Recently, the National Health Insurance Administration issued an announcement that as of the end of the first quarter of 2024, according to the price procurement credit evaluation system, 4 companies were rated as "particularly serious" and 21 were rated as "serious" untrustworthy.
So what is the price of credit evaluation, and what does it have to do with the common people's medical treatment? Let's look at an example.
According to the judgment document of a county people's court in 2022, employees of a drug distribution company engaged in commercial bribery. The provincial-level medical insurance department where the case occurred instructed the provincial centralized pharmaceutical procurement agency to collect and verify the information on the transaction situation reflected in the judgment document and found that the lipoic acid tablets (0.3g*6) of a drug manufacturer involved commercial bribery worth 14,092 yuan. According to the calculation of the sales unit price of 63 yuan/box during the period involved in the case, the rebate of the drug accounted for 55.92%, and the rebate amount reached 35.23 yuan/box, so it can be said that more than half of the money that the patient took out of his pocket became the payment for the drug rebate. After the case occurred, the bribe-giver was criminally punished in accordance with the law, but the price of the drug was still sold at 63 yuan per box, and the part of the inflated space used to pay the kickback in the past still existed, and the patient still had to pay for it. Based on the "price procurement credit evaluation" system established by the National Health Insurance Administration in August 2020, the pharmaceutical centralized procurement agency in the place where the kickback occurred interviewed the manufacturer and pointed out that the company's improper price infringed on social interests, and finally the company took the initiative to reduce the price of the drugs involved in the case to 27.77 yuan per box according to the rebate ratio of not less than 27.77 yuan/box.
In the above case, how did the "price procurement credit evaluation" achieve a significant reduction in drug prices?
1. What is the credit evaluation system for price bidding?
Pharmaceutical companies "can set their own drug prices", but they must also comply with the "Price Law" and other relevant laws and regulations to ensure that the pricing is in line with the principles of fairness, reasonableness, honesty and trustworthiness, and consistent quality and price. However, there are always a few unscrupulous companies that want to make more money and engage in some improper means, such as sending kickbacks for marketing. From 2013 to December 2019, there were more than 3,000 bribery cases in the pharmaceutical sector. From 2016 to 2019, more than half of the top 100 pharmaceutical companies in China were found to have directly or indirectly given kickbacks, among which the most frequent companies were involved in more than 20 cases in three years, nearly half of the cases had bribes of more than 1 million yuan, and the amount of kickbacks in a single case exceeded 20 million yuan. As the saying goes, the wool comes from the sheep, and the money for kickbacks and other behaviors given by enterprises is ultimately paid by the patients.
The credit evaluation system for price procurement established by the National Health Insurance Administration is a price management tool, which adopts credit rating and appropriate measures for enterprises with untrustworthy behaviors in price procurement to promote the return of pharmaceutical product prices to a reasonable level and safeguard the vital interests of the people.
2. How to evaluate credit evaluation? How many evaluation results are there?
Through clues such as judgment documents and administrative punishment decision documents of relevant departments, the provincial centralized pharmaceutical procurement institutions are to track down untrustworthy conduct that occurs within the province, mainly based on the severity of the amount of bribes, improper price behavior, and disruption of the order of centralized procurement, and are divided into four credit levels: "general, moderate, serious, and particularly serious". For example, a single bribe of more than 10,000 yuan is considered "average", a single bribe of more than 100,000 yuan is considered "moderate", a single bribe of more than 300,000 yuan is considered "serious", and a single bribe of more than 2 million yuan is "particularly serious". In 2023, according to the judgment of a county people's court, the bribe giver confessed that he had sold more than 3,000 pieces of a certain brand of surgical anti-adhesion solution he represented, and the amount of a single bribe exceeded 100,000 yuan according to a rebate of 90 yuan per piece, and the enterprise involved in the case could be assessed as "medium" untrustworthy.
3. What circumstances may there be dishonest behavior in price solicitation?
Pharmaceutical companies involved in commercial bribery, tax-related violations, and monopolistic behaviors often have the behavior of promising to obtain improper benefits in the process of pricing, marketing, bidding, and performance. After the court judgment, the illegal acts were punished, but the inflated prices of pharmaceutical products were not corrected, the financial source of the illegal acts was not cut off, and the interests of the masses were still suffering. In view of the above situation, it is necessary to uncover the enterprises behind the enterprise and the improper price behavior through the credit rating system, and restrain it through the credit rating system.
4. What are the consequences of dishonest enterprises?
Like our personal credit reporting, trustworthy people will enjoy convenience everywhere because of good credit, while untrustworthy people may face consequences such as restricting loans and high-speed rail travel, and untrustworthy enterprises will also face similar consequences.
Depending on the level of dishonesty, companies will face different consequences. Pharmaceutical enterprises rated as "average" are given written reminders and warnings; pharmaceutical enterprises rated as "medium" are to mark the rating results and remind medical institutions of the risk information of untrustworthiness of the procurement objects; in addition to reminding and warning and reminding of risks, disposition measures such as canceling the qualifications of the drugs and medical consumables involved in the case will be cancelled; Disposal measures such as bidding and delivery qualifications.
For example, in 2020, a company's deer melon polypeptide injection paid a bribe of more than 880,000 yuan in Zhejiang Province with a rebate of 8 yuan/branch, and the company was the first case in the country to be rated as a "serious" untrustworthy enterprise.
5. How can a dishonest enterprise repair its credit?
Dishonest enterprises have the opportunity to turn over a new leaf. Carry out credit restoration by eliminating inflated prices of pharmaceutical products, unreasonable returns or public welfare donations, and entities that effectively point to the actual control of untrustworthy conduct.
6. Where can I check the credit evaluation results of price bidding?
Every quarter, the Provincial Medical Insurance Bureau and the Pharmaceutical Centralized Procurement Agency publish the list of rated enterprises on the official website. As of the first quarter of 2024, there are 399 untrustworthy enterprises across the country, including 4 "particularly serious" untrustworthy enterprises, 21 "serious" enterprises, 49 "moderate" enterprises, and 325 "average" enterprises.
7. What is the effectiveness of the credit evaluation of price procurement?
Since the establishment of the system, a total of more than 70 kinds of drugs have been repaired through price reduction, with an average price reduction of 21.58%, saving more than 9,400 yuan and more than 4,800 yuan for corporate public welfare. There are also more enterprises that are afraid of the risk of dishonesty in price procurement, and take the initiative to cooperate with the medical insurance department and pharmaceutical centralized procurement institutions to correct unfair high prices. Under the condition that the market determines the price, how to better play the role of the government in the institutional innovation of "price procurement credit evaluation" has gradually become a "sword of Damocles" hanging over the heads of illegal enterprises, and has formed a set of "combination punches" with the centralized procurement of drugs organized by the state and the special management of drug prices on the network. Of course, the credit evaluation of pharmaceutical prices and procurement mainly relies on the facts of dishonesty such as drug rebates determined by the official judgment of the judicial department, which objectively will have a certain lag, and will continue to be optimized in the future.
Ordinary people spend money to buy medicine to prevent and cure diseases, and should not pay for things that should not be there such as "kickbacks". The medical insurance department has shown the trick of price procurement credit evaluation, which is to find ways to return the price of drugs to the value of disease prevention and treatment, so that the business operation can return to the right track of speaking with quality and efficacy, and strive to make the cost of medical treatment more and more transparent, and the healthy life of clean air is easy to get!