These problems are the key to the centralized collection of Chinese patent medicines.

Source | Cyberblue

Contributed by | Fu Qingzhu

How to break the industry difficulties when the signal of centralized collection of Chinese patent medicines comes out?

On August 9, 2021, the National Medical Insurance Bureau issued the Reply of the National Medical Insurance Bureau to Recommendation No.4126 of the Fourth Session of the 13th National People’s Congress, stating that "on the basis of improving the quality evaluation standards of Chinese patent medicines and formula granules, we will adhere to quality priority, take clinical demand as the guide, and start with high-priced and large-quantity varieties to scientifically and steadily promote the centralized procurement reform of Chinese patent medicines and formula granules".

The introduction of this reply means that the procurement of Chinese patent medicines and even granules has been put on the agenda. However, as the first batch of people in China who participated in centralized drug bidding and purchasing and engaged in big data research of traditional Chinese medicine for a long time, the author is not optimistic about the procurement of traditional Chinese medicine in the short term.

Say so, we might as well stroke the train of thought:

01

What is the quantity purchase of traditional Chinese medicine?

"Drug procurement with quantity" refers to defining the procurement quantity when bidding or negotiation is carried out in the process of centralized drug procurement, so that enterprises can quote according to the specific quantity. This procurement method is also the goal that China has been striving to achieve for many years. In fact, this method is also an upgraded version of the centralized bidding and purchasing of drugs in medical institutions nationwide since 2000, which is no stranger to the vast number of pharmaceutical and medical device manufacturers at home and abroad. However, it is really a new thing for domestic Chinese medicine production enterprises, especially Chinese medicine decoction pieces enterprises.

Let’s start with the following basic definitions of popular science:

First, which Chinese medicines can be included in the quantity procurement? The "traditional Chinese medicine" that can be included in the quantity procurement mainly includes Chinese patent medicines and Chinese herbal pieces (including new-type pieces and formula granules) used in clinical practice in medical institutions.

Second, what is quantity procurement? Procurement with quantity is relative to centralized procurement, which can be understood as large-scale "group purchase" or "group purchase", that is, many hospitals form a "procurement consortium" to conduct similar "group purchase". At present, in areas where quantity procurement is implemented, the purchased products need to account for 60%-70% of the total usage, which is equivalent to a big "group purchase". Purchase with quantity, specify the purchase quantity, and the manufacturer will quote and negotiate, and the lowest price will win the bid. Enterprises can reduce the price of purchased drugs and increase the market share of products through market-oriented bidding with quantity, which is beneficial to both supply and demand sides and drug users.

Third, which institutions can carry out centralized procurement and quantity procurement? At present, it is mainly enforced in non-profit medical institutions under the supervision of medical insurance and medical and health authorities (note that it is not non-profit or non-profit). Social organizations such as retail pharmacies can also spontaneously organize "purchasing consortia" to carry out "group buying", which is referred to as "GPO purchasing" for short, but it is often not mandatory by policy.

Fourth, what does "4+7" procurement with quantity mean? It refers to the first batch of 11 pilot cities promoted by the state, including 4 municipalities directly under the central government and 7 provincial capital cities: Beijing, Tianjin, Shanghai, Chongqing, Shenyang, Dalian, Xiamen, Guangzhou, Shenzhen, Chengdu and Xi ‘an, which basically covers half of the domestic clinical drug circulation. These cities will take out more than 50% of the purchasing share every year, which has a great relationship with the market share of production enterprises and is a matter of life and death.

Therefore, once the country promotes the "4+7" or even nationwide procurement of traditional Chinese medicine, it will surely become a key event for Chinese medicine enterprises, which is expected to cause a major reshuffle of the Chinese medicine industry, and the industry must pay attention to it.

02

Why is it difficult to implement the procurement of traditional Chinese medicine for a long time?

Before answering this question, we must clarify two points:First, the centralized bidding and purchasing of proprietary Chinese medicines has been carried out around 2001, and the effect of reducing fees is very obvious, but it has not yet been included in the "4+7" procurement; Second, the centralized bidding and purchasing of Chinese herbal pieces. As early as 2001, the documents No.308 and No.309 jointly issued by five ministries and commissions in the State Council all proposed to "actively explore the centralized bidding and purchasing of Chinese herbal pieces".

However, it was not until 2018 that attempts were made in Shanghai, Gansu and other places, and the effect was not obvious; In July 2020, 12 provinces, including Shandong and Inner Mongolia, directly established a platform for the joint collection and purchase of Chinese herbal medicines, and prepared to carry out large-scale procurement activities of Chinese herbal medicines. However, the thunder and the rain are too small, and there is no more.

Why can’t centralized bidding or quantity procurement of traditional Chinese medicine products be promoted?

The apparent reason is that the overall purchase volume of Chinese medicine products without proprietary Chinese medicines is small, and the overall purchase volume of pieces of Chinese medicine in medical institutions nationwide is less than 56 billion yuan, which is only a fraction of the total purchase volume of chemicals and medical devices, and it lacks attention. But the deep-seated reason is that there are two bottlenecks, and there is no breakthrough for a long time:

The first is the standard issue.

Traditional Chinese medicine (TCM) is a practical weapon of TCM, and its personalized demand is very obvious. A large number of raw medicinal materials and even decoction pieces are agricultural and sideline products, which are non-standard products. You may say that the Pharmacopoeia has the standard of decoction pieces, but that is only the minimum quality threshold, and it can’t cover the complicated and changeable commodity circulation specifications of Chinese herbal medicines at all.

For example, 280 and 380 pieces of Lycium barbarum, Ningxia goods and Qinghai goods, new goods and old goods, although they all meet the pharmacopoeia standards, can they be regarded as the same commodity? Without a unified standard, how to divide the quality levels? If we simply use the Pharmacopoeia standard to evaluate products, it will undoubtedly lower the quality level of Chinese patent medicines and granules as a whole and destroy a large number of well-known brands of Chinese medicine.

Shanghai, Zhejiang and other places are going to separate the products using raw materials from GAP base or traceability base, but everyone in the industry knows that the construction of GAP base in China is difficult to land, and the construction of traceability base is just in its infancy. The concept is bigger than the essence. Can it be used as a criterion at this stage?

At the same time, even if you establish a commodity circulation standard, will this standard be recognized by both the supply and demand sides? How to run through the whole process of Chinese herbal medicine raw materials, Chinese herbal pieces, granules, production enterprises, products and demand side is a very difficult and grand project, which can not be straightened out by a single link.

The second is the price issue.　

The price problem is divided into three levels:

The first is how to define the cost of different quality Chinese herbal medicines. Origin, growth cycle, harvest time, content, appearance and processing technology will all affect its pricing. This problem is actually closely linked to the circulation standard and is an extension of the standard problem.

Secondly, the price fluctuation during the period of centralized mining. The nature of agricultural and sideline products of most Chinese herbal medicines leads to the reality that they still have to "eat by the sky". In the past five years, the price amplitude of Chinese herbal medicines in China has reached more than 18.5%. In August 2020, the same kind of forsythia was 55 yuan (kg price, the same below), and it will rise to 115 yuan in 2021; The raw land has skyrocketed from 11 yuan to 35 yuan. How do you let the successful bidder complete the distribution at the original price?

Allowing the price increase violates the rules of the game of winning the bid at a low price under the same quality, and how to accept the price increase basis? If the price increase is not allowed, the winning bidder will be miserable and it is very likely to lose money to perform the contract; If the roasted seeds and nuts add fuel to the fire and monopolize the raw materials of the winning products to raise the price, the enterprise will even lose the pants, and finally the severe consequences of "winning the bid is death" will not be ruled out.

More crucially, the higher the bid, the higher the price. At present, the principle of "bidding and bidding, the lowest price for supply" is generally adopted in raw material procurement of production enterprises, and all kinds of arrears and deduction of suppliers’ payment for goods have also existed for a long time, so as to minimize the cost of raw materials. If we really realize the so-called "genuine quality and conscientious processing" through centralized purchasing activities, and make the raw material sources and costs of those brand enterprises known to the world, we will inevitably face the embarrassing situation of "more recruitment and higher fees" due to the improvement of quality. Originally, centralized purchasing wanted to reduce prices and control fees, but as a result, the price of centralized purchasing rose sharply. Can the medical insurance department accept it? This is really a paradox.

To sum up, when designing the centralized collection activities of traditional Chinese medicine, the operators often fail to consider the complexity of traditional Chinese medicine products, especially in terms of standards and prices, and lack of fundamental countermeasures and convincing evaluation system, so there are many obstacles in the actual promotion, and most attempts eventually end in vain.

03

How to break the traditional Chinese medicine collection?

It is precisely because of the complexity of the centralized collection of traditional Chinese medicine that the procurement of traditional Chinese medicine in medical institutions has been in a blind spot or even a "gray zone" for a long time.

The so-called "high-end decoction pieces" and "selling granules with gold" such as Niuhuang, Cordyceps sinensis, Saussurea involucrata, etc. have long been an open secret in the industry, seriously damaging the principle of "openness, fairness and transparency" in drug circulation. Therefore, the centralized collection of traditional Chinese medicine must be implemented as soon as possible. But in the face of many practical difficulties, how to break the game?

The author believes that the key to the breakthrough of centralized collection of traditional Chinese medicine lies in rationalizing the industrial chain by using the big data platform of traditional Chinese medicine industry, and realizing the bottom logic of traditional Chinese medicine products from raw material production, processing, circulation to sales, thus achieving a closed loop.

In this closed-loop front-end, it is an order agriculture based on the concept of blockchain, which is directly linked to the annual orders of demanding enterprises. When the commodity codes are sold out, external capital cannot intervene at all to ensure the stability of supply prices; In the circulation link, it is the two-dimensional code traceability of the whole process; In the sales link, we encourage order agriculture and full traceability with high quality and good price, so that the traceability input of enterprises is worth the money; Finally, basic functions such as standardized warehousing and logistics and third-party testing should be completed.

In this closed-loop system, the construction of big data platform for Chinese medicine industry is very important and is the core grasper. All information such as origin information, product information, price fluctuation, employee data, supply and demand data, quality standards, etc. will be included in this big data platform, and the bottom layer will realize the whole process with unified coding.

Only after the above preparations are completed, can the centralized collection of traditional Chinese medicine have the basis for implementation, and can the original intention of the medical insurance department to raise quality control fees be realized.

I believe that the centralized collection of traditional Chinese medicine will surely make a breakthrough on this basis.