"Mitomycin this medicine inventories at a lower price, we can't use it for glaucoma from December surgery." Guangzhou zhongshan ophthalmic center, sun yat-sen university doctor reflect to the reporter. 

 

Recently, an important adjuvant in glaucoma surgery mitomycin break goods across the country, many people exclaim, "and" a cheap medicine would disappear. In previous years, the wind of drug shortages intensified at a lower price, also attracted the attention of the national level, more department notice, cancel the highest cheap medicine retail price, but the Chinese medicine entrepreneurs association ming-de yu had interviewed pointed out that low medicine is still at an annual rate of more than a dozen "disappear". How to guarantee the sustainable supply of low specific, become the focus of the society from all walks of life. 

 

Emergency mitomycin or break goods across the country 

 

Cheap drugs, refers to the safe, effective and commonly used generic and low price, also known as the essential drugs. In recent years, the shortage of low-cost "wonder drug". 

 

In the recent outages of mitomycin, for example. Mitomycin is one of the important adjuvant glaucoma surgery. Glaucoma surgery, want to do an outflow channels in the eye, the channel after surgery can't heal quickly, otherwise can't produce the effect of drainage, so you need to inhibit the growth of scar of the drug, the effect of mitomycin in this respect, 5 bottles are packed in a wooden box is 58 yuan, unit price is 11.5 yuan, is real cheap medicine. But because the price is low, the enterprise production of steam, according to the national food administration of drug safety database query, at present there are only three companies have production batches of the product. 

 

The doctor said, although to get the production batch number three, but only the sea for a long time is pharmaceutical company in the production and supply. After 2014, the sea is bought by Pfizer pharmaceutical, renamed the sea is, Pfizer stopped mitomycin production, hospitals can only use the inventory, now is almost ran out. The sea square face reporters, "since approval number belongs to the sea is Pfizer has no production this product, also did not participate in bidding of the products." As to when will start the production, the staff said, "to the assessment by the company." According to a new version of GMP regulation, resumption of production, need to make the necessary technical transformation, is expected to last a long period. 

 

Without mitomycin, clinical medical institutions can only find alternatives. Zhongshan ophthalmic center glaucoma, according to professor liu heng as cheap medicine 5 - fluorouracil (5 - FU) can be used as an alternative, but the "control of intraocular pressure is not so good, the success rate of surgery may be slightly lower". Also has the doctor said, mitomycin foreclosures for clinical also is not very big, the influence of mitomycin is important auxiliary medicine medicine but it is not necessary, and domestic drug outages, still can use to replace imports. But it is understood that the import of mitomycin price about 400 yuan/box. 

 

Dilemma prices also hard shortages 

 

Can replace after some cheap medicine shortage, but prices soared; Can't replace after some cheap medicine shortage, led directly to the emergency life-saving medicine. In 2011, the heart surgery drug "protamine" national shortage of affected many hospital operation arrangement, worried a lot of doctors and patients. In addition, the drug for the treatment of heart failure rescue "west orchid injection" shortage, actinomycetes to treat tumors in children D, for the treatment of infant spasm corticotrophin life-saving medicines such as low shortages. 

 

The personage inside course of study reflects, cheap drugs are shrinking at an annual rate of more than a dozen. 

 

It is worth noting that in 2014, the national development and reform commission to cancel 280 kinds of cheap and 250 types of low prices the highest retail price of proprietary Chinese medicine, western medicine allows firms in drug use average daily cost of standard (average daily cost no more than 3 yuan, western medicine Chinese traditional medicine is not more than 5 yuan) to pricing, to arouse the enthusiasm of drug firms production, promote the effective supply of cheap medicine. 

 

As policy open, cheap drugs for price increase. The reporter understands, in 30 of digoxin only about 3.5 yuan a box, now the price is $35. Often used in the treatment of rhinitis maleic acid chlorobenzene that min (chlorpheniramine maleate) present price 12.5 yuan/box, and the only 5 yuan/box. Is there a drug store, told reporters, head since 2016, the drug ushered in the new wave "boom", a total of 1262 varieties, 154 varieties increase more than 50%. Among them, low medicine is the most fierce rise, vitamin B complex is up 400%, dipyridamole, essential balm rose by more than 300%, erythromycin eye ointment, liver wessing prices have doubled. There are also many old medicine has changed the packing, raise prices and then back to the shelf. Capsules, such as fu phlogistic spirit for the past 16 grain of only 3 yuan, after the "new" price to 12 yuan. 

 

But the growth of the price doubled, still cannot completely relieve the shortage of cheap medicine. Reporters visited guangzhou several pharmacies, found that in the treatment of hyperthyroidism domestic "he ba azole" out of stock, has been largely replaced by imports of "governance". Heart disease medicine "digoxin tablets" also, is there a drug store, said digoxin tablets to at least a week in advance reservation. 

 

Because of cheap drugs cost less profitable 

 

An unnamed listed pharmaceutical company vice President, told reporters that cheap medicine price just appearance, the cost of production increase and tender bargains, as well as the influence of the low price drugs did not increase the profits of space, drug companies manufacturing power is still insufficient. 

 

He pointed out that the original basic drug price is too low, many enterprises are manufactured in a "damaged", now rise in price is only the price return to normal, and not much profit space. Like digoxin cheap drugs, rose from 3.5 yuan / 30 pieces of 35 yuan / 30 pieces, seemingly have increased 10 times, but carefully, average daily cost no more than 3 yuan, is allowed in the country within a reasonable range. 

 

"Production costs rising sharply, drug firms pressure is too big." The medical people reluctantly said, and will be directed at "raw materials control pin. We have learned, at present the country strictly control the production approval number, API approved manufacturer of active pharmaceutical ingredients quantity is little, once the manufacturers alliance or distributor alliance formation, control the supply of active pharmaceutical ingredients on the market, people improve API prices, will significantly raise the cost of downstream pharmaceutical enterprises. For example, some cheap medicine enterprises with production batches may nearly a dozen, but due to the control pin active pharmaceutical ingredients, can really get the raw material production enterprise may be only one or two, adding to the shortage of cheap drugs. 

 

"Some cheap medicine raw materials was monopolized by the individual or group, after the goods, the price has been bid up, for the price of this kind of behavior management departments to resolutely crack down, but if it is due to normal factors lead to rising costs, to allow firms to adjust the price reasonably. Don't demonize prices." The medical people said. 

 

On the other hand, the medical professionals also pointed out that the current drug bidding system drugs at a lower price is not the "friendly". Some small dosage, drugs, market demand is not big but effective low prices has not laid the ability of sales network, can only rely on into the medical insurance directory to ensure sales, and hospital bidding process will drug prices down as far as possible, make the enterprise profit space is too small, have to adjust the production according to the market situation and even give up production. 

 

It is understood that after the centralized bidding, joint negotiation, drug prices would fall by 10% to 10% generally. Had lower drug prices low, the volume is not large, plus the bidding bargain, squeeze at both ends and drug firms "heart a horizontal, just don't do". 

 

Can take measures such as fixed-point production 

 

Chinese pharmaceutical enterprise management association Guo Yunpei pointed out that although allows for low drug policy appropriate to raise prices, but in the process of implementation, the provincial bureau of drug bidding platform still failed to "respect the value of the drug law" completely, low-priced drugs are interacting, in severe cases, a blow to the enthusiasm of enterprises. 

 

Guo Yunpei said, to solve the problem of the shortage of low-cost medicine, should straighten out the low-price drug review, bidding, procurement, distribution, paid work, and establish a shortage has occurred or may be a shortage of medicine directory listing, classified management. 

 

For classification management, Guo Yunpei suggestion, response to the national average daily cost no more than 3 yuan (western medicine) and 5 yuan low-cost medicine (TCM), hang on ShengJu bidding platform network directly, do not set "minimum reference", make the clinical medical treatment organization directly to negotiate trade and production enterprises; For necessary and irreplaceable rescue medicine, clinical medicine and a few rare disease varieties of medicine, even though their daily expenses exceeds the national medicine at a lower price, policy to tilt, still can take the province won the bid on the number of average price for the benchmark for bidding, bidding process to be "lenient", not forcing prices; With no cheap medicine enterprises should mark or abandon target, to find out information in time, directly by the tender department and enterprise interview, through the way of price negotiation, at a reasonable price to satisfy the needs of both companies and hospitals. 

 

"Related departments in addition to allowing low-cost medicine to return to normal level, also can be in low medicine distribution has also offer certain preferential policy, taxation and financial subsidy, to encourage the production of cheap drugs." Guo Yunpei said. 

 

Face the problem of low drug shortage frequently, national health TiGaiSi state family planning commission deputy director jian-hong yao said, complex causes, shortage of cheap drugs can be taken into the directory management, establish integrated management information system, designated production, reform the price management, and other measures to deal with. 

 

, low medicine designated production pilot since 2014 began, the first pilot of into includes treatment of hyperthyroidism a sulfhydryl imidazole, treatment of leprosy and dermatitis of dapsone herpes samples of seven kinds of a shortage of cheap drugs. At the end of last year, with digoxin oral solution, compound sulfamethoxazole, three varieties of amino acid sodium for injection into the pilot. "Across the country to find several large pharmaceutical factory specializing in the production of certain kinds of drugs, so quantity is large, large amount of later will be able to profit, so encouraged by means of fixed-point production enterprise production." Jian-hong yao said. 

 

Jian-hong yao, however, said that "solve the problem of shortage of medicine also needs to reform the joint efforts of the relevant departments under the framework including hospitals, the society and the drugs production enterprise work together."