The trend of centralized purchase of pharmaceutical equipment in trans provincial Alliance: enhancing bargaining power and squeezing out the moisture of drug price

 The trend of centralized purchase of pharmaceutical equipment in trans provincial Alliance: enhancing bargaining power and squeezing out the moisture of drug price

Shandong Province has also recently completed the first batch of provincial-level centralized purchase of drugs, with an average price reduction of 67.3% for 39 drugs, with a maximum drop of 98.6%. These drugs involve 160 products of 73 enterprises, covering cardio cerebrovascular, digestive, respiratory, tumor and other fields.

This kind of centralized purchase mode of alliance and regionalization can not only realize the policy of complementing each other, but also further squeeze the water of drug price.

The alliance collects and extracts the water of drug price

It can be found that both the provincial centralized procurement and the Procurement Alliance of the five provinces, autonomous regions and cities in Shandong Province are more unified in the overall planning level, but also reflect many common characteristics and future trends.

For example, Shandong Province, represented by the provincial alliance, covers Zaozhuang, Linyi, Jining and Heze. According to official information, in the joint centralized purchase of 26 kinds of commonly used drugs and 25 kinds of medical consumables recently launched by the alliance, the average price reduction is 51%, which is expected to save more than 12 million yuan for the member hospitals of the collective purchase consortium.

For another example, the inter provincial alliance composed of Shaanxi, Ningxia, Gansu, Qinghai, Xinjiang, Xinjiang production and Construction Corps, Hunan, Guangxi, Guizhou and Hainan provinces (autonomous regions, corps) has also been opened: for the 46 intraocular lens consumables list, the average decline rate was 53.26%, and the maximum decline rate was 84.21%.

The purpose of these cross province centralized procurement modes is to complement each others policies in order to enhance the intensity of centralized procurement. Zhan Jincheng, general manager of the Eastern market of ozida medical device service group, said in an interview with first finance and economics.

The notice on carrying out the second batch of centralized procurement and use of drugs issued by the State Medical Insurance Bureau in January this year clearly states that the scope of centralized procurement and use of drugs is the state organizes the centralized procurement and use of drug varieties, and selects products from generic drugs corresponding to generic drugs that have passed the quality and efficacy consistency evaluation (including approval for listing according to the new registration and classification of chemical drugs) Life .

However, in February this year, the notice of the state medical security administration on printing and distributing the key points of medical security work in 2020 pointed out that encourage and standardize local governments to carry out procurement with quantity for drugs that fail to pass the conformity evaluation of generic drugs.

Thirdly, the mode from local level to national level helps to keep the price of centralized purchase to the lowest.

The total purchase volume of one province and five provinces is absolutely different, which also helps each centralized purchasing alliance to negotiate better. Mr Zhan said.

Guo Xinfeng also believes that this practice can be used step by step to squeeze the price of drugs. If the water of the generic drug cannot be squeezed out once, it needs 2-3 times of repeated squeezing to dry out.

As an example, he said: the average decline of the 4 + 7 pilot project was 52%, while the expansion of the 4 + 7 pilot project decreased by 59% on the basis of the 4 + 7 pilot project. Therefore, it is necessary to give in and squeeze water for the first time. After the drugs have passed the consistency evaluation, the national centralized procurement will squeeze again, so as to achieve the fundamental purpose

From the perspective of the medical service industry, high drug prices are difficult to reflect the value of doctors diagnosis and treatment. Only by squeezing the water of generic drugs can doctors and hospitals reasonably and legally earn sunshine technology income, and pave the way for the smooth implementation of the follow-up DRGs. Guo Xinfeng added.

The logic behind the centralized collection of antibiotics

The reporter found in a first batch of commonly used drugs joint procurement documents of Chongqing, Guizhou, Yunnan, Hunan and Guangxi provinces and cities that 17 kinds of drugs contain a number of antibacterial drugs, such as piperacillin sodium, tazobactam sodium, ceftazidime, ornidalchloride, mezlocillin, cefotaxime, tigecycline, etc.

According to the first batch of commonly used drugs joint procurement document of Chongqing, Guizhou, Yunnan, Hunan and Guangxi Zhuang Autonomous Region issued on October 29, 17 kinds of drugs contain many kinds of antibacterial drugs, such as piperacillin sodium, tazobactam sodium, ceftazidime, ornidazole sodium chloride, mezlocillin, cefotaxime, tigecycline, etc.

After amoxicillin and azithromycin were included in the national procurement catalogue at the end of 2020, the scope of antibiotic drugs was further expanded.

Guo Xinfeng told reporters that in July, the National Health Insurance Bureau delineated 500 varieties for centralized purchase, which accounted for the top 80% of the purchase amount. Meanwhile, it also standardized the centralized purchase of various places. It is recommended that the varieties selected in the centralized purchase should not exceed 50, and 20-30 are the best. The logic of product selection should focus on a certain disease treatment field.

Therefore, there is a procurement alliance led by Chongqing to carry out the procurement of antibacterial drugs mainly with quantity. Guo Xinfeng said, the behavior of purchasing in this area may bring about a drop in both quantity and price of antibacterial drugs. But in the long run, it will further reduce the abuse of antibiotics.

However, there are also some doctors who are engaged in the management of antibacterial drugs in a class-A hospital in Shanghai, who told reporters that the procurement of antibacterial drugs with quantity must be cautious.

Antibacterial pharmacology should be strictly controlled and used. The doctor cautioned, remember to grasp the degree of purchasing with quantity. It is not just because the strategy of low price is the king that makes it impossible to guarantee the quality and supply of antibacterial drugs and become a means of vicious competition. In addition, it is also necessary to consider various aspects, and do not easily hit the sustainable development ability of pharmaceutical companies.

With the approaching of the third batch of procurement with quantity at the national level, what experiences need to be summarized in the first two batches of centralized purchase?

Purchasing with quantity also needs to look back. Among them, there are three core issues that need to be paid attention to, including the number of admission, the real sales volume, and the situation of payment collection. Beijing Dingchen medical management consulting center in charge of Shi lichen told reporters.

The performance of some enterprises participating in purchasing products with volume is not as good as expected, Mr. Shi said. For example, the sales volume of entecavir dispersible tablets of China biopharmaceuticals was about 2.335 billion yuan, which was about 240 million yuan lower than that of the same period last year. This shows that the sales volume of entecavir dispersible tablets after price reduction did not meet the expectation. In addition, there are hard and fast rules for payment collection, such as 30% prepayment for medical insurance, or payment must be made within 3-6 months. However, it is understood that some enterprises have failed to meet the expected payment for products purchased with quantity, and the payment arrears are still a serious problem.

From the perspective of capital market, we should pay more attention to the fields and innovative enterprises that can carry out independent pricing, but this needs a certain amount of time accumulation. In the future, products with limited innovation capability, technology content and limited participants will enjoy local blue ocean market no matter whether the pricing mode is changed or not.