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on august 22, jiangxi province issued the "implementation plan for the three-in-one action of centralized procurement of drugs in jiangxi province", stating that it will carry out the "three-in-one" action of centrally procured drugs "into retail pharmacies, into village clinics, and into private hospitals" across the province.

previously, centralized procurement drugs were only purchased through public hospitals based on quantity reports. provinces such as jiangsu and shandong encouraged pharmacies to also purchase centralized procurement drugs.however, jiangxi is the first province to clearly stipulate the "three entries".

jiangxi clearly stated that the thousands of drugs selected can help the prices of related drugs in the three types of terminals "return to a reasonable level". the plan requires the three major channels to make commitments on prices:village clinics implement "zero-margin" sales; retail pharmacies and private hospitals sell at the promised price, and are allowed to increase the price by no more than 15% based on the winning price.

this means that the sales of products selected in the centralized procurement have gradually extended from public hospitals to grassroots and retail. according to this trend, whether the products are sold in hospitals or outside hospitals, they may have to participate in centralized procurement in the future. even if they do not participate in centralized procurement, it is impossible for the prices to maintain independent high prices in the outside hospital channels.in particular, those original drugs that are not included in the centralized procurement will face the problem of having no channels to go to in the future. the so-called "county market" may no longer exist in the future.

is there no way out without centralized procurement?

the health bureau understands that the product coverage areas involved in the lists of "drug varieties for jiangxi province's centralized procurement of drugs "three-in-one" action" and "drug varieties recommended for jiangxi province's centralized procurement of drugs "three-in-one" action" released by jiangxi province on the same day are also relatively comprehensive.

the “three-in-one” drug varieties involve a total of 591 varieties and 1,467 products.the “three-in-one” private medical institutions are recommended to have 333 varieties of medicines, with a total of 724 products; the “three-in-one” retail pharmacies and village clinics are recommended to have 223 varieties of medicines, with a total of 466 products., involving common diseases and chronic diseases such as cardiovascular and cerebrovascular diseases, digestive system diseases, respiratory system diseases, endocrine and metabolic diseases, urogenital diseases, systemic anti-infectives, skin diseases, etc.

jiangxi stipulates thatin principle, the proportion of drug varieties recommended for "three-in-one" allocation shall not be less than 60%.

image source: jiangxi provincial medical insurance bureau official website

in the specific implementation, in addition to promising the sales price, the "three-in" units must also "unify" other aspects. the document points out thata unified signboard with centralized procurement identification should be hung to display the list of centralized procurement drugs equipped by the unit in a prominent position for a long time and update it dynamically.; set up special areas in a unified manner and standardize the management of centrally procured drugs; unify price labels and use double labels to publicize the selected prices and sales prices of centrally procured drugs; and unify supervision and management.

in recent years, the balance of my country's pharmaceutical market has gradually tilted toward outside hospitals and grassroots. according to the 2023 data of minenet, the market share of graded hospitals has dropped by 7.1 percentage points in seven years. a large number of prescriptions have been outflowed, resulting in a large difference in drug prices in different channels. especially after the centralized procurement, the market differentiation between inside and outside hospitals is very serious.data show that the scale of out-of-hospital channels for hypertension drugs has exceeded that of hospitals of the same level, accounting for 53% of the entire market.

once a large number of collectively procured drugs enter the out-of-hospital market, many pharmaceutical companies will have to adjust their sales logic, and both the out-of-hospital and grassroots markets will face a major reshuffle.

in particular, there are a large number of chronic disease products in the "three-in" drug catalog, and these drugs have a considerable sales volume in retail channels. once the cheap centralized procurement drugs come, the sales of non-selected products will be greatly affected.those most affected should be original research drugs or high-priced products that are not included in the centralized procurement, which may not even be able to enter the chinese market in the future.

in april this year, hebei province officially started the cleanup of products outside the centralized procurement. more than 20 original research drugs that did not meet the listing conditions were removed from the network because their prices were higher than the "shanghai red line price". as the coverage of centralized procurement products expands, it will be more difficult for these products to enter hospitals and grassroots retail.

the “threshold” of outpatient sales channels

with unified demarcation lines for “collectively procured products,” there will also be “thresholds” for out-of-hospital sales channels in the future.

the emphasis on "collective procurement of drugs to the grassroots" is a change that has occurred in the past two years. on july 15, the national medical insurance administration's official website issued a statement saying that shi zihai, deputy director of the national medical insurance administration, led a team to guizhou and guangxi to conduct research and conduct on-site inspections of grassroots medical institutions and designated retail pharmacies.understand the situation of centralized procurement drugs entering grassroots level, pharmacies and centralized procurement settlement.

as early as 2021, the shandong provincial medical insurance bureau took the lead in piloting the centralized procurement of drugs at the grassroots level in zibo. at that time, after three years of practical exploration, the policy had set the tone to provide patients with centralized procurement drugs in accordance with the "five unified" model.in august last year, shandong launched the first batch of "collective drug procurement into the grassroots" activities, covering 8,488 retail pharmacies, 11,314 village clinics, 233 private hospitals, and 9 online platforms., and simultaneously started officially selling the collectively procured drugs to the public.

in addition to jiangxi province, many pilot projects have been followed up. according to public information, guangdong, zhejiang, hainan, inner mongolia, xinjiang and other places have actively promoted the pilot project in prefecture-level cities. among them, the medical security bureau of alxa league, inner mongolia, publicly selected 12 designated retail pharmacies as "designated pharmacies for centralized procurement of drugs", and the price of 55 commonly used centralized procurement drugs dropped by more than 50%.hainan, jiangsu, shandong, jiangxi and other places are following up on the pilot program at the provincial level.

what is certain is that with the implementation of a combination of policies, the overall national pharmaceutical market will become more and more standardized, and each contracting unit will also usher in a large wave of "traffic".for many pharmaceutical companies that have not participated in the centralized procurement, they need to consider adjusting their business ideas.

logically speaking, the priority of the "three-entry" units in the centralized procurement of drugs should be higher than those that are not qualified. in the future, medical insurance and other aspects may also have different treatments.most pharmacies and private hospitals may fall into the category of “three entries”.the so-called county market and the vast market will not be so easy to deal with in the future.

written by miaomiao

editor: jiang yunjiating

operation｜han jinrui

illustration｜visual china

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