According to the National Health Insurance Administration, the results of the selection of continuous procurement will be implemented nationwide in May 2024, which will be smoothly and orderly connected with the previous round of centralized procurement, so that patients can continue to benefit. Visual China | fig
Feel a centimeter or so around the navel, preferably not in the same position as the day before, take the injection pen and gently prick it, and slowly push the insulin under the skin with a thin needle. That's how people with type 1 diabetes live day in and day out.
Insulin is a lifelong treatment for people with type 1 diabetes. More than two years ago, the state organized the first round of centralized procurement of insulin, and the price of insulin dropped from the high price of the world to the low level of the world, and the 10 million "sugar friends" who used insulin in China could benefit.
On April 23, 2024, the National Conference on the Disclosure of Insulin Special Succession Declaration for Centralized Drug Procurement was held at Shanghai Hongqiao Hotel.
Different from the large-scale national procurement, a total of 13 companies participated in the renewal of the bid for the special centralized procurement of insulin, and the waiting area was not crowded. At 9 o'clock in the morning, the representative of the enterprise submitted the application materials, at 10 o'clock the notary collected and pasted the seal, and before 11 o'clock, the on-site staff completed the declaration information publicity and the announcement of the proposed selection results.
"The price selected in the continuous procurement is basically the same as the price in the previous round. On the evening of April 23, the National Health Insurance Administration announced that 53 products participated in this continuous procurement, and 49 products were qualified for the selection, with a winning rate of 92%, and the winning price was stable and decreased, and it was reduced by 3.8 percentage points on the basis of the first round of centralized procurement price reduction. In other words, after two rounds of centralized procurement, the average price of related insulin products was reduced by about 51.8%.
According to the National Health Insurance Administration, the results of the selection of continuous procurement will be implemented nationwide in May, which will be smoothly and orderly connected with the previous round of centralized procurement, so that patients can continue to benefit.
On April 23, 2024, the National Conference on the Information Disclosure of Insulin Special Succession Declaration for Centralized Drug Procurement was held in Shanghai, and the results of the proposed selection were announced on the spot. Southern Weekly reporter Huang Sizhuo | fig
The sequel picks up action faster than the last one
The newly revised Guidelines for the Diagnosis and Treatment of Type 1 Diabetes Mellitus in China (2021) mentions that diabetes mellitus is an endocrine and metabolic disease caused by the combined action of susceptibility genes and environmental factors, with an incidence of about 1.01 per 100,000 person-years in all age groups. Due to the large population base and the increasing incidence rate year by year, the disease burden of type 1 diabetes is serious and has become one of the major public health problems.
In this context, the national centralized procurement has set its sights on insulin. In mid-August 2021, the National Health Insurance Administration issued the "National Organization of Insulin Centralized Procurement Plan (Draft for Comments)", and in November of the same year, the 6th batch of centralized drug procurement (insulin special) was opened in Shanghai, and the average price of the selected products was reduced by 48%.
A patient who has been injecting insulin for many years told a reporter from Southern Weekend that before the centralized collection, the price of buying a Novo Nordisk insulin product at the pharmacy's own expense was about 83 yuan per piece, and the price dropped to about 46 yuan per piece after the centralized collection, but now when buying the same insulin product at the community health service center, it only costs about 16 yuan per insulin after medical insurance reimbursement, "it is much cheaper, and it is very convenient to buy medicine."
According to the data disclosed by the National Health Insurance Administration on April 17, 2024, the annual insulin consumption of public medical institutions across the country was about 250 million before centralized procurement, and after centralized procurement, the 22-month insulin dosage reached 650 million, with an average annual dosage of about 350 million.
The first round of centralized insulin procurement has been implemented since May 2022, and the two-year agreement period has come to an end.
On March 29, 2024, the National Drug Joint Procurement Office issued the national centralized drug procurement document (insulin special continuation), held a training meeting for insulin special agreement expiration procurement enterprises on April 9, and completed the bid opening and announced the results of the proposed selection on April 23.
This round of insulin is divided into 6 purchasing groups and 11 quotation units, involving prandial human insulin, basal human insulin, premixed human insulin, prandial insulin analogues, basal insulin analogues, and premixed insulin analogues.
"In terms of classification, the product covers the second and third generation insulins commonly used in clinical practice. Jiang Changsong, assistant to the dean of the National Medical Security Research Institute of Capital Medical University and director of the price procurement office, told Southern Weekend that it can be seen from the report volume data that the proportion of the second generation has decreased and the proportion of the third generation has increased, "which is not only in line with the sales strategy and trend of pharmaceutical companies, but also enables Chinese patients to use better products at lower prices, which is a win-win situation."
Cycle Extension, Reporting Increase, "Resurrection Mechanism"
The rules of centralized procurement affect the whole body, so they have attracted much attention from the outside world. This special insulin succession is no exception, sending many mild signals to the market.
First of all, compared with the two-year agreement period set by the first centralized procurement, this centralized procurement will extend the agreement period, that is, from the date of implementation of the selected results to December 31, 2027. Secondly, the number of procurement reports from more than 35,000 medical institutions across the country has also increased, an increase of about 13% from the 210 million reports of the first centralized collection, exceeding 240 million. Both will help increase the enthusiasm of pharmaceutical companies to participate in supply competition, and can also stabilize the drug expectations of clinicians and patients.
More interestingly, the centralized procurement of insulin introduces a "resurrection mechanism". According to the rules listed in the continuation document, the products that fail to be shortlisted by the bidding group and are not qualified according to the bidding selection rules, and the declared price is not higher than the specified price, can be "resurrected" and also enjoy the winning qualifications.
"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, and for companies that have not won in the competition, but have a strong willingness to benefit patients, they will be given the opportunity to be selected for 'resurrection', but they can only get a smaller amount of agreement. On April 17, the National Health Insurance Administration pointed out in an article on its official website that, in general, the centralized procurement of insulin guides companies to benefit patients through the "quantity-price linkage" game, while avoiding large fluctuations in clinical use.
This is the first time that a volunteer supervisor has appeared at the national drug procurement site. Southern Weekly reporter Huang Sizhuo | fig
The Southern Weekend reporter noticed in the quotation information publicity session that when the quotation of each company was projected on the big screen, the representatives of the enterprises present raised their mobile phones to take pictures, and some representatives even set up tripods to record the whole process.
At the same time, a number of volunteer supervisors sat in the first row of the audience to observe and record, which was also the first time that volunteer supervisors appeared at the national centralized procurement site. On April 3, 2024, the National Health Insurance Administration issued an announcement on the solicitation of voluntary supervisors of centralized pharmaceutical procurement in 2024, aiming to guide the whole society to pay attention to the medical insurance cause, give full play to the role of supervision, and enhance public participation in centralized procurement. According to the list released on April 19, 20 volunteer supervisors come from different units in different provinces and cities, including lawyers, scholars, and civil servants.
Judging from the results of the proposed selection, the 13 contestants participating in the renewal of the contract are three foreign companies and ten local companies, none of which have returned home, and the bidding products of some companies have even been selected.
"Patients are more dependent on insulin use, and the first round of centralized procurement price reduction of 48%, the room for decline is already very limited, so this renewal bidding is to hope that more companies will participate in supply, stabilize supply, stabilize product quality, and also achieve the goal of a slight reduction in insulin prices. Gu Hai, deputy dean of the Institute of Public Policy at Nanjing University, told Southern Weekend.
The winning price has risen and fallen, which is basically the same as the previous round
On the morning of April 23, the insulin manufacturer submitted the application materials, and the notary staff of the New Hongqiao Notary Office witnessed and pasted the seal on the spot. Southern Weekly reporter Huang Sizhuo| fig
China is one of the countries with the highest diabetes-related expenses in the world, and the insulin market alone exceeds 10 billion yuan.
In the first round of centralized procurement, the overall price of insulin fell to a low level in the world. 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.
Regarding the most high-profile continuation of the purchase price, as early as a week before the bid opening, the National Health Insurance Administration issued a document to feed the market a "reassuring pill": because the first round of centralized procurement has been greatly squeezed out of the inflated space, forming a more reasonable price, the continuation of procurement pays more attention to stabilizing supply, stabilizing prices, and controlling price differences.
The rules for continuous centralized procurement follow the previous bidding model and the selected categories in categories A, B and C, and within the same procurement group, each product is determined according to the ranking order and classification, according to a certain proportion of its procurement demand in the first year.
On the evening of April 23, when the National Health Insurance Administration announced the results of the continuous centralized procurement, the price of the selected was stable and decreased, and it decreased by 3.8 percentage points on the basis of the first round of centralized procurement price reduction.
In the first round of centralized procurement, the price difference of the third-generation premixed group, which had the largest price difference, narrowed from 2.3 times to 1.6 times, making the market competition fairer and the supply of enterprises more secure. At the same time, the proportion of selected products in category A with lower quotations increased from 40% in the previous round to 71%. The selected products in category A with lower quotations include products from internationally renowned enterprises and domestic brands, as well as products from newly listed enterprises, so as to better meet the needs of the masses.
According to the public information, the price of many products has been moderately reduced, and the winning bid price of the same product of some companies has risen slightly compared with the first round of centralized procurement. For example, Gan & Lee Pharmaceutical's 6 bidding products are all planned to be selected, all of which are slightly higher than the first round of centralized procurement quotations, and the share price of Gan & Lee Pharmaceutical rose on the 23rd.
The above-mentioned article also admits that centralized procurement is not the lowest price to win the bid, including the special centralized procurement of insulin, and the bidding mode has been adopted for each batch, and the enterprise has independently quoted to form a reasonable price in the competition, squeeze out the inflated drug price, and stop taking the old road of "setting high prices" and "fighting sales".
"[Centralized purchasing] is not the lower the price, the better, the quality, accessibility, supply security and other aspects of the drug are all factors that need to be considered. Gu Xuefei, director of the Medical and Health Technology Assessment and Innovation Development Department of the Health Development Research Center of the National Health Commission, said in an interview with Southern Weekend.
Southern Weekly reporter Huang Sizhuo
Editor-in-charge: Cao Haidong