About 10 million diabetic patients in China use insulin, but the price of insulin in China has been higher than that of European countries for a long time, which is not commensurate with the status of China's large market, and the burden on patients is heavier. At the end of 2021, the state organized a special centralized procurement of insulin, with an average price reduction of 48%, and the domestic insulin price basically returned to a reasonable level, and the results of centralized procurement began to be implemented in May 2022. In the past two years, how have 10 million "sugar friends" been used?
1. How do "sugar friends" use it?
The standardization of medication has been improved, and the level of medication has been upgraded. Before the centralized procurement, the annual insulin consumption of public medical institutions in China was about 250 million, and after the centralized procurement, the 22-month insulin dosage of the selected insulin reached 650 million, with an average annual dosage of about 350 million. This indicates that with the reduction of drug burden, the accessibility and standardization of insulin therapy have been improved. At the same time, because the third-generation insulin has certain advantages in terms of drug frequency, compliance, safety, and blood glucose control compared with the first-generation and second-generation insulin, and has higher clinical recognition, the price difference with the second-generation insulin has been narrowed after the centralized procurement price reduction, which has further improved the accessibility and indirectly promoted the upgrading of the drug structure. Before centralized procurement, the proportion of third-generation insulin was 58%, and after centralized procurement, it increased to 70%, which is close to the drug structure of European countries.
2. Is centralized procurement the "lowest price winning bid"?
Centralized procurement is not the lowest price to win the bid. Squeezing out the inflated drug price and reducing the burden on the masses is an important goal of centralized volume procurement. The bidding mode has been adopted for each batch of centralized procurement, including the special centralized procurement of insulin, and the enterprise has made its own quotation to form a reasonable price in the competition. At the same time, China's market demand is large, and in order to stabilize supply and maintain competitive vitality, centralized procurement is neither the exclusive bid nor the lowest price bid. At present, the competitive intensity of each batch of centralized procurement is roughly "3 out of 4", "4 out of 5", "4 out of 6", etc., and there are clear terms in the procurement bids, which are similar to "last elimination", and the declared enterprises have a great chance of being selected, and allow different enterprises to have a moderate price difference. A few people in the industry exaggerate the "lowest price winning the bid", and there is a suspicion of deliberately confusing the public and rhythm, so that people who do not understand it mistakenly think that the rules of centralized procurement are "extreme", so that the price is too low to affect the quality, and the deep-seated reason is that some people are not suitable for the fair competition environment under centralized procurement, and hope to return to the old way of "setting high prices" and "fighting sales".
In addition, considering that insulin, as a biological product, has special features in production, supply and use compared with chemical drugs, centralized procurement has set up a "resurrection" rule, which uniformly gives the opportunity to "resurrect" the winner of the "resurrection" although it does not win the competition but has a strong willingness to benefit patients, but can only obtain a smaller amount of agreement, while for enterprises that are selected in normal bidding and have a relatively low price, more agreement volume is favored. In general, the centralized procurement of insulin guides enterprises to benefit patients through the game of "quantity and price linkage", while avoiding large fluctuations in clinical use. Judging from the results, the mainstream companies participating in the first round of insulin centralized procurement bidding were selected, and the overall price fell to a low global level. For example, the third-generation insulin glargine has dropped from more than 140-160 yuan per vial to about 70 yuan, and the second-generation insulin has generally dropped from about 50 yuan per vial to less than 30 yuan. Some well-known international pharmaceutical companies and domestic industry leading enterprises have significantly reduced their prices to exchange price for volume, significantly expanding their market coverage. At the same time, there are also some well-known domestic and international pharmaceutical companies actively strive to show a certain degree of sincerity to benefit patients, and achieve the selection through "resurrection".
3. What to do after the expiration of the agreement?
Carry out continuous procurement and consolidate the results of centralized procurement. The two-year agreement period for centralized insulin procurement will expire in May 2024. Recently, the National Organization Drug Joint Procurement Office issued a national bid for the unified procurement of insulin.
At the same time, because the first round of centralized procurement has greatly squeezed out the inflated space to form a more reasonable price, the continuous procurement pays more attention to stabilizing supply, stabilizing prices, and controlling price differences. Specifically, the procurement bidding documents specify that the quotation of the enterprise "shall not be higher than the highest winning price in the first round of centralized procurement" to prevent price rebound; for those who rank high in the bidding, they will be inclined in the agreement volume and the selection of medical institutions to encourage enterprises to benefit patients; if the quotation is not higher than a certain average price in the first round of centralized procurement, even if they are not shortlisted in the bidding, they can be "resurrected" to be selected, but the agreement volume needs to be appropriately reduced to reflect fairness. In addition, in order to safeguard the interests of patients, the medical insurance department will strengthen price management for products that do not actively respond to centralized procurement, prevent the price of non-selected products from being too high, and protect the enthusiasm of selected enterprises.
The industry has responded positively to the continuous procurement of insulin, believing that it is conducive to promoting standardized competition and clarifying expectations. All companies have indicated that they will actively participate in centralized procurement and continue to provide patients with high-quality and affordable insulin products.
Source | National Health Insurance Administration
Edit | Fu Meiru Zhang Wenqing
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