The six batches of drugs collectively purchase 234 kinds of drugs, accounting for 30% of the total annual drug purchases of public medical institutions; Two batches of high-value medical consumables were collected from "sword finger" coronary stents and artificial joints, with an average price reduction of more than 80% After three years, the reform of centralized procurement with volume has entered a new stage of normalization and institutionalization. In terms of the results achieved, the overall situation is "price reduction, volume increase and high quality". Towards the deep water area of pharmaceutical reform in the 14th five year plan, what are the key points of centralized procurement in 2022? Can the varieties collected by local alliance be included in the national collection? How will the priority and rational use of selected products in centralized purchase be promoted? The third sector will carry out drug centralized purchase in an all-round way, and the centralized purchase will speed up and expand in 2022 In October 2021, after the implementation of the fifth batch of drugs collected by the state, Zhang Wei, director of anorectal surgery of the First Affiliated Hospital of Naval Military Medical University, found that the price of oxaliplatin injection, the original drug for the treatment of colon cancer, decreased from nearly 2000 yuan to 310 yuan. "At first, patients couldn't believe that the doctor prescribed the same medicine." Zhang Wei said that from "can not afford to use" to "rest assured to use", centralized mining has brought tangible benefits to patients. In 2019, 25 kinds of drugs collected in 11 pilot cities of "4 + 7" will be expanded to the whole country; In 2020, 32 kinds of drugs and 55 kinds of drugs were successfully selected into the "list" of the second and third batch of national centralized drug procurement respectively; In 2021, the fourth batch and the fifth batch of national centralized purchase of drugs will "buy" 45 and 61 kinds of drugs respectively, and a new breakthrough in the centralized purchase of biological drugs will be achieved in the Sixth Batch of special centralized purchase of insulin Drugs such as hypertension, diabetes, digestive system diseases and other common diseases, chronic diseases, drugs and rare diseases, such as malignant tumors, have shown "acceleration". Increasing speed and expanding area is the due meaning of normalization and institutionalization of centralized mining. "Strive to achieve an average of more than 350 varieties of drugs and more than 5 varieties of high-value medical consumables in each province by the end of 2022 through national organizations and provincial alliance procurement." Chen Jinfu, deputy director of the national medical insurance administration, said that in 2022, the centralized purchase of drug consumption will work together to "make efforts" in three aspects: increasing the speed of varieties, expanding the scope of fields and continuously increasing efficiency, so as to further expand the benefits of people's medication and medical treatment. What is the general direction of centralized drug purchase in 2022? The state medical insurance administration gave a clear answer: the centralized purchase of drugs is carried out in three sectors: chemical medicine, Chinese patent medicine and biological medicine. As the first centralized procurement of Chinese patent medicine alliance in China, the centralized procurement of Chinese patent medicine of 19 provinces (autonomous regions and municipalities) led by Hubei Province was successfully opened in December 2021, and the average price reduction of 111 selected products was 42.27%, providing experience and possibility for the centralized procurement of Chinese patent medicine nationwide. In this regard, the national medical insurance administration said that based on the alliance procurement organized by some provinces last year, the scope of Chinese patent medicine should be expanded in an orderly manner in 2022 to further squeeze the living space of "gold sales". What areas will the centralized purchase of consumables focus on in 2022? "This year, we are going to collect orthopedic spine consumables, and we are currently making a thorough study." Chen Jinfu introduced that in 2022, the centralized collection of high-value medical consumables will focus on orthopedic consumables, drug balloons, dental implants and other varieties. In November 2021, Ningbo Medical Insurance Bureau of Zhejiang province carried out a special investigation on the dental implant project, visited the front-line dental medical institutions, and solicited opinions and suggestions on the limited price dental implant project. At the same time, Sichuan Province issued the "eight provinces and two districts" notice on carrying out the information collection of some oral high-value medical consumables products, and the declared product scope involves some medical consumables constituting the oral implant system. For the intensive collection of dental implants that has attracted much attention, local governments have first "tested the water" to explore a feasible path for standardizing dental medical services. "From the process and results of round after round of centralized purchase, the preparatory work is more and more sufficient, the scheme design is more and more rigorous, and the medicines and consumables benefiting the people are more and more abundant." Jin Chunlin, director of Shanghai Health and health development research center, said that Jicai is improving people's accessibility, sense of gain and sense of well-being of a healthy life through "replacing cages with birds". "Price reduction without quality degradation" promotes the priority and rational use of selected products In January 2021, Mr. Gao from remote mountainous areas in Yunnan successfully implanted 590 yuan coronary stents in the First Affiliated Hospital of Kunming Medical University, becoming the beneficiary of centralized coronary stents in Yunnan. In recent years, with the national centralized procurement, the prices of many high-value medical consumables, including coronary stents, have decreased significantly, reducing the medical burden of patients. "Price reduction" has become the key word of national "group purchase" drugs and high-value medical consumables. So, how about the efficacy and safety of selected drugs and high-value medical consumables collected at low prices? The State Food and drug administration takes the quality supervision of products selected in centralized procurement as the top priority of drug supervision, and establishes a green channel for the registration application of generic drug consistency evaluation. By the end of 2021, 693 varieties had passed the consistency evaluation. In terms of strengthening the quality supervision of centrally selected drugs and high-value medical consumables, the State Food and drug administration has gradually realized the traceability of the whole process after the listing of centrally selected drugs, and listed the products such as coronary stents and artificial joints as the focus of quality and safety risk investigation and management. "Up to now, according to the results of product sampling and adverse reaction monitoring, no quality abnormality has been found in the selected varieties of national centralized mining." Li Maozhong, head of the drug administration department of the State Drug Administration, said. In the intelligent consumables management cabinet of Fuwai Hospital of the Chinese Academy of Medical Sciences, rows of selected coronary stents are orderly discharged. "Basically, most of the mainstream products we use are within the scope of bidding." Yang Weixian, vice president of Fuwai Hospital of the Chinese Academy of Medical Sciences, said that centralized mining has little impact on the continuity of the overall operation. According to the survey results of Fuwai Hospital, centralized procurement has no significant impact on doctors' diagnosis and treatment behavior, and the satisfaction of discharged patients with coronary heart disease is still 99%. How to get through the selected products of "low price and high quality" to enter the "last mile" of medical institutions? In the list of drugs used by medical institutions, the National Medical Insurance Bureau, together with relevant departments, guides all localities to give priority to the selected drugs collected by the national organization, and further promotes the use through prescription review, spot check, drug monitoring and other measures. Tianjin and other places have clearly stipulated the indicators of the proportion of drugs used by the state to organize the centralized purchase of winning bids in the performance appraisal system of secondary and tertiary public hospitals, so as to guide and strengthen the use of drugs used by the state to organize the centralized purchase of drugs. Experts suggest that relevant procedures can also be set in the doctor's prescription information system to encourage doctors to give priority to issuing the winning drugs of centralized procurement organized by the state. For the priority allocation and use of high-value medical consumables, Wang Xuetao, head of the drug administration department of the National Health Commission, said that the National Health Commission will further standardize the clinical use of devices, including consumables, and standardize the operation of centralized procurement of consumables to ensure medical quality. "The national medical insurance bureau does not conduct centralized procurement independently of medical institutions." Chen Jinfu said that medical institutions are the main body of centralized purchase and use, and the demand is determined by medical institutions according to the actual use demand, so as to fully ensure that medical institutions give priority to the use of bid winning products. Inter provincial procurement varieties shall be incorporated into national mining as appropriate to further stimulate enterprise innovation It is reported that the provincial alliance is the main body of centralized mining. For some large varieties or areas where centralized mining reform is difficult, the form of centralized mining mainly takes the form of "national organization, alliance procurement and platform operation". In the future, there will be more and more bidding varieties of inter provincial alliance, and it will become the mainstream trend. Then, will the varieties collected by inter provincial alliance be considered into the centralized collection of national organizations? The national medical insurance bureau gave a clear answer: the varieties purchased by the inter provincial alliance will not be included in the centralized purchase of national organizations. After the exploration of inter provincial alliance, if the total number of varieties is small and the competition pattern is insufficient, the state will "sell" and let more collective dividends be promoted nationwide. "The speed of promoting centralized purchase is still relatively fast." Chen Jinfu said, however, in regional and provincial alliances, there are also cases where the local people's rate of return has been carried out is high, and the price of corresponding varieties cannot be reduced in areas that do not participate in the alliance. In this regard, the National Medical Insurance Bureau will also gradually promote other provinces to follow up the varieties that have been intensively purchased, so that the coverage of reform dividends can be rapidly extended to more regions. In 2022, the National Medical Insurance Bureau will guide local governments to promote centralized mining around large varieties and common diseases according to clinical needs, and strive to achieve more than 100 provincial centralized mining varieties in each province, and cover 5 varieties of high-value medical consumables. Over the past three years, the state has organized the centralized collection of drugs and consumables with large clinical dosage and falsely high price to carry out accurate "targeted treatment", which not only solves the problems of difficult and expensive medication for patients, but also has a positive "catfish effect" on the development of the pharmaceutical industry. According to the data of the National Medical Insurance Bureau, the sales expense rate of the winning pharmaceutical enterprises showed a downward trend after centralized mining, and the R & D expenses of some enterprises, especially the leading enterprises, gradually increased. From the early "4 + 7" lowest price bid winning to the second and third batches of relaxing the competition pattern and appropriately maintaining the competition rate, the continuously improved centralized procurement rules are like a "baton", focusing the innovation attention of enterprises on the areas of real needs of patients and medical institutions. Ying Yazhen, vice president of the National Medical Security Research Institute, said that the volume procurement system is following the market law, coordinating the industrial development strategy, cultivating the development capacity of the innovative drug industry and promoting the high-quality development of the pharmaceutical industry. "We do not pursue the lowest price, and we are firmly opposed to running bidding." Chen Jinfu said that centralized procurement is to set rules according to specific varieties, competition pattern, volume ratio and other factors. Next, it will strengthen the role of supply, quality, credit and other related factors, purify the ecological environment of pharmaceutical circulation from the perspective of system and mechanism, and encourage enterprises to promote the regulation of the circulation industry through standardized competition. Standing at the new "crossroads" of reform, the National Medical Insurance Bureau will continue to promote the balance retention policy. According to institutional regulations, part of the medical insurance funds saved by centralized collection will be retained by medical institutions for the incentive of doctors and the embodiment of the value of technical labor services. "Cutting off the gray interest chain of pharmaceutical consumables is the 'first knife' of medical reform." Zhan Jifu, director of the Standing Committee of Sanming Municipal People's Congress in Fujian Province, said that the price reduction space realized by centralized mining will free up the "old cage" for improving the sunshine income of medical staff and reducing the medical expenses of ordinary people, and remove the "root cause" of "supporting doctors with medicine" in the past. (Xinhua News Agency)