Outbreak of the market outside the hospital! Prescription circulation rules were released and injections were excluded

On May 24, the Hunan Provincial Health Commission, in conjunction with the Hunan Provincial Administration of Traditional Chinese Medicine and the Hunan Provincial Drug Administration, issued the Notice on Printing and Distributing the Hunan Provincial Prescription Circulation and Supervision Work Plan (Trial) (hereinafter referred to as the Trial Plan), proposing to establish a unified prescription circulation and supervision platform across the province, realize the circulation of prescription data of various medical institutions, and carry out the extension of hospital prescriptions, intelligent online review, chronic disease continuation Rational drug use monitoring.
It is understood that the first batch of pilot hospitals include Central South University Xiangya Third Hospital, Hunan Cancer Hospital, Affiliated Hospital of Hunan Institute of Traditional Chinese Medicine, Changsha Central Hospital, Changsha First Hospital, Changsha Third Hospital and Shimen County People's Hospital. After the pilot, it will be gradually promoted to the second and third level medical institutions in the province.
Hunan requires that the drugs that can be extended should mainly be oral or topical preparations for chronic diseases and common diseases. Injections (except for insulin needles for self use), psychotropic drugs, narcotic drugs, toxic drugs for medical use, radioactive drugs and other drugs with high risks of drug use or requiring special management should not be included in the scope of prescription circulation.
Clarify the access conditions and exit mechanism of drugstores, and prohibit illegal unification
In order to further deepen the reform of public hospitals, improve the residents' experience of medical treatment and drug purchase, and improve the level of medical health and convenient services for the people, Hunan Province has formulated the Trial Plan according to the spirit of the State Office's Opinions on Promoting the Development of "Internet+Medical Health" and other documents.
The Trial Implementation Plan proposes to establish a unified prescription circulation and supervision platform across the province, realize the circulation of prescription data of all medical institutions, carry out hospital prescription extension (including hospital HIS system, Internet medical service system, etc.), intelligent online prescription review, chronic disease continuation, rational drug use monitoring, etc., and achieve online supervision of prescription circulation by health administrative departments at provincial, municipal and county levels.
At the same time, we will develop a prescription service system. Based on the prescription circulation and supervision platform of Hunan Province, we will innovate the traditional drug dispensing service mode, establish a prescription service system, connect the patient side, the doctor side, the pharmacy side and the management side, and provide "Internet+medical health" services such as prescription extension, drug purchase appointment, and medication consultation for the majority of patients. Patients can purchase drugs at medical institutions or retail pharmacies on the basis of electronic prescriptions issued by the hospital for common and chronic diseases and reviewed by pharmacists.
From the perspective of specific implementation, the pilot hospital should make clear the doctors, pharmacists and extensible drug catalogs that can carry out the prescription circulation work in this institution in combination with the actual situation. The retail pharmacy can voluntarily participate in the circulation and supervision platform according to the access conditions of the pharmacy, and connect with the retail pharmacy management information system.
As for the access conditions and exit mechanism of retail pharmacies, Hunan requires that retail pharmacies voluntarily apply for access and adopt the commitment system, and should meet the following conditions: no administrative punishment has been imposed by the regulatory authorities due to major violations of laws and regulations in the past year, and the basic conditions for instantly uploading the code, price and other information of stored drugs in each store to the prescription sharing platform; During business hours, licensed pharmacists in retail pharmacies or retail chain pharmacies meet the requirements for remote prescription review determined in the Hunan Provincial Standards for the Setting of Remote Prescription Review by Licensed Pharmacists, and can conduct prescription review in real time and guide rational drug use; Retail pharmacies that have not carried out remote examination of prescriptions should be equipped with licensed pharmacists, and those that handle Chinese herbal medicines should also be equipped with licensed Chinese pharmacists (only one licensed pharmacist and licensed Chinese pharmacist can be equipped) to guide the use of drugs in real time; All pharmaceutical service areas with obvious signs on the business premises; Provide drugs consistent with the circulation prescription of the hospital.
Hunan also puts forward strict requirements for pharmacies that access the prescription circulation platform. If there are: refuse to open the information data involved in prescription circulation; Changing the drugs listed in the circulation prescription of the dispensing hospital without authorization; The patient was unable to get the medicine from the store due to insufficient drug reserves, which was verified to be 10 times or more annually; Violation of regulations; Failure to review prescription drugs as required; In case of serious violation of the Good Supply Practice for Drugs and other violations of laws and regulations, they will bear the corresponding legal liabilities and be disqualified from participating, and shall not apply within two years.
The outflow of prescriptions is accelerated, and the market outside the hospital is favorable
In recent years, the prescription circulation platform model similar to Hunan has been launched in some regions. Shandong, Jiangxi, Gansu, Guangdong and other provinces and cities are actively exploring the establishment of a prescription circulation model under government supervision.
On March 25, the Implementation Plan for Accelerating the Cultivation of New Consumption, which was developed by 28 departments, including the National Development and Reform Commission, the Central Cyberspace Office, the Ministry of Education, the Ministry of Industry and Information Technology, the National Health Commission, the State Food and Drug Administration and the State Health Insurance Bureau, proposed that the guidance document for the circulation of electronic prescriptions would be issued, the design of technical routes would be improved, and the online and offline integrated supervision would be strengthened. With the introduction of guiding document policies in the future, the implementation of electronic prescription circulation mode may be accelerated.
In the industry's view, the prescription circulation platform will also become the main carrier of prescription outflow. With the implementation of the prescription circulation platform covering the provincial level, it will have a huge impact on the circulation of prescription drugs in the regional market, and also bring more traffic opportunities to the retail pharmacies.
Prescription circulation is a specific measure to deepen the reform of the medical and health system and promote the development of "Internet+medical and health" services.
With the implementation of a series of medical reform measures, such as the proportion of drugs, zero margin, hierarchical diagnosis and treatment, consistency evaluation, medical insurance fee control, and volume purchase, as well as the continuous innovation of the "Internet+" model, the Internet+"medical, pharmaceutical, and medical insurance" linkage model has gradually taken shape. Since 2020, with the impact of superimposed epidemic situation, the separation of medicine and the outflow of hospital prescriptions have accelerated significantly, and the market outside the hospital has continued to expand.
A research institute reported that by 2028, the market scale of prescription outflow will exceed 720 billion yuan, and chain pharmacies will undertake 500 billion yuan. With the further implementation of the "separation of medicine" policy, the outflow of prescriptions will directly benefit medical insurance stores, hospital stores and DTP pharmacies in the future. There are also views that with the promotion of medical reform policies, outpatient pharmacies in hospitals may be cancelled in the future.
It is noteworthy that under the circumstance that many negotiated drugs for medical insurance cannot enter the hospital channel, the prescription outflow of innovative drugs has become a major trend. According to a data provided by Tongji Medical College of Huazhong University of Science and Technology, the sales channel of innovative drugs launched in the past two years is mainly in DTP pharmacies (up to 90% of sales) rather than hospitals. According to the data from Mi Nei Wang, in 2020, in urban drug stores, anti-tumor drugs will show a high growth trend with high prices and the addition of a variety of new drugs, and will enter the first place in the drug subcategory with a compound growth rate of up to 60.8%.
Based on this, the National Health Insurance Bureau and the Health Commission recently issued the Guiding Opinions on Establishing and Improving the "Double Channel" Management Mechanism of National Health Insurance Negotiation Drugs, which timely included the varieties with high clinical value, urgent needs of patients and low substitutability into the "Double Channel" management. This is also regarded by the industry as a new starting point for the out of hospital market. The "dual channel" management mechanism also mentioned that it will rely on the national unified medical insurance information platform, deploy the prescription circulation center, connect medical insurance agencies, designated medical institutions and designated retail pharmacies, and ensure the smooth circulation of electronic prescriptions.
For enterprises, the internal and external markets are also facing new layout strategies. Industrial enterprises represented by transnational pharmaceutical enterprises, especially those that have not won the bid for domestically sourced products, have increased their investment in the retail market outside the hospital. More and more pharmaceutical industry enterprises and innovative pharmaceutical enterprises have also announced the launch of a new retail strategy for prescription drugs. At the same time, as an important force to undertake the outflow of prescriptions, large chain pharmacies, such as Sinopharm, Shanghai Pharmaceuticals, China Resources and other pharmaceutical distribution giants, continue to actively layout and make full preparations to undertake the outflow of prescriptions.