On April 17, the National Health Insurance Administration disclosed the price and dosage information of insulin centralized procurement. According to the disclosure, 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, 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 results of centralized procurement began to be implemented in May 2022. According to the National Health Insurance Administration, centralized procurement is neither the exclusive winning bid nor the lowest price winning bid. After centralized procurement, the 22-month dosage of selected insulin reached 650 million, with an average annual dosage of about 350 million. In response to the expansion of centralized procurement, the National Health Insurance Administration responded that even if it is not shortlisted in the bidding, it can be "resurrected" to be selected, but the amount of agreement needs to be appropriately reduced to reflect fairness.
Not the "lowest bid"
The average price reduction of insulin centralized procurement reached 48%. However, the National Health Insurance Administration mentioned that 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.
According to reports, the current competitive intensity of each batch of centralized procurement is roughly "3 out of 4", "4 out of 5", "4 out of 6", etc., there are clear terms in the procurement bids, similar to the "last elimination", the declaration of enterprises has a great chance of being selected, and allows different enterprises to have a moderate price difference.
The National Health Insurance Bureau said that some people in the industry exaggerated the "lowest price winning bid", and there was a suspicion of deliberately confusing the public and rhythm, so that people who did not understand it mistakenly thought that the rules of centralized procurement were "extreme", so that the price was too low to affect the quality, and the deep-seated reason was that some people did not adapt to the fair competition environment under centralized procurement, and hoped to return to the old way of "setting high prices" and "fighting sales".
Deng Yong, a professor of health law at Beijing University of Chinese Medicine, told Beijing Business Daily that through centralized procurement, the price of insulin can be effectively reduced, the economic burden of diabetic patients can be reduced, and more patients can afford the necessary treatment drugs. In addition, through the open and transparent bidding and procurement process, fair competition among pharmaceutical manufacturers is promoted, which is conducive to the survival of the fittest, and promotes industrial upgrading and technological innovation.
The average annual consumption is about 350 million
In the past two years, how have 10 million "sugar friends" used insulin?
According to the National Health Insurance Administration, 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 for "sugar friends" 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.
It is understood that the first national procurement of insulin was opened in November 2021, and the centralized procurement varieties are mealtime human insulin, basal human insulin, premixed human insulin, prandial insulin analogues, basal insulin analogues, and premixed insulin analogues, with a total of 6 procurement groups, involving more than 10 companies such as Novo Nordisk, Eli Lilly, Sanofi, Tonghua Dongbao, Tianmai Biotechnology, Gan & Lee Pharmaceutical, Zhuhai Federal Pharmaceutical, Yuheng Pharmaceutical, Wanbang Biochemical, East Sunshine and Hisun Pharmaceutical.
The National Health Insurance Administration said that in general, the centralized procurement of insulin guides enterprises to benefit patients through the "volume-price-linked" game, 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 to less than 30 yuan per vial. 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.
In response to questions related to centralized procurement, a reporter from Beijing Business Daily contacted Novo Nordisk and Gan & Lee Pharmaceutical, but did not receive any reply as of press time.
The relevant person in charge of Tonghua Dongbao told the Beijing Business Daily reporter that previously, the company's human insulin injection, prospermin human insulin injection, prospermin human insulin mixed injection, insulin glargine injection, and insulin aspart injection won the bid for centralized procurement in 2021, and the results of the renewal will be disclosed next week. Centralized procurement is conducive to the company to further expand the sales of related products, especially insulin analogue products, accelerate product access, and increase market share.
In terms of improving the accessibility of drugs, the relevant person in charge of Tonghua Dongbao said that on the one hand, the company actively responded to the national insulin special centralized procurement policy, and the price of the company's insulin products decreased to varying degrees in the first insulin centralized procurement, reducing the economic burden of patients' medication and improving the company's insulin accessibility. On the other hand, due to the particularity of the use of insulin products, the company continues to strengthen patient education, improve patients' attention to blood sugar control, and at the same time, the company also continuously strengthens the after-sales service of products, aiming to provide more high-quality and convenient services for the majority of patients.
The "resurrection" rule has been set up for centralized purchasing
It is worth mentioning that, 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 gives a unified chance of "resurrection" to win the company that has not won 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 will be granted. It is reported that some well-known domestic and international pharmaceutical companies have actively tried to show a certain degree of sincerity to benefit patients, and achieved the selection through "resurrection".
In May 2024, the two-year agreement period for centralized insulin procurement will expire. Recently, the National Organization Drug Joint Procurement Office issued a national bid for the unified procurement of insulin. According to the National Health Insurance Administration, the continuous procurement of insulin still clearly produces the winning companies through bidding, and encourages enterprises to exchange price for volume.
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.
Beijing Business Daily reporter Yao Qian
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