Drug pricing mechanism should be clarified as soon as possible

A new round of drug price reforms was initiated and Shanghai was the first to issue a "local version." Recently, the Shanghai Municipal Price Bureau, the Health and Development Commission and the Medical Insurance Office jointly issued a document stating that other types of medicines other than medicines within the pricing range of the Shanghai government will be subject to market adjustment prices, which are independently set by pharmaceutical production and marketing companies.

Prior to the pharmaceutical company's products to enter the medical system must be through the record and tender. The release of the New Deal means that the controversial bidding limit will be the first stop in Shanghai. Objectively speaking, the original intention of this system is to reduce the space for drug price hikes by reducing intermediate circulation links. However, contrary to expectations, the tendering system has caused many drug companies to fall into the “not to win the bid and die and win the bid for the death”. This is due to the fact that the strength of technical inspections is lagging behind. Currently, the bidders led by medical institutions and local health administrative departments are not likely to have the quality of drugs. To make a detailed internal assessment, it can only be replaced by external indicators. The main approved content is whether the pharmaceutical company has GMP certification. In the case that most bidding drug companies have this qualification, this external evaluation index loses its practical guiding significance, and "low price theory" emerged as the times require. For this reason, some companies have launched price wars at all costs, and the phenomenon that drug bid prices are lower than normal production costs has become a common occurrence. However, with the ultra-low-cost finalists after the successful bidder, it is not possible to "suicide" the supply at an upside price, so there is a phenomenon of direct stock-out or renamed price increase. It can be seen that neglecting the technical considerations of the drug bidding model actually interferes with the normal development of the industry, and even encourages the industry to use generic drugs to reduce the cost of scientific research inputs. The lack of R&D investment and weak innovation capacity is a problem that plagues the deep development of China's pharmaceutical industry. The key issue.

Shanghai's loosening of the system for non-government-priced drugs is a test of the market-oriented reform of drug prices in China. Peng Sen, vice chairman of the National People's Congress Financial and Economic Committee, said last month that the time for the full liberalization of drug prices has matured, and the price of drugs is expected to be released in a step-by-step manner. In view of this, it will become a general trend for the administrative department to completely withdraw from the drug pricing link. If drug pricing power is returned to the market, price controls can be spontaneously formed under the joint effects of manufacturers' profit-seeking nature, peer competition pressure, and supply and demand game mechanisms, which in turn will prompt the pharmaceutical industry to achieve new breakthroughs. However, it needs to be pointed out that to really play the decisive role of the market in drug pricing, it is necessary to break the current "taking medicine to support medicine" model and weaken the strong discourse power of public hospitals in the drug procurement market. Otherwise, once the drug pricing power is fully passed to the market, it will inevitably lead to a new chaos in the price system.

In fact, market-oriented reforms do not mean the complete withdrawal of administrative forces, but they must reorient their responsibilities and shift their focus to optimizing the industrial order. In view of overseas, the administrative departments of developed countries will also have more interventions in the drug price system, but it is indirectly controlled by third-party forces. For example, in Germany, the medical separation system effectively blocked the channel for doctors to realize their interests through drug sales, while the medical insurance agency played the role of patient “spokesperson”. Germany's health insurance system covers 90% of the population. Patients who go to pharmacies to buy drugs do not need to pay directly to pharmacies, but are settled by the medical insurance institutions and drugstore industry associations. The facts show that professional insurance institutions will play with pharmacies in order to ensure their own economic interests, thereby increasing the transparency of drug information and pushing drug prices back to a reasonable range. In view of this, while the marketization reform of China's drug pricing mechanism is fully initiated, it is also necessary to actively explore the path of reform for the “technology-based” business model of medical institutions, so that pharmaceutical manufacturers can have more room to face terminal patients. Reduce drug sales links and marketing costs, and then effectively reduce the high price component of drug prices.

The pharmaceutical market is related to people's health and has certain public-good properties. Its pricing mechanism should be clarified as soon as possible. Of course, the reform of drug prices also requires the active cooperation of deep institutional reforms such as the transformation of profit models for medical institutions and the cultivation of commercial insurance markets, which can be described as a systemic battle.