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OBJECTIVE To evaluate the efficacy， safety and cost-effectiveness of generic drugs and original drugs of voriconazole. METHODS The information of patients who used voriconazole generic drugs selected in National Centralized Drug Procurement （generic drug group） or non-selected original drugs （original drug group） in the treatment of fungal infection was collected from the our hospital. The propensity score matching was carried out to eliminate bias. The comprehensive efficacy was evaluated according to clinical efficacy， image findings and microbiological test， and stratified analysis of different populations was conducted based on fungal species， underlying diseases， etc.， the efficacy of different stratifications was evaluated. Evaluation of safety was performed by using the incidence of adverse reactions. The total cost， defined daily doses （DDDs） and defined daily dose cost （DDDc） were used to evaluate the cost-effectiveness. RESULTS A total of 436 patients were included， and there were 190 patients in each group after matching. In terms of efficacy， the effective rates of voriconazole generic drugs and original drugs were 62.63% and 59.47% （P＝0.528）； in terms of safety， the incidence of adverse reactions caused by generic drugs and original drugs of voriconazole was 13.68% and 7.89%， respectively（P＝0.069）. In terms of cost-effectiveness， the average total cost of generic drugs was 4 636.26 yuan， and that of original drugs was 8 613.20 yuan （P＜0.001）. After the implementation of National Centralized Drug Procurement， replacement rate of generic drugs increased to 87.30%， and DDDc decreased by 59.08%. CONCLUSIONS The efficacy and safety of voriconazole generic drugs are similar to those of original drugs in the treatment of fungal infection， and it is more cost-effective in terms of treatment cost.
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OBJECTIVE To analyze the current situation of pediatric drug use under centralized drug procurement， and to provide reference for the subsequent design of pediatric drug centralized procurement rules. METHODS The comparative analysis method was used to analyze the problems in the centralized procurement， clinical use and supply of pediatric drugs from the aspects of centralized procurement selection results and actual use of pediatric drugs， price difference and online prices of pediatric drugs. The solutions were put forward to optimize the centralized procurement and pricing rules of pediatric drugs. RESULTS & CONCLUSIONS The demands for pediatric drugs in China were increasing， but the supply of marketed pediatric drugs was insufficient （including insufficient coverage of disease fields， insufficient varieties， insufficient suitable dosage forms for children， insufficient specifications for children， etc.）， and the development of pediatric drugs was relatively difficult. After merging the dosage forms of centralized procurement according to the medical insurance list， some suitable dosage forms and specifications for children couldn’t be selected， resulting in a shortage of clinical pediatric medication. Relevant enterprises’ enthusiasm for developing and producing pediatric drugs and participating in online competitions had decreased. There was also the problem of underpricing of pediatric drugs under the drug price difference ratio rule. It is recommended that when conducting centralized drug procurement， special drugs for children should be grouped separately for centralized procurement based on attributes and the population covered by the indications. The specifications of suitable pediatric drugs that were not selected are converted into the agreed purchase quantity of medical institutions in a certain proportion. It is necessary to further optimize the pricing rules for pediatric specialized drugs， ensure a certain profit margin for such drugs， increase the willingness of production enterprises to research， develop and supply drugs， and thus ensure the use and supply of pediatric drugs.
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OBJECTIVE To analyze the effects of the national centralized drug procurement （NCDP） policy on drug availability and the structure of drug use in public hospitals. METHODS Using hypoglycemic， lipid-lowering， antiviral drugs， and psychiatric drugs for the treatment of mental illness and depression as objects， the interrupted time series model was used to quantitatively evaluate the changes in consumption sum of drugs， consumption amount and daily cost of the target drugs in national sample hospitals as well as the changes in per capita medication frequency， outpatient prescription amount， and medical insurance surplus of target drugs in a third grade class A hospital before and after the implementation of NCDP policy. RESULTS After the implementation of the NCDP policy， the volume for the four bid-winning drugs increased significantly （P＜0.01 for the remaining three categories except for hypoglycemic drugs）， but DDDc （P＜0.01） and the amount of related drugs （P＜0.001） decreased significantly. The volume for the non-winning drugs （except for lipid-lowering drugs） decreased significantly （P＜0.05）， and DDDc also decreased significantly （P＜0.05 for other 3 categories except for psychiatric drugs）； the volume （P＜0.01） and DDDc （P＜0.01 only for psychiatric drugs） for alternative drugs all increased except for antiviral drugs. The structure of drug use for different drugs was affected differently by the NCDP policy，and that of hypoglycemic drugs was affected obviously； the proportion of alternative drugs increased after centralized procurement. The outpatient prescription amount of each hospital significantly decreased after centralized procurement，and the decrease in the cost paid by the patients using lipid-lowering and antiviral drugs related to centralized procurement was greater than 0.60； the remaining medical insurance amount for bid-winning drugs was approximately 1.252 5 million yuan. CONCLUSIONS NCDP policy effectively alleviates the burden of medical expenditure and also drives the structure changes of drug use such as the substitution of generic drugs for original drugs， the growth of the volume of alternative drugs.
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OBJECTIVE To systemically sort out the main practices of local drug online procurement， so as to provide reference for national and local governments to improve drug online procurement policies and drug price formation mechanism. METHODS By searching the official websites of 31 provincial medical security bureaus and drug-centralized procurement platforms in China， the classification methods and main goals of local drug online procurement were summarized， then the main practices of local drug online procurement were analyzed based on the main goals， and corresponding suggestion was put forward. RESULTS & CONCLUSIONS There were two classification methods of online drug procurement in each province， one is based on online or purchase methods， and the other is based on drug dimensions. Five main objectives of online drug procurement in each province are to ensure reasonable drug prices， meet clinical drug demand， ensure stable drug supply， cooperate with the implementation of drug policies， and standardize the behavior of transaction subjects. In order to achieve the five goals， each province has taken some targeted measures， but the severity of the policy varies greatly. In order to further improve the online drug procurement policy and improve the market-oriented online drug price formation mechanism， it is suggested to build the top-level design of online drug procurement， strengthen the management of the price comparison relationship of similar drugs， give full play to the monitoring function of the drug-centralized procurement platform and establish a national unified drug-centralized procurement platform.
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Centralized drug procurement in large quantities is a major step to deepen the medical and healthcare system reform, to improve the mechanism of drug price formation, and to give full play to the role of medical insurance in guiding drug prices in China. Combined with the practice of centralized drug purchasing in public hospitals, the authors sorted out the practical problems and causes from four aspects which affected the implementation of centralized drug purchasing policy in public hospitals: selection on centrally purchased drugs, procurement and supply, clinical use, and hospital financial operation. On this basis, suggestions were put forward to provide reference for the normalization of centralized drug procurement work, such as coordinating national and regional drug collection policies, reasonably setting distribution costs, extending the agreed procurement period, and carrying out special evaluation for drug collection.
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OBJECTIVE：To put forward policy suggestions for the adjustment and reform of centralized drug procurement mode in China. METHODS ：The evolution process of centralized drug procurement mode in China was reviewed ，and problems were found through literature research and expert interview. Combined with the experience of drug procurement platform construction，GPO procurement and medical insurance payment control fee management in the United States and Singapore ，the reform suggestions were put forward for basic model assumption of bidding procurement based on cost control target and drug bidding procurement policy. RESULTS & CONCLUSIONS ：China’s drug bidding procurement system has gone through the stages of unified purchase and marketing ，decentralized procurement ，centralized procurement start-up and adjustment ，comprehensive implementation of online centralized drug procurement ，exploration of the integration of “two bidding ”（bidding for essential medicine and bidding for non-essential medicine ）and joint procurement ，and pilot stage of national drug bidding and procurement. At the present stage ，there are many problems in centralized drug procurement ，such as the diversified subordination relationship of the platform ，the possible monopoly of enterprise selection under the policy of “two invoice system ”，price reduction becoming the core performance index of bidding procurement ，and the suspected monopoly operation of GPO procurement exploration. The model analysis based on the goal of cost control shows that drug cost is a function of efficiency ，drug quantity and price. High price leads to high cost ，while low efficiency leads to high cost. In the future ，the goal of drug bidding and procurement should not only foucs on price control ，but also on efficiency. The function of bidding and procurement will return to the essential function of “price for quantity ”. It is suggested that a relatively independent and unified platform should be established for drug bidding and procurement in China ，and the grouped procurement mode should be gradually standardized ，the expenditure control function of medical insurance payment audit should be exerted instead of simple price reduction ，and absolute unified lowest price procurement should be avoided.
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In this study, the evolution of the centralized drug procurement policy and the logical relationship between drug procurement policy and medical insurance payment policy were explored by means of policy and literature review.This paper first examined the three stages of the centralized drug procurement policy, and especially analyzed the characteristics and trends of the current centralized bidding of drugs.Focus was put on the relationship of between the centralized drug procurement and medical insurance drug payment were then explored, and the practical feasibility to solve the drug problem with the help of supporting reforms of the above two systems.As a result, the study found that centralized drug bidding procurement has evolved into negotiation and the lowest price linkage procurement method under the price control of the provincial platform and it could also provide the basis for the formation of medical insurance payment standard of generic drugs.But the functions of National Drug negotiations and the Provincial Health Insurance negotiations overlapped.Fortunately, the drug bidding procurement, medical Insurance payment and other related institutional arrangements could promote the separation of pharmacy from medicine which is likely to provide a solution to the issue of unrealistic drug prices with the support of other coordinated sets of reforms.
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In 2015 , policy reforms on centralized drug purchasing system have been released one by one , and the quality of medicines has been highly valued .Centralized drug purchasing system distinguishes different qualities of drugs mainly through bidding grouping , in order to achieve “uality priority”.However , there are yet some existing problems in group bidding policy at present , such as lack of a unified hierarchy , no scientific indicators and so on , which inevitably weaken the leading role of centralized purchasing policy over the quality of medicines .This paper , focuses on the study of group bidding , and the existing main problems are found through the statistical analysis of rel-evant policies introduced in different provinces .Finally, it explores some optimization strategies for “Group Bidding”which is of paramount importance .
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In this research paper , we intend to come up with making proposals to centralized drug procurement in each province in China .Document consultations about drug centralized procurement in each province in 2015 were used to collect information and this information was further summarized and comparatively analyzed .From the results , it's clear that each province has designed an implementation plan based on the No .7 and the No.70 documents. When carrying out the centralized procurement , the practice on organizational structure , procurement classification , procurement with quantity , drug distribution and payment collection in each province vary from one province to anoth-er.In view of the observed results , it is worthwhile that each province should centralize its tender and procurement system , explore new ways for involving health insurance department in centralized drug procurement , implement joint reformation for public health services , medical insurance and medical production-circulation , and oppose regional protection in any form to ensure the success and equity of centralized drug procurement .
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Many stakeholders are involved in the implementation of centralized drug procurement , namely government agencies ,drug bidding or procurement agencies ,pharmaceutical companies ,medical institutions ,doctors ,patients and health care institutions among others.The game falls into three stages.The first is that between government agencies or drug procurement agencies and medical institutions or doctors ;the second is that of price negotiations between the hospital and the winner pharmaceutical enterprise ; the third is that between doctors , patients and medical insurance agencies.Major setbacks found in the implementation of such a policy are as follows :disappearance of classic inexpensive drugs from the market ;rebates and commissions in the second bargainingphenomenon ;slow progress in the implementation of the purchase with quantity indication policy ;rapid rise of medical costs for national health insurance.Recommendations by the authors include optimization of the centralized drug procurement ;improvement of the public hospital performance appraisal system and talent evaluation system ;promotion of the purchase with quantity indication policy ;building of the game pattern of equal‐footing negotiation between hospitals and pharmaceutical companies ; and introduction of the payment management of medical insurance .