Research on the implementation of the base medicine system: The dispute over the distribution of base medicines has given rise to a unified national standard

Business News Agency September 2 hearing: “The implementation of the basic drug system is very concentrated for commercial companies. Many of the original first-tier merchants are not eligible for distribution. Qualified may not necessarily have the ability to develop terminal and distributor channels. Also began to shrink, now is the stage of change." In the "Pharmaceutical Economics" "Basic Drug System Implementation Pathway Research" Jiangxi station, the general manager of Huiren Pharmaceutical Ding Chenchang told reporters.

Obviously, in the first year of the implementation of the basic medicine system, the pharmaceutical industry will bear the brunt of the central government procurement and distribution disputes. For the pharmaceutical commercial circulation field, due to the concentration of national policies and government will orientation, the provinces “preferred” large companies in the selection of pharmaceutical distributors, which has a great impact on the pharmaceutical business structure. According to the reporter’s understanding, as the issue of the procurement and distribution of basic medicines has become increasingly prominent, the Ministry of Health is proceeding to formulate the “Opinions on Purchasing and Distribution of Essential Drugs.” It is said that the unified national standard for the procurement and distribution of this base medicine will be introduced at the end of this year.

Jiangxi-based drug distribution "2+1" dispute

Since the promotion of the basic medicine system for more than six months, the distribution pattern of Jiangxi Jiji Pharmaceuticals has been highly concentrated in the two provincial distributors of Huiren Pharmaceutical and Jiangxi Nanhua Medicine, which are the top two “bossies” of pharmaceutical circulation in Jiangxi Province.

The reason for the high concentration is that the Jiangxi-based drug distributors choose the “2+1” plan, and each city can choose two provincial distributors and one local distributor to distribute the base drug to the pilot township hospitals.

On November 20, 2009, Jiangxi Province promulgated the "Jiangxi Provincial Implementation Plan for the Establishment of a National Essential Drug System (Interim)", and on December 1st took the lead in launching the implementation of the National Drug-based Pilot Project. According to the implementation plan, by the end of December 2009, all the government-sponsored community health service agencies of the 491 township hospitals and the three cities of Pingxiang, Xinyu and Yingtan in the province will implement the base medicine system.

On December 14, the Jiangxi Provincial Bureau of Drug Bidding and Purchasing Leading Group issued an accompanying “Detailed Implementation Rules for the 2009 National Essential Drug Centralized Purchasing and Distribution Enterprises in Jiangxi Province” (hereinafter referred to as “Implementation Rules”).

The requirements of the “Implementation Rules” are obviously toward large enterprises: In addition to basic conditions such as “Pharmaceutical Licenses”, management systems, and distribution capabilities, distribution companies also stipulate that: The total pharmaceutical sales in the previous year exceeded 200 million yuan or more." "Logistics facilities and equipment, storage area is not less than 5,000 square meters (cold storage is not less than 100 cubic meters)", "Distribution network can cover township health centers in distribution service areas ( And other conditions for the establishment of a community health service agency; the company responsible for the establishment of drug distribution companies within the district and city must also have “a total of more than 30 million yuan in drug sales in the previous year's drug wholesale enterprise”, “the logistics facilities and equipment, and the storage area is not less than 2,000 square meters (cold storage is not less than 50 cubic meters), covering not less than 4 vehicles in the distribution area of ​​the jurisdiction and the distribution network covering the service area.

In accordance with the "Implementation Rules," 10 provincial-level distribution companies will be selected from companies that meet the requirements for provincial-level distribution registration. Each of the regional-level cities will be selected as three successful companies, among which provincial-level companies There are two distribution companies and one city-level distribution company, namely, the “2+1” model of general information.

The Jiangxi Province-based drug distribution regulation means that Jiangxi's 255 pharmaceutical wholesalers have already had a large number of “deaths and injuries” in the drug-based distribution market. Wang Wei, director of the Drug Market Supervision Department of the Jiangxi Food and Drug Administration, told reporters that there are 255 drug wholesalers in the entire Jiangxi drug market between 6 billion and 8 billion yuan, and there are more than 70 non-corporate units.

Distribution is too concentrated and there are drawbacks

In fact, the distribution of too concentrated Jiangxi is not a case. In the implementation process of the provinces and cities, the basic medicine system has more or less exhibited a situation in which distributors are concentrated: The distribution of Beijing community hospitals is highly concentrated in Beijing Pharmaceutical Co., Ltd., Shanghai. The biggest winner of the municipal community hospital distribution is Shanghai Pharmaceuticals Co., Ltd., Shandong Pharmaceutical Market, where Weifang-based drug distribution focuses on Shandong Haiwang and so on.

The use of administrative measures to promote the distribution of base medicines has triggered similar incidents like “booking”. In June, Chongqing’s Yubei District Court held a public hearing to hear that Chongqing Tiansheng Pharmaceutical Co., Ltd. filed a case against the Chongqing Municipal Health Bureau to push the contradiction between the industry and the local government on the basis of drugs to the peak.

“In fact, we have no objection to concentration. Large companies have the most strength in the distribution of base medicines. As long as they can ensure the distribution and quality of the base medicines, they can ensure the reduction of drug prices and the benefits for the people. Why can't they concentrate on large companies?” Qi Hongwu thinks so. His point of view also represents the views of many big pharmaceutical businesses.

Many small and medium-sized pharmaceutical commercial companies have different voices: Large enterprises still lack the distribution capabilities of primary hospitals, which is not conducive to the distribution of basic medicines, and SMEs have already done a good job in the pharmaceutical distribution market of primary hospitals in various regions. Well, how companies survive after being deprived of their qualifications for distribution.

From the investigation of Guangdong and Jiangxi provinces by this reporter, there are also many problems in the distribution of essential medicines. The phenomenon of “second tendering” and “government changing market share” is more common.

Ding Chenchang reported to reporters that in some counties in Jiangxi, distributors had “second tender”. "Two plus one, there are still three distributors, the county health bureau let you 3 to let, who is much more profit distribution." And this situation, also appeared in Xiaolan Town, Zhongshan, Guangdong, commercial companies largest nonprofit The variety reached 28 points. The gross profit rate of basic drug distribution is generally only 5 to 8 points.

“Basic drug distribution has the characteristic of 'oligopoly distribution'. Some local governments use market share for low prices, forcing commercial companies to make profits, and commercial companies to squeeze upstream. How can production companies guarantee quality?” Hui Ren Group Human Resources Director Xiong Xiaoming To cite an example: Cephradine is packaged at 0.25g/24 capsules, and the market price is more than three, but raw materials, capsules, and production add up. This price is not enough for production costs.

" Of the 307 varieties of the National Drug List, 23 manufacturers are currently involved in the oral administration of chloroquine, primaquine, amitriptyline, etc., procaine, acetamide, anti-rabies serum, and anti-venom serum injection, etc., since the manufacturers do not submit bids. Variety, Nanhua can not be assigned to township hospitals.” Xu Guobao, deputy general manager of Jiangxi Nanhua Pharmaceutical Co., Ltd., told reporters.

Xu Guobao believes that the reason why manufacturers do not bid is because the bid price is too low, or the actual transaction price is too low, which leads to the “price upside down.”

From this point of view, the various drawbacks that exist in the centralized bidding and procurement of medicines are also inevitably appearing in the distribution and procurement of pharmaceuticals. These disputes also reflect the industry's expectation of a unified national "pharmaceutical procurement advice". How to ensure that medicines are distributed according to quality and quantity, taking into account fairness, has become a difficult issue for policy makers.