It's been three years since we procured medicines, and how it has changed our lives

Reporter | Yuan Yiming Edit | Xie Xin

Since the second half of 2018 "4 + 7", the state organized centralized drug procurement (hereinafter referred to as "volume procurement") has officially landed the fifth batch, three years later, with the amount of procurement to the Chinese people's life and pharmaceutical industry what has been brought, the National Medical Insurance Bureau gave the answer.

On November 3, the Chinese Pharmaceutical Society of the State Medical Insurance Administration and the China Medical Insurance Research Association jointly released the Blue Book on the Progress and Effectiveness of Medical Insurance Drug Administration Reform (hereinafter referred to as the Blue Book). The "Blue Book" tracked and analyzed the drug use of 804 hospitals (including 596 tertiary hospitals and 218 secondary and below hospitals) in 31 provinces in China, and believed that the purchase of drugs with quantity has greatly reduced the price of drugs and realized the substitution of generic drugs for original drugs. At present, the five batches of procurement cover a total of 218 kinds of drugs, covering the mainstream drugs of chronic diseases and common diseases such as hypertension, diabetes, hyperlipidemia, chronic hepatitis B, etc., with an average price reduction of 54%, and the price of selected drugs has dropped from more than 2-3 times the international price to a comparable level.

On the other hand, the Blue Book concludes that the national procurement of quantity will put the original research drugs and generic drugs of the same quality on the same platform to compete fairly, so that the results of the competition are directly linked to the sales volume. Under such a model, the original research drugs no longer enjoy supranational treatment, and the proportion of the original research drugs used in the first batch of collection drugs has dropped from 22% to 11%; among them, the proportion of original research drugs such as atorvastatin calcium tablets with larger dosages has dropped from 50% to 25% in the "4+7" pilot areas and from 37% to 11% in other regions.

In addition, the procurement with quantity has also significantly improved the quality level of the people's drugs, and the proportion of high-quality drugs such as generic drugs and original research drugs used nationwide has reached more than 90%. This has also stimulated the vitality of generic drugs, which has further increased the concentration of the pharmaceutical production industry, and the head pharmaceutical companies have shifted the focus of development to the development of first imitation and difficult generic drugs. Specifically, in order to enjoy the reform dividend and seize the market, generic drug companies continue to increase investment in consistency evaluation. As of the end of September this year, 537 generic varieties and 2696 products have passed the consistency evaluation.

In fact, since the establishment of the National Medical Insurance Bureau in 2018, in addition to volume procurement, the restart of new drug medical insurance negotiations is also far-reaching.

The "Blue Book" pointed out that the 34 innovative drugs listed from 2016 to 2020 were included in the national medical insurance directory, of which 4 varieties entered the medical insurance at the time of the adjustment of the 2017 version of the medical insurance catalogue, 1 variety was negotiated for 18 years, 9 varieties entered the medical insurance during the adjustment of the 2019 medical insurance catalogue, 12 varieties entered the medical insurance at the time of the adjustment of the 2020 medical insurance catalogue, and 8 varieties were not included in the national medical insurance directory.

Among the varieties transferred into the 2017 version of the national medical insurance catalogue, the time from listing to entering medical insurance is about 4-9 years, while in 2019 this time is reduced to 1-8 years, and in 2020, this time is further shortened to 6 months to 5 years.

For example, it took less than a year for sindillimab to enter the medical insurance from December 2018 to 2019, edaraphone from July 2020 to December 2020 to enter the medical insurance, and it took only about half a year for isazamib, anlotinib, and serritinib from the listing to the 2018 drug negotiations.

Judging from the clinical use data, the amount and dosage of innovative drugs after entering medical insurance have increased significantly in a short period of time. In 2017, the year-on-year growth rate of the quarterly use of negotiated drugs was between 100-135%; in the second and third quarters of 2019, this growth rate was as high as 1349% and 1582%. In 2020, due to the impact of the new crown pneumonia epidemic, the total drug dosage has dropped sharply, the growth rate of new negotiated drug use in 2019 is still very high, and the dosage in the third and fourth quarters still increased by 657.6% and 768.6% year-on-year; in 2020, the new negotiated drugs were implemented on March 1, 2021, and the year-on-year growth rate of the quarterly consumption reached 55%.

In addition, rare diseases are also one of the areas that cannot be ignored, the Blue Book pointed out that the 2009 edition of the medical insurance catalogue contains 22 rare disease drugs, covering 13 diseases of rare diseases; the 2017 edition of the medical insurance catalogue contains 30 diseases of rare diseases, covering 15 rare diseases; the 2019 edition of the medical insurance catalogue contains 39 rare disease drugs, covering 19 diseases of rare diseases; the 2020 edition of the medical insurance catalogue contains 45 rare disease drugs, covering 22 diseases of rare diseases.

In 2009, the amount and dosage of rare disease drugs that have been in the medical insurance catalogue increased steadily, but the growth rate decreased year by year; the amount of drugs transferred in the 2017 version increased by more than 100% in one year after the implementation of the catalogue, and the clinical dosage of drugs transferred in 2019 was small, but the amount of dosage increased significantly.