Qihong Wu: The market price of essential drugs is high or low.

From 2009 to 2010, the national basic drug system was vigorously promoted, and the centralized procurement of basic drugs by provinces was fully implemented. Because there was no uniform rule in the country at the beginning, basic bidding in various regions basically continued the previous non-basic drug tendering method. The biggest problem that emerged was that “the prices of basic medicines in all localities will be higher than the prices of the previous market purchases of basic medical institutions,” and thus the local governments are active. The mechanism of secondary bargaining was discussed so that the basic drug system could be implemented.

During the period, Chongqing-based drug lawsuits and reports of high bid prices throughout the country became hot topics of the year. After the “Astronomical Asparagus Film” incident appeared, the virtual drug price rose to the whole social focus.

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At the end of 2010, with the "Notice of the General Office of the State Council on Issuing the Guidelines for Establishing and Regulating the Basic Drug Purchase Mechanism of the Basic Medical and Health Institutions of the Government" (Guobanfa [2010] No. 56), the "Anhui Model" was the lead. Entities bid evaluation, single source commitment, quantity and price link, recruitment and integration, only recruiting production enterprises, unified payment, full supervision, and distribution and transfer markets characterized “Basic Drug Tendering Action” fully implemented. Up to now, 27 provinces (cities) have been implemented.

The above method has broken through the boundaries of the price of drugs that could not really reduce the price of drugs for more than 10 years. For the first time, the successful bid price is close to the market supply price. However, there is a case where the winning bid price is lower than the production cost, and it is difficult to guarantee the safety of drug use. Controversy, public opinion, on the other hand, tends to be low prices.

Whether drug prices are imaginary or hypocritical is definitely not a feeling, and it is not a matter of course. The amplification effect of public opinion dissemination may mislead the policy direction and allow us to habitually take a headache and cure our feet. When drug prices were high, we saw the introduction of discussion papers on the mechanism for the formation of drug prices, the investigation of the price of basic drugs, the introduction of a strict price filing system, etc.; when prices were low, we saw the formulation of “floor prices” and the basic drugs are expected to be unified. Pricing and strengthening supervision over the production of Chinese medicines came to the surface. The industry seems to be fluctuating in the perception of low prices or high prices. The reason, I believe, is that there is no objective standard for evaluating the price of drugs.

Investigation of the production costs of basic medicines in the entire society can solve the above problems. However, at present, the cost of declaration by enterprises and the mechanism for examination and approval by the government departments for registration have resulted in greater dispersion of costs for the same product, making it difficult to obtain a uniform price for the same product. On the other hand, companies are starting from profitability, and it is difficult to ensure that every company's heart will willingly take the initiative to report the true costs. In addition, there are more than 4,700 manufacturing enterprises in China. It is very difficult to verify all the product costs of all companies. The cost investigation and bottom-up results are only sample data. It is not so easy to conclude whether the price is high or low.

Leverage price leverage

Price is the leverage of the market and regulates market demand so that prices can fluctuate within a certain range. In the purchase and sale of products, operators always want to raise prices, and buyers always want to lower prices. This is an objective contradiction. Therefore, under the market environment, there will inevitably be an exchange of equal value. If one party always takes advantage of the other and the other party suffers, the purchase and sale of such products cannot be sustained. The law of survival of the fittest has also made the price of products lower and lower. The market is a regulator of prices, just like a fair scale, which is the most fundamental means to make prices reasonable, and administrative mediation only plays a macro-control role. This is an objective law.

Before the centralized procurement of essential medicines, the market of basic medical institutions in China, like retail pharmacies, private clinics, and private hospitals, is a market that tends to be marketized. Its procurement orientation is that the lower the purchase price is, the more profitable it is. Strong incentive to lower drug purchase prices. Although the difference between purchase and sales prices is between 40% and 65%, on the surface, the price difference rate is higher than the state's pre-county and above-county medical institutions' 15% price increase, but due to the low purchase price, the retail price is only About 30% of medical institutions above the county level. At this time, the production and management companies will use the real price as the core competitive means. Under such a trading model, there is no room for rebates, no need to "take tickets," and there is no need to build a pharmacy team for promotion, and no government public relations is required. After more than 10 years of market competition, a relatively stable and reasonable price system has been established to maintain the harmonious and sustainable development of the drug supply guarantee system at the primary medical institutions, which constitutes the supply of production enterprises, first-level distributors, second-tier distributors, and primary-level medical institutions. Value chain.

Circular No. 56 fully considered this objective situation and stipulated that “the market price of essential drugs formed before bidding shall be used as the maximum price for essential medicines in various regions” and further reduce prices through batch pricing to provide a good solution to drug prices. Ideas. According to this objective price standard to measure the current bid price of essential drugs, it is not difficult to find that most of the drug prices are still high, and we can also find that the winning price of some products is lower than the market supply price. Then, why is there still the same product with the same product and same dosage form in the new round of bidding, and the price of the winning bid is higher or lower than the market supply price?

The author believes that the first is the lack of market price statistics for essential medicines before tendering; the second is that the higher prices are better to sell the "hidden rules", and even the phenomenon of rising prices does not fall; third, more than 10 years of county and above medical care The non-essential drug tendering by the organization enables the company to familiarize themselves with the laws and have a mature set of coping strategies and methods. Fourth, each company's channel management and control model, target market, and different competition strategies determine the different market supply prices of products; There are some counterfeit drugs that are illegally produced but are smuggled into the market.

It should be noted that the emergence of counterfeit and inferior drugs (a few years ago that have been reported in previous years) in tendering is a concentrated reflection of the long-standing defects in quality standards and corporate integrity of Chinese medicine industry. The demand for price is like a catalyst, which has exacerbated the exposure of this issue. This is not a bidding process. The principle of drug bidding is "quality first and price is reasonable." According to China's "Tendering Law" and international prevailing rules, the essence of tendering is to compare the prices of qualified products. If you want to let tenders bear the assurance of quality It is difficult to bear its weight. This is not a problem that can be solved by setting "floor prices". (