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in september this year, some parents reported that they were taking their children to see mycoplasma pneumonia, but they were unable to use imported azithromycin injections as they wished. as a result, topics such as "it is difficult to buy imported drugs" and "it is increasingly difficult for hospitals to prescribe imported original drugs" have once again aroused widespread attention and discussion.

some people believe that centralized drug purchasing has affected the domestic supply of imported original drugs. so, what impact has centralized purchasing had on the supply of imported original drugs?

the paper reporter learned that since 2018, the national centralized drug procurement has covered a total of 374 kinds of drugs, saving nearly 160 billion yuan in drug costs every year. 60% of this amount has been allocated to innovative drugs negotiated by the national medical insurance. among them are including many imported drugs.

in other words, the national medical insurance catalog is also “upgrading” in the process of “removing the old and incorporating the new”, and more and more innovative drugs are being included.

the relevant person in charge of the shanghai municipal medical insurance bureau told the paper that among the nationally discussed drugs, the number of imported drugs and domestic drugs is basically the same. taking shanghai as an example, in terms of the management of the medical insurance catalog, there is no and will not differentiate between domestic products and imported products. when a drug enters the medical insurance, it has a generic name. as long as it is included in the catalog, the payment policy will be the same.

centralized procurement saves 60% of the annual cost for national development of innovative drugs

the national organization of centralized drug procurement began in 2018 when 4 municipalities and 7 sub-provincial cities were organized to carry out centralized drug procurement pilots. the basic logic is "volume in exchange for price." the "volume" here is generally about 60%-70% of the demand of public hospitals nationwide. this part of the public hospitals should purchase the selected products.

centralized drug purchasing targets mature varieties with sufficient competition. official data shows that since the "4+7" pilot in 2018, the national centralized drug purchasing has organized and carried out nine batches and 10 rounds of national drug purchasing, covering 374 kinds of drugs, with an average decrease of more than 50%. the reporter learned from the shanghai pharmaceutical centralized bidding and procurement management office, which has been responsible for the daily work and implementation of multiple rounds of centralized purchasing, that 70 original research drugs were selected in the first nine batches of imported products, and many imported products achieved rapid growth after entering the centralized purchasing. . for example, a multinational pharmaceutical company won the bid for a total of 7 products in nine batches of drugs. among them, the sales volume of a tumor treatment drug increased by 250% compared with before the centralized purchase, and the sales volume of another mental illness treatment drug increased by 130%. .

in addition to allowing hundreds of millions of people to take high-quality generic drugs at lower prices, the "free the cage and change the bird" effect of centralized procurement allows the latest innovative drugs to enter clinical practice. the reporter learned that the proportion of medical insurance funds for centralized purchasing of generic drugs has gradually decreased. compared with 2019, the current centralized purchasing of generic drugs can save about 160 billion yuan in drug expenses each year, and the innovations included in the national medical insurance negotiations (referred to as "national negotiations") drug sales increase by about 90 billion yuan every year. in other words, 60% of the savings from the centralized procurement of generic drugs were allocated to state-owned innovative drugs.

regarding the above changes, jiang changsong, assistant to the president of the medical insurance research institute and director of the price recruitment office, once said that when the total procurement amount of medical institutions nationwide has not increased significantly, such cost replacement and structural adjustment is really rare and is easy to implement. the development concept of supply-side reform has been adopted. the amount and proportion of mature generic drugs has decreased, while the amount and proportion of innovative patented drugs has increased, in line with the prescription drug market in developed countries, which not only reduces the economic burden of drug use on the public, but also allows patients to use and afford more new and good drugs. .

in the past, the national reimbursement directory was updated every few years. however, in recent years, through annual national reimbursement negotiations, the national reimbursement directory has been updated every year, and many domestic and foreign innovative drugs approved in that year can be included in the directory.

many innovative products of multinational pharmaceutical companies have successfully entered into medical insurance negotiations and entered the medical insurance catalog. astrazeneca from the uk currently has 16 drugs added to the medical insurance catalog through medical insurance negotiations, covering areas such as respiratory, diabetes, rare diseases, cardiovascular and cerebrovascular, and tumors. swiss pharmaceutical company novartis has included nearly 40 drugs in the national medical insurance catalog since 2017. the german pharmaceutical company boehringer ingelheim also has three drugs included in the medical insurance catalog from 2018 to 2023.

multinational pharmaceutical companies with imported innovative drugs are also actively participating in the annual medical insurance negotiations. many chinese heads or senior executives of multinational pharmaceutical companies also personally lead teams to participate in on-site negotiations, which shows the attraction of national talks. the adjustment of the medical insurance catalog in 2024 has been launched. previously, executives of multinational pharmaceutical companies stated in interviews with reporters from the paper that the companies had already started preparing for medical insurance negotiations and hoped to introduce innovative products into the national medical insurance system with the greatest sincerity. .

sales of innovative drugs have increased rapidly after being insured, and the burden of medical treatment has been reduced.

"before 2015, there were basically no innovative drugs in our country, and most of them were generic drugs. the innovative drugs that came to china at that time were all imported without exception, and the prices were basically the highest in the world. because there were no choices, many patients, especially cancer patients, have returned to poverty due to illness. now, this situation is gone forever.” an executive from a multinational pharmaceutical company previously pointed out to media including reporters from the paper that china’s innovative drug industry has made great progress in the past ten years. with rapid development, more and more domestically produced innovative drugs are benefiting chinese patients.

against the background of the above-mentioned industry, domestic innovative drugs can compete with imported innovative drugs on the same stage in national medical insurance negotiations. transmitted to the clinic, compared with the past market structure dominated by imported drugs, patients are now exposed to more domestically produced innovative drugs. according to iqvia data, sales of domestic innovative drugs increased from 21 billion yuan in 2020 to 35 billion yuan in 2022, while sales of imported innovative drugs increased from 23 billion yuan to 44 billion yuan during the same period. it can be seen from this that both imported innovative drugs and domestic innovative drugs have achieved continuous development in the chinese market.

ensuring that state-approved drugs, including imported innovative drugs, can smoothly enter hospitals is another important task of the medical insurance department. during this process, imported drugs and domestic drugs received the same policy treatment.

the relevant person in charge of the shanghai municipal medical insurance bureau told the paper that a drug entered into the medical insurance is a generic name. as long as it is included in the catalog, domestic and imported payment policies will be treated equally.

in july 2023, the shanghai municipal medical insurance bureau, in conjunction with relevant authorities, issued "several measures for shanghai to further improve the multiple payment mechanism to support the development of innovative drugs and devices", which the industry calls shanghai medical insurance's "28" articles to support innovation, and actively promote the "insurance" of innovative drugs. "admission" achieved positive results. according to the above-mentioned person in charge, after the annual adjustment of the medical insurance catalog, shanghai requires medical institutions to hold a pharmaceutical committee meeting within one month to discuss the admission of relevant drugs; for drugs newly added to the national catalog that year, shanghai will implement a three-year the separate payment policy means that the cost of nationally negotiated drugs used reasonably by the hospital can be fully guaranteed.

"in the first year after entering medical insurance, doctors may not know enough about certain drugs, and the dosage of certain drugs has not increased. generally speaking, the clinical use of a drug is basically stable in three years." the above-mentioned person in charge he said that this is a policy given by shanghai after comprehensive consideration of various situations.

the dual-channel mechanism is another important measure to ensure the implementation of nationally negotiated drugs. in may 2021, the national medical insurance administration and the national health commission jointly issued the "guiding opinions on establishing and improving the "dual channel" management mechanism for national medical insurance negotiation drugs." this is from the national level, bringing designated retail pharmacies into the scope of national drug supply guarantees, and implementing a unified payment policy with medical institutions.

the so-called "dual channel" refers to a mechanism that meets the reasonable needs of negotiating drug supply guarantees, clinical use, etc. through the two channels of designated medical institutions and designated retail pharmacies, and simultaneously incorporates them into medical insurance payment mechanisms. this measure has become an important measure to ensure the implementation of national talks.

the above-mentioned person in charge said that the dual channel is equivalent to patients buying medicines in pharmacies and enjoying the same reimbursement policy as hospitals. this is mainly to solve the problem of national drug supply. in addition, in order to cooperate with the dual-channel policy, the medical insurance platform has also established a prescription circulation system, which can transfer prescriptions from doctors to pharmacies, allowing patients to purchase them at pharmacies.

third-party research data shows that shanghai's tertiary hospitals are far ahead in the country in terms of the number and rate of equipped with nationally approved drugs, ranking first in the country. "through a series of rich measures, coupled with the coordination and active implementation of different departments, shanghai has achieved a solid implementation of the national drug distribution work." the above-mentioned person in charge introduced that from january to july 2024, the drugs included in the national medical insurance catalog among the settlement amounts of innovative drugs in shanghai medical institutions, new drugs from multinational pharmaceutical companies increased by 181.3% year-on-year. it can be seen that through "emptying the cage and changing the bird", more and more life-saving and emergency imported new drugs have achieved rapid growth after being included in medical insurance, which has improved the accessibility and affordability of imported innovative drugs, and the cost burden on patients has also been greatly reduced.