Jiangsu province focuses on the drug demand of special population and improves the drug supply guarantee system

The drug supply guarantee system is an important part of China’s basic medical and health system. In recent years, Jiangsu Province has focused on the drug demand of children, rare patients, elderly patients and other special groups, made great efforts to improve and perfect the drug supply guarantee system, and continuously improved the ability and level of pharmaceutical services.

Children’s medication in China has been in a state of "shortage" for a long time, which can’t meet the needs of pediatric disease diagnosis and treatment, and has become a "long-standing problem" concerned by all walks of life. In recent years, Jiangsu Province has made innovations in purchasing, equipping and using policies to fully guarantee the clinical supply of drugs for children.

Open up a green channel for centralized procurement. In the centralized procurement of drugs at the provincial level, according to the principle of national classified procurement of drugs, direct online procurement of pediatric generic drugs is adopted, and the "zero threshold" shortlisting policy is implemented.

Relax the management policy of equipment use. In August 2019, the Jiangsu Provincial Health and Wellness Commission issued the Notice on Further Strengthening the Administration of the Use of Medicines for Children, which clarified that when selecting medicines for use in medical institutions, the requirements for varieties, dosage forms and specifications suitable for children should be relaxed, and it is allowed to be exempted from the restriction of "no more than two kinds of medicines with the same generic name, no more than two kinds of injections and oral dosage forms, and 1-2 kinds of compound preparations with similar prescriptions".

Simplify the examination and approval procedures for preparation dispensing. In October 2019, the Jiangsu Provincial Health and Wellness Commission and the Provincial Food and Drug Administration issued a policy to include children’s special preparations that have been used clinically for 10 years or more in the scope of dispensing, and to adopt a variety, scope and quantity, one year for approval, and one quarter for filing, etc., to simplify the procedures for dispensing children’s special preparations between different hospitals and expand the supply channels for children’s medicines.

At present, there are 168 medical institutions in Jiangsu Province dispensing 35 hospital preparations made by 10 medical institutions, totaling 200,000 boxes (bottles, bags and sets).

In July 2019, Jiangsu Province took the lead in researching and issuing the "Jiangsu Province Rare Disease Drug Supply Guarantee Scheme", establishing and improving the supply guarantee mechanism of rare disease drugs, and further improving the accessibility of drugs for patients with rare diseases.

Make a drug list. In March, 2020, Jiangsu Province entrusted hospitals, universities and other relevant experts to study and formulate the Catalogue of Drugs for Rare Diseases in Jiangsu Province (including 383 kinds of drugs, involving 116 kinds of rare diseases) and the Catalogue of Drugs for Key Guaranteed Supply of Rare Diseases in Jiangsu Province (including 38 kinds of drugs, involving 23 kinds of rare diseases), which provided guidance for medical institutions to rationally choose and equip with drugs for treating rare diseases.

Promote the connection between supply and demand. In view of the characteristics of low demand for rare drugs, high distribution cost, and high risk of scattered inventory loss in hospitals and pharmacies, the provincial-level drug storage and storage enterprises were mobilized to actively assume social responsibilities and take the form of storage and allocation to ensure the clinical supply of drugs. Guide the provincial rare diseases branch to use information technology to build a communication platform between drug supply enterprises and member units of the rare diseases cooperation network to dynamically understand the supply of rare diseases drugs and the demand for clinical diagnosis and treatment in real time.

Standardize the use of equipment. Guide the provincial rare disease diagnosis and treatment cooperation network hospital to include the required rare disease drugs into the hospital prescription set and drug list; Medical and health institutions that establish a two-way referral mechanism are appropriately equipped with rare disease drugs according to actual needs, and do a good job in follow-up supportive treatment, follow-up and management of patients with rare diseases.

Strengthen monitoring training. Guide medical and health institutions and enterprises that store medicines in short supply to carry out the diagnosis and treatment of rare diseases, reasonably calculate the demand for medicines, establish an inventory early warning mechanism, and prevent the occurrence of shortage risks. Organize and carry out training for medical staff to improve the clinical standard diagnosis and treatment of rare diseases and the level of rational drug use.

As a group with high incidence of chronic diseases and common diseases, the elderly people’s drug demand and cost burden are obviously higher than the average level. In recent years, Jiangsu Province insists on strengthening medication management as an important measure to promote the health of the elderly, constantly expanding services and improving quality, and making efforts to meet the basic medication needs of the elderly.

Introduce a "long prescription" medication policy for chronic diseases. In 2018, the Provincial Health and Wellness Commission and the Provincial Department of Human Resources and Social Security jointly issued the Notice on Strengthening the Work of Drug Supply Guarantee in Primary Health Care Institutions, clarifying that among patients with three chronic diseases such as hypertension, diabetes and stroke who signed contracts with family doctors, explore the provision of long-term prescription services with a dosage of no more than 2 months. In 2020, combined with the drug demand of the elderly under the normalization of epidemic prevention and control in COVID-19, long-term prescriptions of no more than 12 weeks will be prescribed for eligible patients according to their condition, which greatly facilitates the drug use of the elderly.

Strengthen the management of home pharmaceutical service. In 2019, Yizheng City, Yangzhou took the lead in piloting the family pharmacist service. In 2020, family pharmacist training was carried out in stages throughout the province, providing 12 drug treatment management services for patients with chronic diseases such as hypertension and diabetes.

The basic drugs for the treatment of the elderly in the pilot project are fully guaranteed. In some areas, we will explore ways to promote the full guarantee of basic drugs for primary treatment for the elderly. As early as 2016, Nantong City and Qidong City issued policies to fully guarantee the injections with unit price below 10 yuan and the non-injection essential drugs with unit price below 20 yuan for the participants over 70 years old who were hospitalized in primary health care institutions. On this basis, the full coverage will be extended to all essential drugs for treatment from 2020.