During the ongoing Two Sessions, representatives have put forward suggestions to refine the volume reporting rules for centralized drug procurement.
On March 5, the Fourth Session of the 14th National People's Congress commenced. This year's Government Work Report emphasized the need to optimize centralized pharmaceutical procurement and price management, deepen reforms in medical insurance payment methods, and improve policies on the use of surplus funds.
Centralized procurement employs a "volume-for-price" mechanism, significantly reducing price markups in the circulation of drugs and medical devices. How to further enhance centralized drug procurement and price governance has become a key topic of discussion among NPC deputies and CPPCC members at the Two Sessions.
Yuan Yuyu, an NPC deputy and Chairman of Medprin Regenerative Medical Technologies, stated that since the regular implementation of volume-based procurement for medical consumables at the national and provincial levels, the substitution of domestic products has accelerated. This has not only effectively reduced patient burdens and standardized market competition but also injected strong momentum into the high-quality development of the pharmaceutical industry. The volume-based procurement system is now advancing towards normalization and refinement, with a dynamically adjusted selected price mechanism being gradually established. However, as the range of products covered by centralized procurement expands, various sectors still face implementation challenges, such as protecting historical volumes and issues related to malicious low-price competition.
Therefore, Yuan Yuyu proposed three recommendations: first, optimize the volume reporting rules for centralized procurement to balance efficiency with market innovation vitality; second, improve price constraints and the mechanism for reinstating selected bids to curb malicious low-price competition; third, refine the market access rules for new products within the procurement cycle to stimulate innovation.
Dai Lizhong, an NPC deputy and Chairman of Sansure Biotech, noted that while centralized procurement and price governance have significantly reduced testing costs, benefiting the public, they have also led to sharp declines in profit margins for some companies, weakening their capacity for R&D investment. Under the cost pressure from DRG (Diagnosis-Related Groups) and DIP (Diagnosis-Intervention Packet) payment systems, some medical institutions tend to reduce or avoid ordering tests, opting for older, cheaper technologies over precise, high-value diagnostic methods. This hinders the adoption of precision medicine and constrains the development of clinical precision medicine concepts.
Dai Lizhong suggested establishing a balance between "cost control" and "innovation" by implementing differentiated medical insurance payment policies. He recommended that medical insurance authorities create an "exemption channel for innovative technologies." For precision diagnostic items, such as early screening and companion diagnostics, that have undergone clinical validation and significantly improve diagnostic efficiency, a protection period or exemption coefficient could be established within the DRG/DIP payment reforms, excluding them from the annual cost-control assessment base to encourage the priority use of high-quality domestic IVD (In Vitro Diagnostic) products. He also proposed that centralized procurement incorporate a comprehensive evaluation of "technical bids" and "price bids," offering policy support to companies with high R&D investment ratios that align with intelligent manufacturing upgrades, ensuring reasonable profit margins for investment in next-generation technology R&D.
Chen Baohua, an NPC deputy and President of Zhejiang Huahai Pharmaceutical Co., highlighted the issue of disconnection between "procurement" and "payment." He pointed out that in some regions, coordinated mechanisms are not fully in place, resulting in high-priced generic and original drugs not selected in centralized procurement still enjoying high medical insurance payment standards. This disconnect undermines the original intent of centralized procurement—to reduce price markups and guide rational drug use—and creates unfair competition for compliant generic drug manufacturers that ensure quality and supply.
To address this, Chen Baohua recommended accelerating the establishment of a direct linkage mechanism between the selected prices in centralized procurement and medical insurance payment standards. He suggested that the National Healthcare Security Administration issue detailed rules stipulating that selected prices serve as the benchmark for medical insurance payments. For generic drugs included in centralized procurement, regardless of selection, the highest selected price should uniformly set the payment standard. For drugs priced above this standard, medical insurance funds would settle at the standard rate, with patients covering the excess; for drugs priced below, settlement would be at the actual price.
In recent years, the National Healthcare Security Administration has redirected savings from centralized procurement towards paying for innovative drugs with significant clinical value, meeting urgent clinical needs, and encouraging pharmaceutical R&D innovation.
At the Two Sessions, CPPCC members also proposed strengthening the strategic purchasing of innovative products by medical insurance funds. Ding Lieming, a CPPCC member and Chairman of Beta Pharma, suggested that, on the basis of ensuring basic coverage, efforts should be made to appropriately expand the coverage of innovative drugs under medical insurance, incorporating more eligible new, effective, and life-saving drugs into the payment scope to enhance the leveraging role of medical insurance funds.
Additionally, Ding Lieming recommended continuously optimizing the medical insurance directory negotiation mechanism. He noted that negotiation is a critical step for the commercialization of innovative drugs, but the current value assessment system needs improvement. The significant disparity between domestic and international pricing for China's independent innovative drugs affects international price maintenance and fails to fully reflect R&D costs and clinical value, impacting companies' commercial expectations and investment enthusiasm. He proposed that negotiations consider multiple factors to scientifically determine payment standards, ensuring reasonable prices and returns on innovation, and exploring a reserved time window for autonomous pricing to stabilize market expectations.
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