For years, Zhang Ping of Shexian County, Anhui Province has been taking Amlodipine for her high blood pressure. The medication, commonly prescribed to treat hypertension and coronary artery diseases, was unavailable at Chinese hospitals in early 2019.
As Anhui Province was not included in the pilot group buying program, Zhang had to buy similar drugs from another pharmaceutical company priced dozens of times higher.
The situation was similar in Shanghai. According to Gong Bo, director of the Drug Price and Bidding Department at Shanghai Healthcare Security Bureau, Shanghai was looking into group purchases in August 2012. Previously, there were considerable pricing differences between hospitals. Some drugs were several times more expensive than the market price while other drugs were priced near cost.
Before 2019, branded imported drugs were grouped separately from generic domestic drugs in the provincial drug procurement platform. This worked out for international firms, as there was less competition between imports to participate in the program. However, dozens of domestic pharmaceutical companies were left to scramble over a single slot.
In some provinces, more than a dozen pharmaceutical companies won bids for the same drug, but hospitals would often pick one foreign and one domestic maker. This led to cutthroat competition between company representatives.
“China’s high drug price stemmed from unscrupulous promotion tactics of pharma company reps. China’s medical reforms over the past 20 years have a history of combating such activities,” a senior official from NHSA told NewsChina on condition of anonymity.
Zhu Hengpeng, director of the Center for Public Policy Research, Chinese Academy of Social Sciences (CASS), said that by the end of the 1990s, China had 16,000 pharmaceutical distributors, most of which were notorious for poor logistics and chaotic management.
Public hospitals have been the largest consumers of China’s drug market. There are 2,709 drugs included in basic health, work-related injury and maternity insurance. Public hospitals contributed to roughly 80 percent of total drug sales nationwide.
Zhu Hengpeng said hospitals would profit from a combination of markups, public discounts from pharmaceutical companies and under-the-table kickbacks. As a result, hospitals would opt for higher-priced drugs with larger kickbacks, which eventually narrowed patients’ choice for cheaper drugs.
“Drug purchases in large quantities have been crucial to eliminating collusion between hospitals and pharmaceutical company reps,” the NHSA official said.
Chen Qiulin, director of the Division of Social Security of the Institute of Population and Labor Economics at CASS, told our reporter that while pharmaceutical companies are pessimistic about the group buying program, the public welcomed the prospect of lower prices. “Widespread public support is the biggest difference compared with previous drug pricing reforms,” he said.
In an October 2018 article headlined “Access to Antihypertensive Drugs in China” published in the American Heart Association’s weekly journal Circulation, Wang Jiguang, director of the Department of Hypertension at Shanghai’s Ruijin Hospital, and co-authors compared five common hypertension drugs in China and the US, including Amlodipine and Nifedipine. The article found that domestic drugs were priced between 1.5 and 6.25 times higher than those sold in the US.
“Drugs sold in China or the US are high in price but have different characteristics,” said the NHSA official. While generic drugs in the US are cheap and patented drugs are expensive, in China there are fewer innovative drugs available. Also, generics and imports are widely used but expensive. During the group buying opening bids, many international firms provided the lowest prices for generic drugs anywhere in the world.
“It sent a clear message to foreign-owned pharmaceutical companies that generic drugs should be sold at the same price and even cheaper in China than abroad,” said Gong Bo. “Only new innovative drugs should be sold at a premium.”