Weakened direct intervention pushing benchmark reform

Li Lei, former Director of the Price Supervision Division of the National Development and Reform Commission, forwards the future of the price reform of pharmaceuticals at the 2014 Pharmaceutical Fair. He bluntly stated that it is necessary to establish a reasonable compensation mechanism for medical institutions by rationalizing the prices of medicines. The focus is to allow hospitals to establish reasonable compensation mechanisms. Another point is that regardless of medical care, service prices, and drug prices, it should be urged to reach a reasonable range.

According to Li Lei, drug price reform must handle the relationship between the government and the market. The government should improve drug price management methods and weaken the direct intervention in drug prices. More importantly, the reform of drug benchmark prices is imminent.

Change the circulation rate and the maximum retail price to a breakthrough

For a long time, the supervision of drugs can not be separated from the dual role of the government and the market. This can be reflected from the Chinese social medical insurance system and the government's expenditure on drug control.

Li Lei suggested that the reform of drug prices in the future must handle the relationship between the government and the market, and it is necessary to get rid of the simple cycle of management and release. In the past, it was tube and then put and then managed. The next step was not to simply put it. The government regulation and market regulation coexist, but this trend shows up. Weakening of government control, market forces continue to strengthen.

Specifically, the government must improve the management of drug prices and reduce direct intervention. "Changing the ratio of circulation and the maximum retail price is a double-control or breach. The differential control can easily induce medical institutions to pursue high-priced drugs."

In this regard, in April this year, the 8 ministries and commissions including the National Development and Reform Commission have made explorations and started to take low-cost medicines. For the same kinds of drugs used to treat a certain disease, the commonly used low-cost drugs with relatively low costs are cancelled from the original government's maximum retail price, and instead they are used to control the daily use cost ceiling. The government determines the daily average cost standard for low-priced drugs and the list of low-priced drugs.

In the context of this policy, decision makers should also strengthen departmental collaboration to improve the security system in raw materials, registration, price management, procurement, clinical, medical insurance payments, and quality supervision, and improve price management. For the medicines with a small amount and a shortage of market supply, the country has designated production and uniform pricing.

Li Lei believes that it is also necessary to continue to improve the procurement methods and procure centralized purchases of medicines that are included in the list of low-priced drugs on a provincial basis. The provincial-level pharmaceutical procurement agencies will directly access the production companies with corresponding qualifications, and the medical institutions will purchase online transactions.

In macro-monitoring, he believes that relevant ministries should continue to increase policy support. “How does the Ministry of Industry and Information Technology guide? How does the Department of Drug Surveillance approve? All of this needs follow-up. The Ministry of Human Resources and Social Development and the Health and Development Commission should also accelerate the reform of the Medicare payment method, investigate the active cost-saving of medical institutions and medical personnel, and prioritize the use of low-priced drugs. ”

The time has come to advance the reform of drug benchmark prices

In order to straighten out the relationship between the government and the market, the more important point is that the time for advancing the reform of drug benchmark prices has matured.

In fact, after the Third Plenary Session of the 18th CPC Central Committee proposed to deepen the reform of the medical and health system, Li Lei had more than once openly publicized the reform of the benchmark drug prices. This topic was heated up in December last year. According to media reports, the National Development and Reform Commission once held a medical price symposium at the time and disclosed that the drug price management model will shift from the "maximum retail price" to the "base price" control.

In layman's terms, the benchmark price model is to implement fixed medical insurance payment for drugs. Patients choose drugs with different prices. Excessive amounts are paid by patients. Pharmaceutical companies actively carry out price competition to form more reasonable drug prices.

Li Lei analysis said that promoting the reform of pharmaceutical benchmark price management means that the first is that government departments indirectly regulate and guide market prices to form the basis for the management of drug prices; second, drug purchase and sales of the two sides through the market to form a basis for the specific transaction price; The benchmark price becomes the basis for pharmaceutical companies to set market prices, fees collected by medical institutions, and payment by medical insurance departments. Fourth, the base price of drugs becomes the reference or basis for patients to choose drugs.

In his opinion, the following drug benchmark price management seeks to establish four mechanisms: First, the market competition mechanism; Second, the market price discovery mechanism, the hospital becomes the procurement entity, can find the real price of drugs in the market; Third, the cost control Mechanism, which mainly involves the medical insurance department, including how to reasonably use the cost of medical insurance; fourth is the consumption restriction mechanism, and patients can choose drugs of different prices.

Under the above mechanism, medical institutions have the right to drug proceeds, and can obtain the difference between the actual purchase price and the benchmark price; the medical insurance department has the right to pay and can determine the specific payment price based on the benchmark price of drugs or a certain percentage; pharmaceutical companies have pricing power and can be high The maximum retail price is set at the benchmark price, but the patient is paid for the premium above the benchmark price; the patient has the right to choose drugs.

However, there are certain conditions for the implementation of drug benchmark price management. Li Lei said that these conditions are: First, the price administrations relinquish the control of drug spread rate, change the management of the maximum retail price of drugs, the competent pricing department organizes the relevant departments to formulate the release of drug benchmark prices, and second, improve the centralized procurement of drugs System, to achieve "harmony," "price and price hook"; Third, medical institutions announced the same species of different prices of drugs; Fourth, the medical insurance department announced the specific payment standards for drugs.

In addition to the reform of benchmark prices and the extension of prices to medical services, Li Lei said that it is also necessary to further play its role in the market to meet the diversified needs of the market, to liberalize the prices of non-public medical institutions and to implement the same payment policies as those of public hospitals.