Policy Effect of the Medicines Procurement Based on Health Insurance Reimbursement Standards in Fujian Province / 中国药学杂志

OBJECTIVE: To analyze the effects of "adjusting structure and vacating space" of the transparent medicines procurement basing health insurance reimbursement standards, through comparing medicines consumption structure of health insurance designated health facilities of Fujian province. And to generate evidence as well as to propose recommendations for policy improvement and experience promotion. METHODS: Based on the 2016 and 2017 provincial medicines pooled procurement database, adopting the pivot table statistical functions of EXCEL software, the consumption value and value in proportion of Class and Ⅱ chemical products (Fujian provincial medicines procurement list therapeutic classification for chemical products), as well as active pharmaceutical ingredients, consumption value and volume (standardized units in tablet/bottle/vial) of originator and generics were analyzed and compared. The consumption value of Class formulations of traditional Chinese medicines (Fujian provincial medicines procurement list therapeutic classification for formulations of traditional Chinese medicines) was also analyzed and compared. RESULTS: Nearly 2.38 billion yuan procurement budget was saved in 2017 through adjustment of the medicines procurement list in Fujian province. There were a certain changes of the consumption structure of medicines. The procurement value of adjuvant and nutraceutical medicines dramatically reduced. The procurement value of medicines for treatment of chronic diseases like hypertension and cancers significantly increased. The procurement volume of generics started to surpass that of the originator, and showed potential competitiveness of generic substitution. However, the originator still dominated the market of quite a number of medicines. Prices of both generics and originators decreased. CONCLUSION: The effect of “adjusting structure and vacating space” has been demonstrated. Fully implementation of the health insurance reimbursement standards will make the above effect more apparent. To promote effective generic competition, Fujian should set the same health insurance reimbursement standard for originator and its generics (quality and efficacy validated) to promote generics substitution.

Compras públicas de medicamentos para hepatite C no Brasil no período de 2005 a 2015 / Public procurement of hepatitis C medicines in Brazil from 2005 to 2015

Resumo O artigo analisa as compras de medicamentos para hepatite C, feitas pelo Ministério da Saúde (MS), de 2005 a 2015. Os dados são do Sistema Integrado de Administração de Serviços Gerais (SIASG). Para estimar o gasto contratado anual selecionou-se medicamentos previstos nos Protocolos Clínicos e Diretrizes Terapêuticas para Hepatite C do MS e incluiu-se todas as apresentações e concentrações que apareceram no SIASG. Houve aumento de 159,5 vezes no gasto com os medicamentos selecionados de 2005 a 2006 porque esses produtos passaram a ser comprados de forma centralizada. Em 2007 houve aumento de 730% no gasto pela incorporação de alfapeginterferona 2a e 2b. Em 2012 a compra de dois novos antivirais de ação direta (AAD) representou 99% do gasto anual. Em 2015, a adoção de novos AAD provocou aumento de 230% (R$ 945 milhões) no gasto do MS. No período estudado houve aumento dos gastos do MS com os medicamentos para Hepatite C devido ao aumento do volume adquirido e à incorporação tecnológica de alfapeginterferona e de novos AAD. Garantir acesso universal ao tratamento da hepatite C depende da implementação de estratégias que aumentem o poder de barganha do MS em negociações de redução de preços de produtos em situação de monopólio.

Abstract This paper analyzes the Minister of Health's (MoH) procurement of medicines for hepatitis C from 2005 to 2015. Data sources were the Integrated General Services Administration (SIASG), to estimate annual expenditure for selected medicines of the MoH Clinical Protocols and Therapeutic Guidelines (PCDT) for Hepatitis C. All presentations and strengths recorded on SIASG were included. The unit prices were estimated based on the purchase with the highest volume each year. There was a 159.5 fold increase in expenditure of the selected medicines from 2005 to 2006, because procurement of those medicines became centralized. In 2007 there was 730% increase in spending due to the incorporation of pegainterferons alfa 2a and 2b. In 2012 the purchase of only two new direct-acting antivirals (DAA) accounted for 99% of total annual expenditure. In 2015 the adoption of a new DAA led to an increase of 230% (R$945 million) in MoH spending. The significant increase of MoH expenditure on medicines for hepatitis C from 2005 to 2015 was due to the increase of volumes purchased as well as the incorporation of alfapeginterferon and new DAAs. Ensuring universal access to treatment for hepatitis C will depend on the implementation of strategies that strengthen the MoH's bargaining power in price reduction negotiations with the manufacturers of monopoly medicines.

Reflection on the Legal Issues of the Pooled Medicines Procurement / 中国药房

OBJECTIVE:To provide policy recommendations for improvement of the pooled medicines procurement policy through legal analysis. METHODS:The pooled medicines procurement policies in China were reviewed and compared with related laws and regulations to analyze the problems and put forward recommendations. RESULTS:For the pooled medicines procurement policy,there were several conflicts between it and the Bidding Law,Government Procurement Law,Anti-monopoly Law and An-ti-unfair Competition Law. In terms of the pooled medicines procurement institution,there were conflicts between it and Bidding Law,Government Procurement Law. In terms of the price-volume linkage and the main body of tendering,there were conflicts be-tween it and the Bidding Law. In terms of the organization and participants,there were conflicts between it and the Anti-monopoly Law and Anti-unfair Competition Law. CONCLUSIONS:The pooled medicines procurement system should rationalize the main body of tendering,insist on volume secured procurement and price-volume linkage,establish reasonable incentive mechanism through supporting heath system reform policies,eatablish and perfect modern government principles in the field of medicines regulation. The pooled drug procurement policy should be moderately adjusted to follow the above laws in order to raise the procurement efficiency.