Like the old man Liu Xigong, there are not a few families of patients who are looking forward to buying medicines in short supply. Niuhuang Jiedu Pill is a box of 3 yuan, erythromycin ointment is a box of 1 yuan, and compound sulfamethoxazole is 2 yuan 100 tablets ... All kinds of cheap drugs that were once well known to the people are increasingly hard to find now. Mitomycin, an essential drug for glaucoma surgery, has recently been exposed in many places and is facing out of stock.
Where is the "life-saving medicine"? Where is the lack of medicine? How to solve the drug shortage dilemma?
The life-saving medicine was cut off. What should they do if they are seriously ill?
In the past, there was one more bottle in 8 yuan, but now what 98 yuan sells is "one medicine is hard to find". As an important therapeutic drug for hepatolenticular degeneration, it is a life-saving drug for patients who take it for a long time.
The reporter learned in the interview that Liu Xigong contacted the pharmaceutical manufacturer, but was told that due to the shortage of raw materials and no money, the company had stopped production, and the biggest possibility was the production at the end of this year.
Protamine is an essential drug for heart disease surgery, which costs more than ten yuan. However, in the first half of last year, this drug was in short supply or even out of stock in many parts of the country.
1977 the world health organization proposes that countries should provide cheap drugs to meet basic medical needs. Fu, a researcher at the Health Development Research Center of the National Health and Family Planning Commission, said that the US Food and Drug Administration also defined drug shortage: "It refers to the situation that a drug and its substitute varieties are out of stock and affect treatment."
In fact, the shortage of cheap drugs in China goes far beyond protamine and mitomycin. Fu believes that the shortage of drugs may indeed have a serious impact on patients, but there are also some enterprises that over-advertise.
Insiders pointed out that the shortage of primary medical institutions is more prominent. Due to the shortage of cheap drugs, some rural patients are facing the crisis of poverty caused by illness and returning to poverty due to illness. Li Fan, vice president of the General Hospital of the Chinese People's Liberation Army, said: "Hypertension is a high-incidence disease in rural areas. Jiangya 0 is recognized by most clinicians as having a good curative effect. Recently, it was found that patients were advised to switch to more expensive compound drugs. "
"Cheap" becomes "high price". What is the shortage of drugs?
In the investigation, the reporter found that the similarities of cheap "life-saving drugs" are safety, necessity, effectiveness, low price, less clinical dosage and fewer manufacturers. But without it, patients can't find alternative drugs, or the price of alternative drugs is extremely high.
Why is there a strange phenomenon of "demand, no supply" for low-priced life-saving drugs? Niu Ganzheng, vice president of China Pharmaceutical Enterprise Management Association, pointed out that drugs are special commodities and are "just needed" for patients. Relying entirely on the market, the cost of drug production rises, the profit margin declines, pharmaceutical companies are unwilling to produce, doctors are unwilling to prescribe drugs, and drugs with low prices and small dosage are easily in short supply.
"China is a big producer and exporter of APIs. In general, the API industry is a fine chemical industry with many production processes, large investment and high energy consumption. " Experts said that raw materials are divided into two types: fermented and synthetic. The upstream of fermentation type is grain, and the upstream of synthesis type is crude oil. The price fluctuation of these upstream raw materials will affect the production of drugs.
How important is API? The person in charge of the drug price-related regulatory agency once said that among thousands of APIs in China, only one enterprise can produce 50 APIs, and one API even needs to supply hundreds of pharmaceutical manufacturers, which shows market dependence.
"In some places, the blind pursuit of low prices in bidding has virtually accelerated the disappearance of cheap drugs." Liu Qun, chairman of Chongqing Tiansheng Pharmaceutical Group, said, "In the case of low profits, manufacturers simply stop production or change their packaging to raise prices."
According to the current policy, essential drugs are purchased centrally at the provincial level, and zero addition is implemented. "In order to open up sales, many companies will use cheap drugs as a stepping stone to squeeze into the procurement catalogue." Sun, an expert from China Academy of Medical Sciences, said that once drugs are invited for bidding once every few years and their pricing is included in the medical insurance payment system, even if the cost rises, the price cannot change according to the market situation.
At the same time, "yellow cattle" are buying and selling, and the order of drug purchase and sale in the market is chaotic, making cheap drugs more "hard to find". According to the survey, the normal retail price of corticotropin for injection is seven or eight yuan, but it has been fried to thousands of yuan on the "black market". Even if the price is so outrageous, it is still hard to find a medicine.
Find out the "family background" of drug shortage and get out of "fire-fighting" management
Drug shortage is a worldwide problem. Wu Xun, deputy director of the state, pointed out that the reasons for the shortage of drugs are complicated, mainly in supply, production, mechanism and monopoly.
The reporter's investigation found that there is a shortage of drugs in the market at present, and the supply of some pharmaceutical raw materials has seasonal characteristics, which directly affects drug production; Some drugs are used in small quantities, with meager profits, and enterprises lack enthusiasm for production; Some drugs have a long supply chain and many links, and the supply and demand sides cannot be effectively docked; There are also individual enterprises that control the sales of pharmaceutical raw materials and do not sell goods. ...
Life is an urgent matter. For drugs that are clinically necessary, small in dosage and easy to be in short supply, we should go out of the "fire-fighting" governance model. Wang Yonghong, director of the Jiangsu Provincial Health and Family Planning Commission, suggested that we should get out of the "information island" as soon as possible, find out the "family background" of the drugs in short supply, and put the drugs that are clinically necessary and have great influence after shortage into the key monitoring list.
Recently, the Food and Drug Administration has also taken measures to encourage the registration and declaration of such products, focusing on the shortage of production capacity and structure, and at the same time speeding up the audit of such short drugs. Wu Xun introduced that the Opinions on Solving the Backlog of Drug Registration Applications issued by the Food and Drug Administration on 20 16 listed 17 cases for priority review, which included all cases in urgent clinical need and market shortage, and defined the priority review procedures and work requirements.
To solve the problem of drug shortage, we should not only deal with urgent needs quickly, but also focus on establishing a long-term mechanism. According to "Several Opinions on Further Reforming and Perfecting the Policy of Drug Production, Circulation and Use" issued by the General Office of the State Council, China will establish and improve the system of information collection, submission, analysis and consultation on drugs in short supply, and take measures such as fixed-point production, drug reserve, emergency production and consultation and adjustment to ensure the supply of drugs in the market.
Spend less on good drugs-the shortage of life-saving drugs is not unique to China. It seems that only by giving full play to the "tangible hand" of the government, establishing a linkage mechanism between departments, regulating the problem of market failure, and ensuring the reasonable supply of medicines in short supply can patients be better "nourished".