China: 药品采购GPO:反垄断法警告你不能胡来

Last Updated: 24 April 2017
Article by Chen Ma

我国的药品流通市场长期以来处于市场竞争和行政管制并存的状态。政府在引导药品价格形成 市场机制的同时,也在积极探索通过行政干预缓解市场失灵的问题,乃至通过影响市场结构来调节药 品价格。

行政干预是把双刃剑。在我国公平竞争审查制度刚刚实施,一线参与竞争审查人员经验欠缺的情况下,一方面行业主管机关在实施行政干预前,自身需要做好充分的分析和评估,另一方面,竞争执法机关也需要密切关注滥用行政权力的行为,通过一个个有影响力的案例帮助行业主管机关树立正 确的观念。此次,国家发展和改革委员会(" 国家发改委")在规范深圳市药品集团采购改革中,就 发挥了非常积极的作用。

深圳市卫生和计划生育委员会(" 深圳市卫计委")试图通过"药品集团采购模式",以降低药品采购费用、遏制医药购销领域内的商业贿赂等不正当行为。但其只允许一家集团采购组织提供药品集团采购服务的举措使得通过遴选的"全药网药业"成为该市场的垄断者,排除了相关市场的竞争。表面上,全药网药业在参与遴选的过程中,经过竞争被选中。但通过竞争保证经济效率并非一劳永逸,深圳市卫计委为相关市场设立了不可逾越的行政准入门槛,将全药网药业确立为一个真正的垄断者。

我们尚不完全知晓深圳市卫计委是否为全药网药业设置了一定的行为准则,该等行为准则是否能在一定程度上约束全药网药业滥用其市场力量。但极有可能的情况是,药品集团采购改革所期望的通过增强买方力量进而实现药价降低的结果,很可能被垄断者所追求的超额垄断利润所吞噬甚至超出。即便该等超额垄断利润被行政力量所规制,垄断所引发的寻租等问题也会严重损害市场的效率、弱化药品生产厂商的积极性,并最终损害消费者利益。而指定药品配送企业的行为违法性则更为明显,不但直接排除了相关市场的竞争者,也没有显见的效率提升。

整改措施在保留"药品集团采购模式"所产生的效率的情况下,引入了广东省平台采购的竞争,能一定程度上缓解相关市场竞争的缺失。但该等措施是否能够保证相关市场的充分竞争,仍需有关部门的后续跟踪评估。

我们期待未来竞争执法机关能够通过更多的案例,监督并指导医药领域的行业主管机关在药品价格形成机制改革方面所采取的措施。

案件综述:

2017 年 4 月 7 日,国家发改委在其网站公布了对深圳市卫计委涉嫌在公立医院药品集团采购改 革试点中滥用行政权力排除、限制竞争行为的调查结果,认定深圳市卫计委违反了《反垄断法》第八条、第三十二条相关规定,构成滥用行政权力排除、限制竞争的行为。深圳市卫计委承诺采取相关措 施予以纠正。

2016 年 7 月 1 日,深圳市卫计委发布了《市卫生计生委关于印发深圳市推行公立医院药品集团采购改革试点实施方案的通知》(深卫计发[2016]63 号),据此,《深圳市推行公立医院药品集团采购 改革试点实施方案》(" 药品集团采购试点方案")开始实施。深圳市药品集团采购(即 GPO)模式 的基本内容是组织全市公立医院遴选一批临床常用药物,实行集中采购。遴选 1 家药品经营企业(经遴选,确定为全药网药业),由其作为第三方集团采购组织,负责开展全市公立医院的药品集中、带量、限价采购,并与全市公立医院、其他药品生产经营企业建立药品采购和配送协同机制,期望实现药品供应价格明显降低、临床合理用药水平提高、医药领域不正之风得到遏制、药品供应保障能力得到增强的目标。经前期筹备,2016 年 7 月 1 日起,深圳全市公立医院启动集团采购改革试点,试点 时间持续到 2017 年 6 月。

自试点开始之日起,该改革就备受争议。根据企业和行业协会反映,国家发改委会同广东省发改委,对深圳市卫计委在推行公立医院药品集团采购改革试点过程中,涉嫌滥用行政权力排除限制竞争的行为进行了调查。经调查,国家发改委认为,深圳市卫计委在推行改革试点过程中存在三种排除、限制竞争的行为:

  1. 只允许一家集团采购组织提供药品集团采购服务。集团采购组织的职责在于接受医院委托代为购买所需药品、提供团购服务。改革前,凡符合国家规定资质、能够为医院提供团购服务的经营者,都可以平等进入深圳市公立医院药品集团采购市场。试点改革后,深圳市卫计委通过遴选,从符合资质的企业中确定一家集团采购组织,使其他有能力、有意愿提供药品集团采购服务的经营者被排除在外,导致深圳市公立医院药品集团采购市场只有一家经营 者,没有竞争。
  2. 限定深圳市公立医院、药品生产企业使用全药网药业提供的服务。一是限定深圳市所有公立医院只能通过全药网药业,不能选择其他具备条件的集团采购组织,也不能在省级药品集中采购平台上自行采购。二是变相限定药品生产企业只能通过全药网药业向深圳市公立医院销售目录内药品,不能通过省级药品集中采购平台销售,破坏了药品市场正常的竞争秩序。
  3. 限定药品配送企业由全药网药业指定。违背了《国务院办公厅关于完善公立医院药品集中采购工作的指导意见》(国办发[2015]7 号)中关于药品生产企业自主选择配送企业的规定。

深圳市卫计委作为卫生、计划生育行业的主管行政机关,对深圳市内与卫生、计划生育行业有关的事务具有决策权和管理权,推行公立医院药品集团采购改革试点是其行使行政权力的表现。但应当注意的是,深圳市卫计委行使权力应当在合理限度内,符合《反垄断法》和《关于在市场体系建设中建立公平竞争审查制度的意见》(国发[2016]34 号)的相关规定。

而深圳市卫计委的上述行为明显超过了"合理限度",违反了《反垄断法》第八条"行政机关和法律、法规授权的具有管理公共事务职能的组织不得滥用行政权力,排除、限制竞争"、第三十二条

"行政机关不得滥用行政权力,限定或者变相限定单位或者个人经营、购买、使用其指定的经营者提供的商品"等规定,构成滥用行政权力排除、限制竞争的行为。

针对国家发改委的调查结论,深圳市卫计委承诺采取三项整改措施:

  1. 确保公立医院药品采购自主权。在坚持集中采购的原则下,对公立医院药品采购不作强制性要求,允许公立医院自主选择委托现有集团采购组织(即全药网药业)或在广东省平台采购。
  2. 确保选择药品配送企业自主权。修订完善公立医院药品集团采购药品配送相关制度,恢复药品生产企业选择确定配送企业的自主权。
  3. 确保药品生产企业自主权。允许药品生产企业自主选择现有集团采购组织或其他采购平台向深圳市公立医院销售目录内药品。

此外,深圳市卫计委承诺将在试点期内修改完善相关政策文件,使其符合《反垄断法》和《关于在市场体系建设中建立公平竞争审查制度的意见》(国发〔2016〕34 号)的规定,支持符合条件的集团采购组织进入相关市场,推进药品集团采购模式的规范有序发展。

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