Dilemma and promotion strategy of “dual channel”management policy for China’s medical insurance negotiated drugs / 中国药房

OBJECTIVE To provide reference for the smooth implementation of the “dual channel” management policy for China’s medical insurance negotiated drugs. METHODS Based on Smith policy implementation process model， the dilemmas for the implementation of “dual channel” policy for medical insurance negotiated drugs were analyzed from four aspects： implementation details and regulatory system， drug selection， drug provision and quality control， the situation of medical insurance funds and information technology capabilities. The corresponding promotion strategies were put forward. RESULTS & CONCLUSIONS The “dual channel” policy for medical insurance negotiated drugs in China might face implementation difficulties such as a lack of clear implementation rules and a full process supervision system， the suitability and operability of some medical insurance negotiated drugs need to be considered in the “dual channel” management， difficulties in drug allocation and quality control， differences in the management and operation of medical insurance funds in different regions， and insufficient informatization capability. In this regard， this study suggests that measures， such as improving the implementation rules of the “dual channel” policy， enhancing the rationality of the “dual channel” drug catalog， establishing a dynamic exit mechanism for “dual channel” pharmacies， promoting professional delivery services， and improving the electronic prescription circulation platform， which can be taken to enhance the implementation effect of the “dual channel” policy.

Landing practices of national medical insurance negotiated drugs in tertiary medical institutions of Zhejiang province / 中国药房

OBJECTIVE To provide reference for the subsequent landing of national medical insurance negotiated drugs （referred to as “national negotiated drugs”） at the provincial level. METHODS By reviewing the data publicly released by the official websites of National Healthcare Security Administration and the Healthcare Security Administration of Zhejiang Province， combined with policy documents， the descriptive analysis was conducted on the number of tertiary medical institutions， the actual allocation of national negotiated drugs， the availability rate of national negotiated drugs， the allocation rate of national negotiated drug varieties， and the allocation rate of medical institutions of various cities in Zhejiang province. The Spearman rank correlation test was used to analyze the correlation between the number of types of national negotiated drugs equipped in tertiary medical institutions in Zhejiang province and the per capita disposable income， the number of tertiary medical institutions equipped with national negotiated drugs， and the implementation time of disease diagnosis-related grouping （DRG） of various cities in Zhejiang province. RESULTS As of the first quarter of 2022， 135 tertiary medical institutions in Zhejiang province were equipped with a total of 261 types of national negotiated drugs， accounting for 94.91% of the 2021 edition of the National Negotiated Drugs Catalogue （275 types）. The allocation rates of Goserelin acetate sustained-release implant， Sacubitril valsartan sodium tablets， Alteplase for injection and other varieties were at high level， and the types of national negotiated drugs equipped were highly coincident with the top 10 causes of death with disease of urban and rural residents in Zhejiang province. The tertiary medical institutions in Hangzhou had the most types of national negotiated drugs， with 230 types， while Quzhou had the lowest， with only 34 types； allocation rate of national negotiated drugs in medical institutions of Zhoushan was the highest （100%）， while that of Lishui was the lowest （57.14%）. The types of national negotiated drugs equipped were positively correlated with per capita disposable income in various cities and the number of tertiary medical institutions equipped with national negotiated drugs （P＜0.01）， and there was no significant correlation with the length of implementation of DRG （P＞0.05）. CONCLUSIONS mail：lanyao@mails.tjmu.edu.cn The landing of national negotiated drugs in Zhejiang province is generally good， with a high rate of equipping tertiary medical institutions with national negotiated drugs and a high rate of equipping drug varieties. Therefore， it is recommended that the provincial implementation of national negotiated drugs should be multi-faceted， and policy-making departments should adopt a dual-channel of “unbundling” and “driving” to smooth the drug chain into hospitals. The health insurance sector should improve the “dual channel” management mechanism to share the pressure on hospitals to use drugs. At the same time， it should also improve the multi-level medical security system and raise the level of reimbursement of medical insurance for national negotiated drugs.

Experience and enlightenment of out-of-hospital pharmacy management under the 340B drug pricing program in the United States / 中国药房

OBJECTIVE To learn from 340B drug pricing program （short for 340B program） in the United States， and provide reference for optimizing the operation and management of designated retail pharmacies under the “dual channel” policy in China. METHODS The status quos of the implementation of out-of-hospital pharmacies under the 340B program in the United States was reviewed to summarize the experience of the management of out-of-hospital pharmacies under the program in the United States， and to propose thoughts of management and possible problems for designated retail pharmacies under the “dual channel” policy in China. RESULTS & CONCLUSIONS Out-of-hospital pharmacies under the 340B program lacked sufficient basic information and medical insurance status of patients compared to medical institutions， which easily led to duplicate discounts and drug diversion issues. Due to the separation of out-of-hospital pharmacies from the management and restrictions on the use of drugs in medical institutions， coupled with the economic incentives brought by the sale of drugs， the 340B program in the United States faced high medical expenditure and adverse selection risks for out-of-hospital pharmacies. In this regard， when China is carrying out the construction of designated retail pharmacies under the “dual channel” policy， it is necessary to clarify the selection criteria for designated retail pharmacies， enhance the financial transparency of medical institutions and designated retail pharmacies， establish a scientific prescription circulation mechanism， strengthen the review and certification of insured patients and prescriptions， and improve the supervision and management mechanism. Meanwhile， the drug sales situation of designated retail pharmacies should be reasonably incorporated into the drug use management of medical institutions， so as to achieve the availability of drugs without abuse， and effectively control costs.

Analysis and practice on the " dual-channel" management mode of national medicare negotiated drugs in China / 中华医院管理杂志

" Dual-channel" management is an important management measure to solve the difficulty of national medicare negotiated drugs entering the hospital and improve the accessibility of the drugs. China clearly included some social pharmacies into the supply guarantee channel of national medicare negotiated drugs, and formed a " dual-channel" supply mode for negotiated drugs together with the hospital supply. By sorting out China′s national medicare negotiated drugs policy management documents and the management modes and specific measures in various regions and periods, this paper summarized and analyzed the progress of process management, multi-level medical security integration, remote handling, drug safety supervision, and information construction in various regions. Based on the relevant policy guidance and local practical experience, the authors explored and optimized the " dual-channel" landing management, so as to provide reference and suggestions for further improving the accessibility of national medicare negotiated drugs and giving full play to the effectiveness of medical security.

Research on Dual-channel Pricing Strategy of Pharmaceutical Retailing Considering Medical Insurance Payment Policy / 中国药房

OBJECTIVE：To provide reference for the drug retailers when making dual-channel pricing decisions in China. METHODS：Based on the analysis of the existing literature and the characteristics of drug supply chain ，taking the dual-channel drug retailers as the research object ，the effects of medical insurance payment policy ，consumers’risk aversion factor and inconvenience cost on consumers ’decision-making behavior were considered ，and dual-channel pricing strategy model for drug retailers was constructed. The reverse induction method was adopted to analyze and solve the model ，obtain the optimal pricing and optimal profit function of the drug retailer. The numerical simulation was adopted to simulate and analyze the effects of consumer medical insurance payment utility ，risk aversion factor and inconvenience cost on drug retailer dual-channel pricing and profits. RESULTS：When the utility of medical insurance payment increased ，the pricing of drugstores and the total profit of dual-channel of drug retailers would increase ；while consumers ’risk aversion factor and inconvenience cost showed a U-shaped trend with retailer ’s dual-channel total profits. In addition ，compared with existing e-commerce platforms ，retailers could make more profits by building their own e-commerce platforms. CONCLUSIONS ：Medical insurance payment policy has a great impact on the profits of dual-channel drug retailers. Drug retailers should continue to pay attention to the trend of relevant national policies and ensure their own profits by adjusting pricing in time. When medical insurance payment utility is in low level ，dual-channel drug retailers can ensure market demand by reducing the retail price of drugstores ，and should use flexible sales strategies to attract consumers. For consumers’risk aversion and inconvenience cost ，drug retailers can adopt strategies such as providing distribution services for consumers with high inconvenience cost.

Application value of dual channel dual curved endoscope in the endoscopic submucosal dissection for gastric angle mucosal lesions / 中华胃肠外科杂志

Objective@#To evaluate the clinical value of dual channel dual curved endoscope in the endoscopic submucosal dissection (ESD) for gastric angle mucosal lesions.@*Methods@#A descriptive cohort study was carried out. Clinicopathological data of 20 cases with gastric angle mucosal lesions undergoing ESD by dual channel dual curved endoscope in our center from October 2016 to August 2018 were collected and analyzed retrospectively. Inclusion criteria: (1) the lesion was located in the gastric angle confirmed by gastroscopy before ESD. (2) CT examination showed no distant metastasis. (3) pathological biopsy confirmed precancerous lesion or early cancerous lesion without submucosal invasion. (4) the whole operation was performed by the same endoscopist with ESD experience of about 2000 cases. Patients with previous ESD history of gastric angle and other serious diseases were excluded. The dual channel dual curved endoscopy (Olympus, GIF-2TQ260M) and other conventional endoscopic surgical instruments were used in all the cases. Complete tumor resection rate, pathological results, intraoperative and postoperative complications, operation time and hospitalization time were observed. Follow - up parameters included residual tumor, local recurrence and heterogeneous lesion.@*Results@#Of 20 patients, 14 were male and 6 were female with an average of 55.6 years (range, 37 to 75). All the tumors located in gastric angle. Specimen size ranged from 1.2 to 5.5 (average 2.9) cm. Operation time ranged from 50 to 120 (average 85.8) minutes. Hospital stay ranged from 3 to 7 (average 5.1) days. The en bloc excision was performed successfully in all 20 cases. There was no perforation or bleeding during or after operation. Pathological results showed curative or nearly curative resection stage in all the cases. No tumor residual or recurrence was found during follow-up for 8 to 30 (average 18.5) months.@*Conclusion@#Dual channel dual curved endoscope can provide good vision and easy control in removing the lesion completely and avoiding complications during the ESD procedure in gastric angle mucosal lesions with good long-term efficacy.

Effect analysis of cataract surgery with transparent corneal incision in different direction by dual channel vision quality system / 眼科新进展

Objective To investigate the effects of cataract surgery with transparent corneal incision in different directions,and discuss the application of dual channel visual quality analysis system in the evaluation of visual quality before and after cataract surgery.Methods Sixty-four patients (64 eyes) with cataract phacoemulsification combined with intraocuiar lens (IOL) implantation were enrolled in our hospital from January to May in 2016,and randomly divided into 2 groups:Group A with corneal incision in the temporal side of the eyes,group B with upper corneal incision.All the cases were examined with standard logarithmic optical acuity and dual-channel optical quality analysis system.The visual acuity,MTF cutoff,Strehl ratio (SR),objective scattering index (OSI) and contrast ratio were compared between the two groups.The OQAS values were 100％,20％ and 9％.Results (1) The visual acuity and corrected visual acuity of all patients increased gradually from postoperative 1 day to 1 week (P ＜0.05),and the visual acuity gradually stabilized after 1 week.The uncorrected visual acuity and corrected visual acuity at postoperative 1 day and 1 week in group A were significantly higher than those in group B at the same time point(P ＜ 0.05).There was no significant difference in uncorrected visual acuity and corrected visual acuity between the two groups at postoperative 1 month and 3 months (P ＞ 0.05).(2) At postoperative 1 day and 1 week,the OSI values of two groups were higher than those before operation,and all the time points were statistically significant (all P ＜ 0.05).The OSI values of group A at postoperative 1 day(2.81 ±0.89) and 1 week(1.98 ±0.73) were significantly lower than those of group B at 1 day(3.46 ± 1.17) and 1 week(2.61 ± 1.20) (all P ＜ 0.05).There was no significant difference in OSI between postoperative 1 month and 3 months (all P ＞ 0.05).The OV9％ values of the two groups were increased at postoperative 1 day,1 week,1 month and 3 months,and all the time points were statistically significant(all P＜0.05).The value of OV9％ in group A at postoperative 1 day(0.29 ±0.09),1 week(0.33 ±0.12),1 month (0.37 ± 0.14) and 3 months (0.42 ± 0.17) were significantly higher than those in group B at 1 day (0.24 ± 0.10),1 week (0.27 ± 0.09),1 month (0.31 ± 0.09) and 3 months (0.34 ± 0.14),which was statistically significant (all P ＜ 0.05).The MTF,SR,OV100％ and OV20％ values of all the patients were not statistically significant (all P ＞ 0.05).Conclusion In the operation of cataract with the temporal and transparent corneal incision,the postoperative intraocular scattering is small,early visual recovery is fast and the visual quality is high.The long-term effect needs further study.Dual channel visual quality analysis system can further quantify the visual quality parameters,has certain advantage in visual quality assessment.

Dynamic changes of blood flow in frontal cortex of diabetic rats / 中国药理学通报

Aim To investigate the changes of cerebral blood flow in rats with diabetic cognitive impairment by two-channel laser Doppler flowmeter,and to explore the changes of cerebral blood flow in diabetic rats with cognitive impairment and to investigate the changes of cerebral blood flow lesions and the central nervous system function changes in the study to provide pre-foundation.Methods Thirty-four male Wistar rats were randomly divided into two groups:blank control group and diabetic model group.The rats in the model group were treated with streptozotocin (STZ) 60 mg · kg-1,and the glucose oxidase method was used to determine fasting blood glucose ≥ 16.7 mmol · L-1 as the standard of the model.The Water maze was used to observe the behavioral changes of diabetic rats.Dual-channel laser doppler flowmeter was used to measure cerebral blood flow in diabetic rats with cognitive impairment.Another 34 male Wistar rats were randomly divided into two groups:control group and diabetic model group.Dual-channel laser doppler flowmeter was used to dynamically monitor cerebral blood flow on 0 d,7 d,14 d,21 d,28 d,35 d,42 d,56 d and 75 d.ELISA was applied to detect the concentration of iNOS,eNOS and ET-1 in cerebrospinal fluid.Results Morris water maze test showed that the time of the platform (latency) was significantly longer than that of the blank control group(P ＜0.05).The cerebral blood flow/100 g of diabetic rats with cognitive impairment was significantly lower than that of the control group (P ＜ O.05),and the blood flow in the model group was significantly lower than that in the model group (P ＜ 0.05).Compared with control group,iNOS and eNOS concentrations were markedly elevated,while ET-1 concentration obviously decreased.Conclusions The decrease of blood flow in the frontal cortex of diabetic rats with cognitive impairment suggests that it may be one of the factors leading to cognitive impairment in diabetes mellitus.Cerebral blood flow reduction occurs in the early stages of diabetes,followed by no significant deterioration.Cerebral blood flow may not be related to the changes of NO and ET-1,but the trend of cerebral blood flow may be related to the change of the two.