with quantity, reduces marketing costs without squeezing R&D costs, and also promotes pharmaceutical enterprises to compete with efficacy and innovation to improve the quality of the industry. Upgrade.
Recently, 4 + 7 city drug centralized purchasing with quantity pilot project has aroused heated discussion. It is reported that the original purchase price of 25 successful drugs in these 11 pilot cities was 7.7 billion yuan per year, but now only 1.9 billion yuan is needed. Some comment that this is the best bargaining in history recruitment reform.
Will the quality of medicines be affected when the price of medicines drops? How to guarantee the enthusiasm of pharmaceutical enterprises?
Control circulation cost
There is still room for profit.
How to reduce the price brought about by centralized purchasing of medicines with quantity?
Atorvastatin calcium tablets, original price 39.5 yuan, won the bid price 6.6 yuan. Li Chengfu, General Manager of Business of Beijing Jialin Pharmaceutical Co., Ltd., introduced that Montelukast Sodium Tablets, the original drug sold for 6.4 yuan, we sold for 3.88 yuan, can still maintain a reasonable profit after the price reduction. Ji Ran, general manager of Shanghai Ambisheng Pharmaceutical Technology Co., Ltd.
In addition, clopidogrel bisulfate tablets are extremely fierce. Shenzhen Xinlitai, the winning bidder, first passed the consensus evaluation in China, but encountered competitors who adopted the low-price strategy. Therefore, the pharmaceutical company decided to reduce the price from 60.3 yuan to 22.26 yuan, and finally won the bidding. On the premise of purchasing with quantity, we can reduce the price by a large margin. Zeng Zhi, regional business manager of Xinlitai, said.
It is worth noting that two foreign enterprises have become black horses this time, and realized the patent cliff of the original research drug, namely, the price reduction of gefitinib tablets and Fosinopril Sodium Tablets by 76% and 68%, which are more than 25% lower than the prices of neighboring countries and regions. The head of AstraZeneca Pharmaceutical Company said that in order to win the bid, their gefitinib tablets had dropped to the lowest price in the world.
It is understood that all 15 Chinese pharmaceutical companies, for reasons of occupying the market, replacing the original research drugs, and transforming new products, have indicated that under the premise of guaranteeing the consumption of drugs and reimbursement, they can consider to exchange volume at a price to reduce circulation costs.
However, some pharmaceutical companies that had dominated the market had suffered a defeat this time. The sales manager of a large pharmaceutical enterprise said that it was unexpected that the competitors would dare to lower their prices. If a drug wants to enter the market, it has a high circulation cost, it must first find a way to enter the medical insurance, then invite tenders everywhere, and finally enter the hospital. As a result, the price of the drug has been pushed up by the agents and the representatives of the medicine, which is the case in many areas. Considering the cost of drug marketing, the pharmaceutical company conservatively quoted price, and eventually lost the bid.
Coincidentally, in the 17 failed pharmaceutical enterprises investigated, the opponents were not expected to cut prices substantially and they were unwilling to reduce the cost of circulation. Therefore, not a few failed to select.
In the view of some medical experts, it is unexpected that the 4 + 7 situation of Red Sea Fighting of pharmaceutical enterprises appears. The big price reduction is the virtual high water content in the circulation of drugs. As the 4 + 7 purchaser promised the quantity and the return of the winning drugs, some pharmaceutical enterprises took the initiative to cut down the cost of marketing and public relations marketing. In addition, most of the winning pharmaceutical companies control the source of raw materials, and the cost is basically locked, so they dare to cut prices substantially.
The average price of 25 kinds of medicines purchased in the 4 + 7 volume was 52%. However, even if the price is cut at half price, pharmaceutical companies still have profit margins. The Audit Office has conducted two surveys and found that the production cost of many medicines only accounts for a small part of the price of medicines, so even if it is reduced by half, the profit margin is still guaranteed.
Drugs need to be evaluated
Continuous regulatory overweight
Some people are worried: the price of drugs has fallen, so will patients take inferior drugs?
The admission rules of 4 + 7 are very clear: the drugs listed are generic drugs or original drugs that have passed the national consistency evaluation. This means that the quality of medicines is guaranteed, not just cheap for good or bad.
With volume purchasing, Shanghai has been piloting for three years. Three local third-tier hospitals have said that in recent years, the use of domestic generic drugs that won the bid has not resulted in quality problems. Originally, Shanghai built a set of comprehensive evaluation index system of quality for drugs, which has certification and standardization for the production, inspection, circulation, environmental protection and other links of the bidding drugs. After the drugs win the bid, there is continuous follow-up inspection. Shanghais experience has been incorporated into the 4 + 7 centralized purchasing with volume.
When the pilot project was launched in Shanghai in 2015, many hospital directors were reluctant to use the winning generic drugs. They felt that the price was too low and the quality might be poor. But after several years of implementation, we found that the effect was good. The generic drugs that won the 4 + 7 bid have passed the national consistency evaluation, so we dare to use them. Lin Houwen, Director of Pharmacy Department of Renji Hospital Affiliated to Shanghai Jiaotong University Medical College, said.
To break the mistrust of patients and doctors on domestic generic drugs, hospitals need to strengthen the guidance of doctors, and doctors need to strengthen the explanation of patients. Bian Xiaolan, Director of Pharmaceutical Department of Ruijin Hospital Affiliated to Shanghai Jiaotong University Medical College, said that in the first batch of pilot projects in Shanghai, drug prices were reduced by 80%. At first, patients did not trust them, but after a period of use, doubts about quality were dispelled. This depends on communication between hospitals and pharmacists, nurses and clinicians.
Shanghais practice proves that strengthening supervision can ensure the stability and reliability of drug quality. Over the past three years, all batches of the selected drugs in Shanghai have met the national inspection standards, and the quality of each batch has been stable by near infrared spectroscopy.
Recently, the State Administration of Drugs has issued the Notice on Strengthening Drug Supervision during the Pilot Period of Centralized Drug Purchase and Use, which will help to further escort the quality and safety of the bid drugs.
Forcing Pharmaceutical Enterprises to Innovation
Promoting Industry Upgrading
Under the 4 + 7 centralized purchasing with quantity, the purchaser guarantees the amount of drugs used and the money returned, and the winning pharmaceutical enterprises no longer worry about the high circulation cost. In this case, the original pharmaceutical enterprises through the pharmaceutical representative public relations and sales with money marketing model, it will be difficult to maintain.
So, will lowering drug prices throw cold water on companies and discourage their enthusiasm for innovation?
First of all, the reason for the reduction of drug prices is that the production and marketing costs are reduced mainly through volume purchasing, and there is no need to squeeze the R&D costs. In addition, the R&D of innovative drugs relies more on capital market financing such as venture capital, science and technology creation board, and has less to do with the sales profits of generic drugs.
Some medical experts have judged that in the process of quality innovation, there must be a painful period in the industry. Only by removing the inefficient and scattered parts of the pharmaceutical industry, can China become a powerful country in generic medicine from a big country in generic medicine.
Drug companies are sensitive to capture, competition rules have changed. The new competition rules are forcing pharmaceutical companies to make choices: change or eliminate, said the head of a winning bidder. The new measures of drug purchasing are of great significance to enhance the concentration of Chinas pharmaceutical industry, drug innovation ability and international competitiveness.
In the past, some pharmaceutical companies competed on the basis ofpublic relations. Now, we have to compete through efficacy and cost-effectiveness. Liang Hong, a professor at the School of Social Development and Public Policy, Fudan University, said, Only by surviving can we hope to become bigger and stronger.
Of course, the pilot project of centralized drug procurement organized by the State has just begun, and there is still room for exploration in some aspects: for example, is the source of goods exclusive or two or three more suitable? How to better track and evaluate the quality of drugs? How to strengthen the linkage between regulatory authorities? The answers to these questions need to be further explored and searched in practice.
Source: Qiao Jing_N6607, Responsible Editor of Peoples Network-Peoples Daily