How to Evaluate Drug Procurement Reform’s Effectiveness? (AI Translation)

【周刊提前读】医药集采行至中场 如何评价效果？下半场如何优化？

The "4+7" city pilot program initiated China's centralized volume-based procurement for pharmaceuticals and medical consumables in late 2018, greatly impacting the industry by mandating significant price reductions and market share realignments.[para. 1][para. 3] Over five years and 13 procurement batches, the initiative aimed to curtail pharmaceutical and consumable prices, achieving an average price cut of 53% for medicines and 82% for medical consumables, like coronary stents. This was achieved through "soul-bargaining" efforts that brought stent prices down from over 10,000 yuan to below 1,000 yuan.[para. 1][para. 2]

A crucial intention behind centralized procurement is structural reform in public hospitals, leveraging saved costs to adjust medical service prices, personnel salaries, and more.[para. 2] The strategy emphasizes maximizing the strategic purchasing value of medical insurance, reflected in initiatives like improved incentive mechanisms for medical institutions and refined procurement reporting and prioritization practices.[para. 3][para. 4] Despite these objectives, hospitals struggle to implement specific plans and might misallocate funds for operational deficits, reducing incentives to utilize procured items.[para. 3][para. 4][para. 5]

In its sixth year, the expanded scope of group purchasing now includes previously untouched areas like biosimilars and in vitro diagnostic reagents. Provincial inter-regional alliances handle new extensions, tackling challenges like maintaining market stability, price level stability, and clinical medication stability amid varying renewal outcomes and potential fragmentation risks.[para. 5][para. 6][para. 7] Completion rates for centralized procurement form part of hospitals' performance metrics, sometimes leading to underreporting and deliberate understatement of drugs needed to avoid penalties.[para. 8][para. 9][para. 10]

Throughout this process, multinational companies have retracted from aggressive price reductions during group procurement phases,[para. 11][para. 12] pointing to long-term concerns over profitability and the loss of business appeal prevalent in past price-cutting strategies.[para. 11][para. 12] However, for many pharmaceutical companies, navigating the complex, regularly revised procurement landscape has stirred notable industry reshuffles, showcasing the challenges of meeting regulatory demands juxtaposed against achieving competitive pricing and product quality.[para. 12][para. 13][para. 14]

Moreover, centralized procurement has inadvertently driven some patients to report difficulty accessing original brand drugs due to increased generic usage. The reform's pressure to meet centralized selection targets alters clinical drug use structures, making original drugs less affordable and/or accessible to patients regardless of personal or clinical preference.[para. 14][para. 15]

The issue of patient choice under collective procurement reflects the core challenge of balancing cost, access, and quality. Consistency evaluations, although a fundamental requirement, lack long-term and detailed post-market studies to effectively assure generic drug quality similar to original products.[para. 15][para. 16] Efforts to initiate rigorous testing and consistent evaluation standards may provide more comprehensive data to balance costs and efficacy, allowing patients better decision-making opportunities based on clinically reliable evidence rather than just price considerations.[para. 16][para. 17]

Moving forward, the focus shifts toward optimizing procurement rules to better accommodate quality alongside pricing, potentially involving scaling reward mechanisms for superior quality, efficacy, and innovation value.[para. 17][para. 18][para. 19] Additionally, forming an integrated strategic plan in alignment with health insurance payment adjustments, fostering fair competition and transparent pricing, becomes critical to sustaining the initiative's ongoing practicality and addressing stakeholder reservations.[para. 20][para. 21]