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“where did the imported azithromycin go?”

recently, a self-media account posted an article online, telling a story about "a disease delayed by domestic azithromycin": the author's child had mycoplasma pneumonia, but the hospital could not prescribe imported azithromycin injection. after using domestic azithromycin injection, the child still had a high fever and recurred. after trying every possible way to get imported azithromycin, the child's condition was under control.

screenshot of the self-media article "children's mycoplasma pneumonia hospitalization: where did the imported azithromycin xishumei go?"

"our own fate makes me wonder about the fate of more children and families... who caused the widespread shortage of zithromax (the trade name of imported azithromycin)?" the author's question resonated with many discussions and made "why some imported drugs are no longer available" a hot topic again.

weibo hotly discussed "many imported drugs disappeared quietly"

yes, this is actually an old question. in recent years, the feeling and topic of "hospitals can no longer prescribe imported drugs" have appeared every once in a while. so, why did imported drugs "disappear"? are imported drugs really much better than domestic drugs with the same ingredients? what should i do if i still want to use imported drugs?

image source: ic library

drug prices have dropped, and imported drugs have "disappeared" from hospitals

the price of drugs for rare diseases has been reduced from 700,000 yuan per injection to 33,000 yuan, and the price of new diabetes drugs has been reduced from 15 yuan per tablet to 5.39 yuan... at the end of each year, many patients expect that the national medical insurance negotiations will include their and their family's commonly used drugs in the centralized bulk procurement (abbreviated as "centralized procurement") through "soul bargaining" and cut the lowest price. however, keen patients will find that after the centralized procurement of drugs, imported drugs have slowly "disappeared", such as the antihypertensive drug "norvasc", the lipid-lowering drug "lipitor", the hypoglycemic drug "glucose" commonly used by chronic patients... and the respiratory and reproductive tract infection drug "zithromax" revealed by the aforementioned netizens, which cannot be prescribed by hospitals, making people very uncomfortable. what's going on?

first, centralized volume-based procurement is similar to group purchasing. the medical insurance department gives the purchase volume, and the companies bid in a market-based manner, ultimately achieving volume-for-price exchange, so there will be many low-priced drugs. however, even for drugs with the same chemical name, due to differences in r&d and imitation, excipients and processes between different manufacturers, the costs are not the same, and the quotations during centralized procurement are also different. generally speaking, the quotations for imported drugs, which are mainly "original research drugs", are generally higher than those for domestic drugs, which are mainly "generic drugs", which has become the basic factor for the "disappearance" of many imported drugs in hospitals.

image source: ic library

the media once interviewed industry experts and summarized the "disappearing" imported drugs into two categories:

one is that hospitals control the proportion of drug costs in total medical insurance expenditures (i.e., the drug share ratio) and are unwilling to purchase. for some imported drugs, the prices after medical insurance negotiations still have a certain profit margin, but because the prices are several times more expensive than domestic drugs, in order to control the drug share ratio, hospitals often give priority to purchasing cheaper domestic drugs and use the remaining medical insurance quota for examinations or surgeries.

another type is that the price of imported drugs is too low, so companies stop production or withdraw from the chinese market. the original intention of many pharmaceutical companies to participate in medical insurance negotiations was to exchange lower prices for a higher market share, but after winning the bid, they found that the price of medical insurance procurement was not enough to cover the actual production cost of the drugs. in order not to make a loss, the manufacturers will choose to stop producing these drugs. there are also some imported drugs that lost market share because of limited price reductions when participating in centralized procurement and failed to win the bid, so they withdrew from the chinese market in order to "stop losses in time."

“cheap goods are not good”, are domestic medicines really much worse than imported ones?

however, it may be difficult for ordinary people to have such a macro and huge market perspective. what they are more concerned about is: "if imported drugs cannot be prescribed, can the effect of domestic drugs be guaranteed?"

weibo users hotly discuss the topic of "efficacy of imported and domestic drugs"

"four years ago, my child was only two years old and had mycoplasma pneumonia at that time. the problem was solved with imported azithromycin. half a year ago, in the spring of 2024, my other child also had mycoplasma pneumonia. he was fortunate enough to use imported injectable azithromycin in a certain hospital." as the self-media author said, the imported azithromycin "xishumei" became famous in the wave of mycoplasma pneumonia infections in previous years, especially last year. many parents, including doctors, believe that compared with imported azithromycin, the domestically produced azithromycin is not as effective.

in this regard, the official account of "china medical insurance" under the national medical insurance administration once publicly explained that this is not actually a question of brand quality, but that the old drug azithromycin has encountered a new problem, specifically the "drug resistance" problem commonly faced by antibacterial drugs. professional literature reports that since 2000, macrolide (azithromycin)-resistant mycoplasma pneumoniae has appeared widely and rapidly in asian countries, accounting for about 80%-90% of related cases in china and japan. many pediatric experts have also publicly stated: "currently common pathogens such as streptococcus pneumoniae and mycoplasma are highly resistant to azithromycin."

ye sheng, director of the comprehensive icu at the children's hospital affiliated to zhejiang university school of medicine, weibo

"if mycoplasma infection is likened to a lock and azithromycin is likened to the key, if the key is not matched properly, the lock cannot be opened. this is a quality issue. drug resistance is like changing the lock cylinder. a key matched to the old lock cylinder cannot open the new lock, no matter who makes it, how serious they are, or how good their craftsmanship is."

according to the official account of "china medical insurance", compared with european and american countries, my country's domestically produced drugs generally started late and had a weak foundation. for quite a long time, they were in a position of imitation and catching up. this was reflected in clinical drug use and patient selection, with a preference and dependence on imported original research products. since 2012, my country's pharmaceutical industry has entered a fast track of development, and the gap with european and american countries has continued to narrow.

taking the varieties involved in the national centralized volume procurement as an example, nearly 40 medical institutions jointly conducted real-world studies on clinical efficacy and safety, and the results showed that the efficacy and safety of generic drugs are equivalent to those of original drugs. the antibacterial drugs included in the study, such as azithromycin, cefdinir, and linezolid, were evaluated for effectiveness and safety based on real-world indicators such as bacterial clearance, improvement rate of clinical symptoms and signs, and incidence of adverse reactions. the results showed that there was no statistical difference in clinical effectiveness and safety between the selected generic drugs and the original drugs.

for many imported drugs and original drugs that have withdrawn from the chinese market, such as metformin produced by merck and adefovir dipivoxil tablets produced by gsk, real-world research results show that domestic metformin has no significant difference from imported original drugs in terms of blood sugar-lowering efficacy and adverse reactions such as liver and kidney damage; adefovir dipivoxil tablets are second-generation drugs for inhibiting the development of hepatitis b. domestic companies have long been supplying third-generation anti-hepatitis b drugs, which have more advantages in efficacy and safety.

image source: ic library

good quality and cheap price,can we open up space for patients to choose for themselves?

in july 2024, the national healthcare security administration released the "statistical bulletin on the development of national healthcare security in 2023", which showed that during the agreement period in 2023, negotiated drug reimbursement was made for 240 million people, and the burden on patients was reduced by nearly 230 billion yuan through negotiated price reductions and medical insurance reimbursement.

through medical insurance negotiations, the inflated drug prices for many years have finally dropped, and a lot of water has been squeezed out. the term "centralized volume procurement" has also become widely known. however, this new thing similar to group purchase also faces practical problems such as shortage of selected drugs and imperfect distribution mechanism. there is the embarrassment of "price reduction death" and "bid death" of winning products, and the survival space of unwinning drugs is squeezed.

how can we make medicine affordable and good for the people? according to a summary of industry research, a series of supervision should be put on the agenda: medical departments should monitor the use and inventory of selected drugs in public hospitals, and drug regulatory departments should establish a supervision and punishment mechanism for selected manufacturers. before volume-based procurement, relevant departments should first conduct a full investigation of drug costs and profits, reasonably evaluate drug prices, respect market rules, set a price bottom line, leave profit space for manufacturers, and ensure the healthy operation of enterprises.

at present, facing the imported drugs that cannot be prescribed by hospitals, many patients have begun to share "drug purchasing strategies" online, such as going to drugstores to buy drugs, using e-commerce platforms to buy drugs... of course, most of them are at their own expense. between "good quality" and "cheap", they choose to pay for the "good quality" in their hearts.

in this regard, chen fangyuan, a member of the shanghai cppcc, former full-time deputy chairman of the shanghai municipal committee of the china democratic league, and director of the department of hematology at renji hospital affiliated to shanghai jiaotong university school of medicine, once suggested: "if the prices of imported drugs negotiated through medical insurance are still relatively high and the people have actual needs, we might as well adjust the payment ratio. the self-payment ratio can be slightly increased, with medical insurance paying 60% and the self-payment 40%, so that the people can choose according to the clinical effect." (dong rui)

this article is compiled from:

shanghai news radio official account: "from "soul-bargaining" to volume-based procurement, drug prices have dropped, but why are some imported drugs no longer available?"

china medical insurance official account: "why is imported azithromycin "withdrawn from the internet?"