Hospital drug structure adjustment, auxiliary varieties bear the brunt
Recently, it was reported that the Beijing Municipal Hospital Authority issued a notice to medical institutions to identify some drugs as “auxiliary drugs”, requiring medical institutions to pay attention to the use in use, involving a total of 21 generic products for injections. It is reported that most of these varieties are used in large quantities.
Although the management of auxiliary drugs has been emphasized for many years, Beijing is the first province and city to carry out standardized management with clear administrative measures. As a key pilot for medical reform, will this practice be widely used?
In the interview with this newspaper, the relevant person in charge of hospital procurement and industry experts believed that with the further advancement of the new medical reform, the implementation of the two total control and total prepayments, the proportion of medicines and the reform of medical insurance payment methods, the major hospitals nationwide Although it may not be as clear as the regulations in Beijing, it has recently started a new round of remediation actions for drugs, non-medical and non-medical non-based drugs, and high-priced drugs may be the first to be cleaned up.
Hospital drug structure adjustment, auxiliary varieties bear the brunt
Auxiliary medication remediation begins?
Control of the use of auxiliary drugs for many years, especially the State Council's "Notice on Implementing the Guidance for Improving the Centralized Purchasing of Pharmaceuticals in Public Hospitals", after focusing on the follow-up monitoring of auxiliary drugs and drugs used in hospitals, etc., all localities have emphasized the assistance in relevant documents. Management of medication.
For example, in Chongqing, it is required to lower the medical insurance payment standard according to the purchase price based on the purchase and sale price. Relevant analysis believes that the implementation of this policy has made it necessary for Chongqing to increase the adjustment of drug use structure, which is the first to use a large amount of auxiliary drugs, irrational drugs, and high-priced drugs. In interpreting the Fujian medical insurance control policy, the Fujian Provincial Medical Reform Office also stressed that one of the main measures is to strengthen the administrative supervision of medical expenses, including special supervision on auxiliary drugs, antibiotics, anti-tumor and new special drugs.
According to the analysis of Gan Rongfu, a senior consultant of Sinopharm, the fundamental purpose of clearing auxiliary drugs in hospitals is to achieve two total control and gradually reduce the proportion of drugs.
"Beijing's approach does not necessarily lead to widespread follow-up." Mr. Zhang, director of the Pharmacy Department of a top three hospital in Guangdong, told this reporter that there is no national definition of adjuvant medicine, and the definition of adjuvant medicine is difficult to generalize, such as in the Beijing list. Brain protein extract for injection may be one of the necessary medications in neurology, but not necessarily in other departments. "The relative nature of adjuvant drugs has made hospitals have different needs for different drugs. For example, cancer hospitals are indispensable for the demand for products that improve immunity."
Mr. Chen, the deputy dean of a hospital in Shanghai, pointed out that it is relatively easy for the hospital to define the auxiliary drugs purchased by the hospital itself, because it is necessary for which diseases and departments are necessary for the construction of their own disciplines. It is very clear that it is easy to achieve control in the doctor's prescription or performance appraisal through information technology.
In-hospital medication list
It is worth pointing out that our reporter learned in the interview that cleaning up auxiliary drugs is only part of the hospital remediation drug list. At this stage, major hospitals adjust the drug structure to achieve administrative indicators, which may cause more products. Direct impact.
Mr. Zhang, the pharmacy department of the above-mentioned Guangdong Sanjia Hospital, told the reporter that at present, the estimated proportion of medicines in the top three hospitals in Guangzhou is about 40%, and the target of 30% is to be achieved, even if the implementation of the zero-rate reduction of some medicines in the future will still be used. Great difficulty. In addition to auxiliary medications, more self-funded drugs, high-priced drugs, or imported varieties with domestically-made drugs that are not medical insurance non-based drugs may become targets for clean-up.
"The self-funded medicine is affected by the medical insurance control fee, and the patient does not have a greater burden of purchasing the medicine by himself at the pharmacy, so it may become the first target to be cleaned. In addition, non-essential auxiliary medicines, such as some Chinese medicine injections in Chinese patent medicines. Products are also easy to become important objects to be cleaned up." Mr. Zhang pointed out.
Gan Rongfu pointed out that Shanghai has confirmed that the top three hospitals are counted according to generic drugs, and that there should be no more than 300 kinds of proprietary Chinese medicines. The total use of medicines in hospitals is about 2,500. Some imported varieties such as oxaliplatin, domestically produced varieties may be procured because the price is much lower than the imported varieties. For imported varieties, in some non-tumor hospitals in Shanghai, patients can only buy at surrounding pharmacies.
In the interview, experts said that although the hospital has a strong demand for the adjustment of the drug structure, the cleanup of the drug list is still cautious, and there is also a lot of pressure inside the hospital, unless the country releases such mandatory restrictions as antibiotics. policy. In the absence of strong external force, it is difficult for hospitals to actively clean up products. Relatively speaking, due to the implementation of the drug electronic trading platform model in Guangdong, the hospital did not choose the right of manufacturers for drugs other than non-cheap drugs. After replacing the manufacturers, some drugs became a good opportunity to be cleared out of the hospital drug list. Other provinces are more difficult to clean up.
"It is based on the development trend of hospital drug structure and purchasing preferences. The development of hospital pharmacies is favored by many large companies, including large-scale chain and pharmaceutical commercial enterprises." Gan Rongfu pointed out that according to relevant data, the current growth of adjuvant drugs is limited. It has gradually emerged. For example, in the first half of the year, cardiovascular Chinese patent medicines increased by only 1.8% year-on-year, while the overall drug use increased by more than 5%. The shrinkage of proprietary Chinese medicines is much faster than the shrinkage of the whole market, which is related to hospital drug management.
The reporter noted that Ping An Securities selected a more representative variety and found that the differentiation of different varieties has intensified. Among the chemical drugs, antibiotics and immunomodulatory drugs are under certain pressure. High-end generic drugs still benefit from import substitution and maintain strong growth rate. Traditional Chinese medicine injections are mostly auxiliary drugs, which are greatly affected by medical insurance control fees. Some regions have imposed restrictions on prices during tendering and are expected to continue to be under pressure.
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