药价谈判制度呼之欲出

A law enacted January 1st of this year meant to move drug pricing from the purview of the government is getting a dose of reality on the latest proposals to carry out the reform. In November of the last year, the National Development and Reform Commission (NDRC) created a reform plan which stated the government would stop setting factory prices and retail price caps for drugs. Following up on this, the National Health and Family Planning Commission has recently drafted a proposal for a trial program to create a committee for price talks between health care administrators and drug makers. Sources close to the commission told Caixin that the State Council is considering the committee plan after several central government ministries discussed the matter. Taking the prices of drugs in Hong Kong, Macau and Taiwan as a benchmark, the commission said the pilot will begin with negotiations over expensive patented drugs manufactured by only one company. Prior to this, China’s drug pricing system was overseen by three levels of administration: the NDRC in charge of prescription drugs in the insurance catalogue, provincial governments for OTC medicines, and local governments were permitted to add or eliminate 15 percent of drugs in the insurance catalog. An analyst who asked not to be named expressed pessimism on moving the pricing mechanism to the health commission, saying that increasing access to affordable drugs will have to address relationships between doctors and pharmaceutical companies. The long-standing practice of bribery by companies to doctors will mean that doctors may still refuse to use less expensive drugs. For Caixin Online, this is Diana Bates. 该《方案》提出“建立国家药品价格谈判指导委员会”，对药品实行价格谈判，旨在“降低药品虚高价格”、“预防和遏制药品购销领域腐败行为、抵制商业贿赂”。 《方案》称，“重点将肿瘤用药、心血管用药、儿童用药、中成药和公共卫生用药中的专利药品和独家产品纳入谈判范围，积累经验，逐步扩大谈判药品类别和品种数量。” 因此，以原研专利药为主的跨国药企将受此政策影响。 同时，《方案》提出要建立国家和地方两级药价谈判机制，不同类别的专利药和独家生产药品会有不同的办法谈判。将运用医保支付标准、纳入公共卫生服务、医疗市场份额等政策策略，采取量价挂钩、单一货源、买赠结合、打包议价、税价联动等方式，实现谈判效果最大化。 具体来说，对于临床用专利药品，将参照港澳台以及其他国家药品价格，结合医院用药数量，依托卫计委预算管理医院、省级医院、高校附属医院及部队医院用药数量“以市场换价格”，谈采合一，在国家层面由专业谈判委员会议定采购价格。 而对于公共卫生专利药，将借鉴艾滋病、结核病等用药纳入重大公共卫生项目采购，带预算谈判、带量谈判、集中采购、集中配送、定点机构、定人使用，由中国疾病控制中心谈判议定采购价。 此《方案》是国家发改委推出放开药品价格管制改革之后，对整个药品市场影响重大的又一行业政策。专利药、独家药等缺乏竞争的药品价格较高，尽管各省多年的药品集中招标采购都没能降低这些药品的价格，但仍然面临国家发改委最高零售价的“天花板”。如今最高零售价的限制解除，业界认为谈判制度的确立意味着压药价的重任又落到了卫计委头上。 一位资深药界业内人士则表达了担忧，直言“不看好”。他认为，以前专利药、独家药定价权掌握在国家发改委手上，现在发改委要放开绝大多数药品价格管制，而卫计委担心放开管制药价没人管，就想来管，“一个想放权，一个想扩权”。 该业内人士对财新记者指出，建立这一谈判机制“不可能达到药价降低效果，不相信卫计委的价格谈判和定价水平会高于国家发改委。”他认为，发改委管价格管了几十年，专业性更强。但价格司司长出事也正是因为这些专利药、独家药，不会因为普通药出事。“谁都知道这块权力很大，企业们都盯着。”