The National Health Insurance Administration issued the "Notice on Promoting Fair, Honest, Transparent and Balanced Inter-Provincial Prices of Drugs with the Same Generic Name and Brand", which clarifies that by the end of March 2024, the unfair and discriminatory high prices of drugs with the same generic name, brand, dosage form and specifications will be basically eliminated between provinces, and the price behavior of pharmaceutical companies will be more fair and honest.
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The person in charge of the Price Procurement Department of the National Health Insurance Administration answered reporters' questions on promoting inter-provincial price fairness, integrity, transparency and balance between the same factory and the same drug
A few days ago, the National Health Insurance Administration issued the "Notice on Promoting Fair, Honest, Transparent and Balanced Inter-Provincial Prices of Drugs with the Same Generic Name and Brand" (hereinafter referred to as the "Notice"). The person in charge of the Department of Pharmaceutical Prices and Bidding and Procurement of the National Health Insurance Administration answered reporters' questions on the relevant situation.
1. What is the main purpose and main content of the Circular?
At the end of December 2023, the National Health Insurance Administration issued the Notice on Promoting Fair, Honest, Transparent and Balanced Inter-Provincial Prices of Drugs with the Same Generic Name and Brand, with the main purpose of promoting the elimination of unfairly high and discriminatory high prices between provinces. By summarizing the price data of drugs sold online on the centralized procurement platform in various provinces across the country, the focus is on the "four same drugs", that is, drugs with the same generic name, dosage form, specification and manufacturer, and the price level of centralized distribution and active transactions is counted, which is pushed to the provincial medical insurance bureau and local centralized drug procurement institutions as monitoring results.
The "Notice" requires all localities to compare the local price of the network with the monitoring results, investigate and find outliers that significantly deviate from the monitoring results, and urge and guide enterprises to correct unfair and discriminatory high prices, so as to promote the price to return to a more fair range. The work is expected to be completed by the end of March 2024.
2. In accordance with the relevant laws and regulations, the price of drugs is regulated by the market and determined by the enterprise independently.
It is the right granted by laws and regulations for enterprises to determine the price of drugs independently. At the same time, following the principles of fairness, legality, honesty and credibility, price discrimination shall not be implemented, which is also a legal obligation for enterprises to set prices independently. Taking the "four same drugs" concerned by the "Notice" as an example, the enterprise itself on the centralized drug procurement platform and accept the purchase of local public hospitals, the platform price of different provinces should be relatively balanced, considering the transportation distance, market size, transaction conditions, payment efficiency and other objective differences between provinces, the price between provinces can fluctuate slightly, but there should not be a situation where the price in some areas is abnormally high. For example, the price of folic acid tablets, a common medicine of a certain enterprise, is 12 yuan per bottle in most provinces in the country, but the price of folic acid tablets in some provinces has reached more than 30 yuan, and the price difference of more than 20 yuan cannot explain its rationality and necessity. Similar abnormal prices are unfair to the local people and the medical insurance fund, and unfair and discriminatory high prices should not be allowed to erode the people's money for medical treatment and life-savings.
In terms of specific operations, local medical insurance bureaus and centralized procurement agencies should promptly contact and interview relevant enterprises for unfairly high and discriminatory high prices found in the investigation, and ask enterprises to take the initiative to correct deviations and treat various regions fairly in terms of prices.
3. The problem of large differences in drug prices in different regions has been a problem for a long time, and what is the basis and background of the recent deployment of system-wide centralized governance?
For a long time, the centralized drug procurement platforms in various provinces have been independent of each other and operated in isolated networks, and there is no interconnection of data. A small number of enterprises take advantage of the information gap between provinces to formulate unfair and discriminatory high prices, but they are limited to information technology means, and the price authorities mainly rely on "discovering together, dealing with them together, specific problems, and dealing with specific problems" in the past, and the results are not ideal.
With the construction of the national medical security information system, the software and hardware conditions for breaking through the inter-provincial information barriers have matured. Since September 2023, the National Health Insurance Administration has organized all localities to carry out actions to improve the quality of drug price data on the Internet, summarize all drugs that have been listed on the Internet, retain the price data with active transactions, and transfer the price data that has not been actively traded for a long time to the background management. On the basis of ensuring the authenticity, completeness and reliability of the data and the interconnection and interconnection of information, the distribution of drug prices on the network was statistically analyzed, and the distributed and representative prices of each drug were taken as the monitoring results and uniformly pushed to all localities to help them systematically investigate the potential unfair and discriminatory high prices.
Fourth, is there a specific price reduction requirement for the price management of drugs on the network?
In recent years, the National Health Insurance Administration has carried out a lot of work related to drug prices, such as centralized drug procurement, negotiation of medical insurance catalogs, and governance of drug prices on the Internet, etc., the most fundamental starting point is to support and promote fair, open and legal market competition and maintain normal price order.
The price management of drugs on the network also takes the promotion of fair competition in the market and the maintenance of good price order as the most fundamental starting point, emphasizing deviation correction and stop loss, and promoting price fairness, integrity, transparency and balance, rather than one-sided pursuit of price reduction. The monitoring price is not the lowest price in the country, but starts from the existing transaction price, uses statistical methods, and uses the median, mode, etc. to find out the fair transaction price. The monitoring price itself is the price level set by the enterprise itself and can guarantee the supply, which is within the affordable range of the enterprise. For enterprises, it is to balance the price between regions, and it is a local correction, and there will be no general sharp price reduction.
5. Can this policy adjustment play a role in curing the long-criticized problem of inflated drug prices?
In a sense, it has gone beyond the simple price category, but the concentrated embodiment of various interest distribution relationships, and its deep-seated reasons exist in all aspects of drug production, circulation and use. Correspondingly, the treatment of inflated drug prices is also more complicated, and it is necessary to play a good combination of punches and work for a long time.
The medical security department will study and optimize the mechanism of pharmaceutical price formation, normalize and institutionalize the centralized procurement of drugs, implement the national drug price monitoring project, use the market-oriented management and supervision tools such as the drug price and procurement credit evaluation system, and work with relevant departments to continue to make efforts in systematically controlling the problem of inflated drug prices.
6. Will the governance of drug prices affect the innovation and development of the pharmaceutical industry?
From the perspective of the demand side, the price governance is to remove the lesion and prevent the expansion of damage, and from the perspective of the supply side, it is to correct the deviation and return to price rationality. These abnormal prices are not a necessary part of the innovation and development of the pharmaceutical industry, and should not be regarded as a source of power for the innovation and development of the pharmaceutical industry.
The ultimate goal is to reshape the market environment and industry ecology in the pharmaceutical field, so that the healthy competition centered on the "product power" such as innovation value, quality and efficacy, and the vicious competition centered on the "marketing power" such as drug rebates will replace the vicious competition centered on the "marketing power" such as drug rebates. With the improvement of the market environment and industry ecology, enterprises that operate with integrity and fair pricing can gain a greater competitive advantage in the centralized drug procurement market.
The national medical insurance department has always supported the R&D and innovation of the pharmaceutical industry and improved the quality of the pharmaceutical industry. Since the establishment of the National Health Insurance Administration, innovative drugs have gained more opportunities to enter the medical insurance payment catalogue more quickly, and quality drugs have gained a clearer market competitive advantage, and the past marketing-centric development model of the pharmaceutical industry has begun to be marginalized. Compared with six years ago, a large number of innovative drugs and therapeutic drugs on the top 20 list of China's drug sales have entered, and a large number of auxiliary drugs and key monitoring drugs have been withdrawn, promoting the change of the drug structure of Chinese patients to improve quality and efficiency. At present, the National Health Insurance Administration is studying and improving the price formation mechanism of newly listed drugs to support the high-quality development of innovative drugs.
Source: WeChat public account of the Chinese government website
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