The "National Essential Medicines List" led by the National Health Commission has not been updated for almost 5 years, and it is almost forgotten by the industry. Nowadays, it is for community health centers, township health centers and other grassroots medical institutionsThe health care system is trying to introduce new rules for primary medication.
Recently, the Hunan Provincial Medical Insurance Bureau listed a "2023 Drug Procurement List of Primary Medical Institutions".Grassroots medical institutions are required not to purchase drugs not on the list, and the existing inventory of drugs outside the list will be sold as of December 10, 2023.
This list from HunanIncluding 1280,000 drug specificationsAmong them, there are 9,637 linkage catalogs, 1,385 selected catalogs, 960 monitoring catalogs, 632 national discussion catalogs, 77 shortage drug catalogs, 70 reserve catalogs, 36 national discussion generic drugs, and 3 fixed-point catalogs. Hunan has clarified the use of these drugs in primary medical institutions, and strictly prohibits the implementation of disguised discounts, rebates and other illegal transactions in various ways.
Grassroots medical institutions originally mainly used the varieties of the National Essential Medicines List, but since 2018, the industry has been looking forward to the adjustment of the Essential Medicines List, but there has been no movement. The Health Knowledge Bureau combed and found,The adjustment of the basic drug list has not been included in the key tasks in the second half of 2023. This may be the reason why the local government has "started anew" and introduced new grassroots drug use standards.
In the past few years, the implementation and use of essential drugs have encountered a lot of resistance, especially in the first hospital, because of the regulation of the proportion of basic drugs, which is equivalent to drawing a red line for the introduction of innovative drugs in hospitals. Nowadays,The shadow of basic drugs gradually faded out, and was replaced by the "procurement list of primary medical institutions" led by the medical insurance departmentI don't know if it will affect the actual use of drugs in medical institutions.
Hunan announced 1280,000 primary medical institutions procured drug specifications, including 9,637 linkage catalogs linked to the network, 1,385 national or provincial centralized procurement catalogs, 960 local centralized procurement catalogs that need to be monitored, 632 national catalogs, 77 national shortage drug catalogs, 70 reserve catalogs, 36 national talk generic drugs linked to the network, and 3 national designated ** catalogs.
This catalogue basically includes the key varieties that the industry is concerned about, such as centralized procurement of drugs, first-class negotiation drugs, and shortage drugsIt means a large expansion of drug use in primary medical institutions.
However, primary medical institutions are not free to purchase. The "Notice" requires,Grassroots medical institutions should purchase according to the needs of clinical drugs, and give priority to the procurement of drugs with the same quality level and high quality and low price. In July this year, Hunan has had a regulation on the use of centralized procurement drugs, basic infusions, and other drugs in primary medical institutions, and the scope of drug use in primary medical institutions has been broadened.
It is worth noting:Primary medical institutions can choose up to 5 varieties under the same generic nameIf the quantity of selected products in centralized procurement reaches the standard, non-selected varieties can no longer be purchased. Other online drugs can also be purchased up to 5 varieties. The large infusion is slightly special, and the total purchase volume of soft bags is not more than 50% in principle, and the rest must be glass bottles and plastic bottles.
At the same time, the Hunan Medical Insurance Bureau did not carry out a "one-size-fits-all" approach to the use of drugs in primary medical institutions because of **lists the rules for the use of additional or substituted varieties.
The notice requires that the specifications of drugs that are not included in the scope of drug procurement of primary medical and health institutions should be the lowest comparable price of the unit and the difference does not exceed the lowest price of 15 times, the purchase amount shall not exceed 40% of the total purchase amount of the generic name of the dosage form of the drug, it can be included in the procurement.
In order to prevent clinical drug abuse, Hunan Provincial Medical Insurance BureauA pharmaceutical monitoring mechanism has been established to strengthen the supervision and inspection of drug procurement in primary medical and health institutions within the jurisdictionOnce it is found that the drug transaction** and procurement behavior is abnormal, as well as the lack of clinical drug ** protection, etc., timely feedback and disposal.
In addition, Hunan requires that all production enterprises, as the first responsible person for drug quality and security, should strengthen drug quality management, select business enterprises with strong distribution capacity and wide coverage, and establish distribution relationships in a timely manner to ensure the use of drugs in medical and health institutions at the grassroots level, especially in remote areas.
It can be seen that while the grassroots market is expanding, it is about to usher in stricter supervision and inspection.
The industry had high expectations for the Essential Medicines List. Because for some innovative pharmaceutical companies,The biggest role of basic drugs is to solve the problem of innovative drugs with good clinical effects in hospitals. However, after the adjustment in 2018, the number of basic drugs was expanded to 685, and there was no follow-up.
The National Health Commission has put a lot of effort into the implementation of essential drugsFor example, it stipulates the ratio of basic drugs in medical institutions at all levels and assesses the use of basic drugs. However, whether doctors use basic drugs or not, it is obviously not a paper document that can be prescribed, and ultimately it depends on the actual clinical situation.
The list of essential drugs has not been updated for a long time, which is seriously out of touch with the reality of the development of China's pharmaceutical industry. A number of industry insiders have told the Health Knowledge Bureau that with the gradual improvement of national living standards, the gradual liberalization of the basic drug catalogue is a general trend, and it will eventually be integrated with the medical insurance catalogue.
In the context of hierarchical diagnosis and treatment,The grassroots ≠ the low-end, and this concept is becoming more and more deeply rooted in the hearts of the people. According to the plan of the National Health Commission's "Thousand Counties Project": by 2025, at least 1,000 county hospitals in China will reach the level of first-class hospital medical services.
Intranet data shows thatIn 2022, the market sales of drugs in township health centers will reach 86.5 billion yuan, accounting for only 4% of the national drug market9%。However, under the goal of "no major illness in the county and no minor illness in the village", more enterprises will pay attention to the primary medical market in the future.
If the primary medical institutions can only adhere to the line of "90% of the varieties must be basic drugs", do not develop more first-class means, and do not accommodate more patients, it is not in line with the general direction of medical and health policies.
In particular, with the normalization of centralized drug procurement and the transparency of clinical drug rules, more and more cheap varieties should enter primary medical institutions. The total number of national and provincial centralized procurement varieties has reached nearly 500, and these drugs are very suitable for grassroots use. If the list of essential drugs is not expanded, it will be difficult for primary medical institutions to choose drugs.
Hunan fired the first shot of grassroots drug reform, and I don't know if it will respond in other provinces.
Written by Xiaomi.
Edited by Jiang Yun Jia Ting.
Operations |Zhu Ying.
Source丨Visual China.
Disclaimer: Original content of the Health Knowledge Bureau, please do not do it without permission**