The Power Struggle Over Prescriptions: Where Do Patient Rights Fit In?(AI Translation)
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- In China, prescription outflow from hospitals to retail pharmacies faces challenges due to hospital control over prescriptions, economic interests, and regulatory complexities.
- Despite policy support for prescription outflow and electronic prescription platforms, progress is slow with few prescriptions actually flowing out of hospitals to pharmacies.
- The situation affects patients' access to medications, particularly innovative drugs included in national medical insurance negotiations but not readily available in hospitals.
文｜财新周刊 周信达
By Zhou Xinda, Caixin Weekly
37岁的湖北人杨福（化名）是名乙肝患者，长期服用恩替卡韦进行抗病毒治疗，但从去年开始产生了较强的耐药性，转氨酶不降反升，转而使用另一种抗病毒药物——富马酸丙酚替诺福韦片（商品名：韦立得），由美国吉利德公司生产，于2019年纳入国家医保目录。不过，杨福家附近的三甲医院药学部称“不属于我院药品常规采购目录内品种”，建议使用齐鲁制药生产的仿制药特立晖替代，或提交临时采购药品申请。
Yang Fu (pseudonym), a 37-year-old from Hubei Province, is a hepatitis B patient who has been taking entecavir for long-term antiviral treatment. However, since last year, he developed significant drug resistance; his transaminase levels did not decrease but instead increased. Consequently, he switched to another antiviral medication—tenofovir alafenamide fumarate tablets (brand name: Vemlidy), produced by the American company Gilead Sciences, which was included in China's National Medical Insurance Directory in 2019. Nonetheless, the pharmacy department of the tertiary hospital near Yang Fu’s home stated that this drug "is not within our hospital's routine procurement catalog" and suggested using Qilu Pharmaceutical's generic drug Tenofovir Alafenamide Tablets as an alternative or submitting an application for temporary drug procurement.
在医院购药无门，他辗转了近十家医保定点药店，终于找到替诺福韦片，但药店工作人员告诉他，由于拿不到医疗机构开具的处方，一瓶韦立得370元吃一个月左右，必须全部由个人掏腰包。像杨福一样卡在处方流转端，致使医保待遇打折扣的患者不在少数。IQVIA数据显示，2022年医院渠道为处方药市场贡献超70%的份额，零售药店渠道仅15%。
Unable to purchase medication at the hospital, he visited nearly ten designated medical insurance pharmacies before finally locating Tenofovir tablets. However, the pharmacy staff informed him that without a prescription issued by a medical institution, a bottle of Viread would cost 370 yuan and last about a month, with all expenses to be paid out of pocket. Patients like Yang Fu, stuck in the bottleneck of prescription circulation and consequently receiving reduced medical insurance benefits, are not uncommon. According to IQVIA data, in 2022, hospitals accounted for over 70% of the prescription drug market share, while retail pharmacies contributed only 15%.
中国的处方权长期由医院掌握。2007年原卫生部令第53号《处方管理办法》明确规定，须由注册执业医师在诊疗活动中为患者开具处方，并在执业地点取得相应处方权。卫生部门是处方的监督管理机构。处方权与注册医师执业地点严格绑定，并经过医师签章、药师审方等手续加以认定。多年来，医院开方，院内药房取药，一气呵成。
In China, the right to prescribe has long been held by hospitals. The Ministry of Health's Order No. 53 from 2007, titled "Prescription Management Measures," stipulates that prescriptions must be issued by registered practicing physicians during the course of diagnosing and treating patients, and must obtain corresponding prescription rights at their place of practice. Health departments are the supervisory and management institutions for prescriptions. The right to prescribe is strictly tied to the registered physician's place of practice and is verified through procedures such as physician signature and pharmacist review. For many years, hospitals have been prescribing medications with in-house pharmacies dispensing them in a seamless process.
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