news

liang jialin/economic observer a father wrote a story about seeking medical treatment: his child was treated in a hospital in zhejiang for mycoplasma pneumonia. among the drugs for symptomatic treatment, the hospital could only give the child a domestic azithromycin, not an imported original drug. after two days of intravenous drip, the child still had a high fever. it was not until he was transferred to another hospital and switched to an injection of an imported original drug, pfizer's zithromax, that the fever subsided. the father asked: why did the imported drugs that were previously available disappear?

first of all, we should clarify that we cannot easily judge that the side effects of domestic generic drugs are definitely greater than those of original drugs based on the subjective description of the parents, nor can we assert that domestic generic drugs are ineffective. in clinical practice, there is a saying that "lucky doctors treat the end of the disease." the disease itself has a course of disease, and it takes a certain amount of time for the drug to take effect after use. the fever subsided after switching to imported drugs on the third day, and it is difficult to rule out the efficacy of the domestic generic drugs "laid down" before.

however, the parent of the child raised a very important clue: imported original drugs like xishumei are indeed not easy to get in the hospital.

the original intention of the national healthcare security administration was to help patients save money. in 2021, the national healthcare security administration guided the national drug procurement office to implement the fifth batch of national drug volume procurement. pfizer's imported original drug was not selected due to its high bid. it is natural for high-priced bidders to be eliminated, but patients' right to choose medicines should also be guaranteed. a current reality is that drugs that are not selected in the centralized procurement are difficult to enter hospitals, and patients have little choice.

in fact, the national healthcare security administration has never said that hospitals cannot purchase drugs that are not selected in the centralized procurement. however, in order to balance the use of the selected varieties in the centralized procurement, the national healthcare security administration has set several prerequisites: first, within a one-year cycle, hospitals participating in the centralized procurement must first complete the use of the selected varieties in the centralized procurement (the hospital shall declare the use independently) before they can use the unselected varieties in the centralized procurement. generally speaking, the unselected varieties in the centralized procurement can be allocated no more than 30% of the space. otherwise, the "quantity" of centralized procurement with volume will lose its meaning. under this policy, some hospitals simply "one size fits all" to only purchase the selected drugs in the centralized procurement in order to meet the medical insurance assessment indicators, and do not purchase unselected drugs at all.

second, it is not that the products that failed to be selected in the centralized procurement do not need to be reduced in price. some places require that within a procurement cycle (such as 2 or 3 years), the prices of the products that failed to be selected in the centralized procurement must be reduced to close to the prices of the selected products (for example: 1.5 times the highest price of the selected drugs or the median price of imported drugs in the global market), otherwise they will be removed from the network for touching the price "red line". sometimes pharmaceutical companies will take the initiative to withdraw from the network for commercial considerations. another generic name of pfizer, azithromycin dry suspension, is also called xishumi, and it was withdrawn from the network because of price issues. this means that hospitals can no longer purchase this drug from the medical procurement platforms built by various provinces.

in addition, some policies of the medical insurance department with good intentions can also distort hospital behavior in practice, so that some original research drugs may not necessarily reach patients even if they enter hospitals. for example, in order to prevent pharmaceutical companies from colluding with hospitals and doctors to implement "loopholes", the medical insurance bureau links the centralized procurement execution assessment with the allocation of funds returned to hospitals after the centralized procurement saves medical insurance funds, which is a "real money" attraction for hospitals. in order to obtain more surplus retained funds, some hospitals have adopted "local policies" and require doctors to obtain approval at all levels before using any imported original research drugs, which has built an artificial barrier for doctors to use drugs. some patients have to go to pharmacies outside the hospital to buy drugs at their own expense, while these drugs are originally within the scope of the medical insurance catalog and can be reimbursed by medical insurance. as a result, patients not only did not enjoy the price reduction dividend of centralized procurement, but also increased the burden of buying drugs at full price. this completely violates the original intention of the country to implement the centralized procurement policy.

objectively speaking, the increasingly strict supervision rules of the medical insurance department are also due to the "cat and mouse game" between hospitals, pharmaceutical companies and the medical insurance department to a certain extent. this is a dilemma faced by many public policies: if you control it, it will die; if you let it go, it will be chaotic. but in any case, any policy and behavior adopted by the medical insurance department and hospitals must follow the principle of maximizing the interests of patients.

the medical insurance department should organize a review of the situation where the use of original research drugs that were not selected in the centralized procurement and were restricted by public opinion, to see if the current rules are lagging behind or even violating medical laws and failing to meet the needs of patients, and optimize these imperfect rules as soon as possible. hospitals cannot pass on the pressure of the centralized procurement of the medical insurance bureau to patients, let alone make profits from it. for example, some hospitals know that some patients are more recognized for the efficacy of original research drugs, or simply have a brand dependence mentality. in order to attract more patients to hospitalization and obtain more hospital income, they stipulate that only inpatients can use original research drugs, and outpatients are deprived of this right of choice-this not only violates the medical ethics of "people first, life first", but also violates the clinical diagnosis and treatment standards of the health commission to distinguish between outpatients and inpatients based on disease indications.