On December 20th, the National Medical Insurance Bureau sent a letter to the medical insurance bureaus of various provinces, autonomous regions, municipalities directly under the central government, and Xinjiang Production and Construction Corps in response to the investigation of the false invoicing case in the pharmaceutical field by the public security department, requesting a serious investigation into whether there were similar problems with the products involved, such as Ginkgo biloba extract injection, Cefotaxime sodium injection, hydrolyzed protein oral solution, etc., and to quickly determine the bottom line of the listed prices. The National Healthcare Security Administration stated in the letter that it firmly opposes the increase in patient burden caused by inflated drug prices, the formation of illegal profit chains through false invoicing, and illegal and irregular behaviors such as "double pricing of one drug" and "selling with money". (December 22, People's Daily Online)

Recently, the Economic Reference Daily reported that in 2022 and 2024, the public security department cracked two cases of false invoicing in the pharmaceutical industry, as part of an investigation by the Economic Reference Daily. The investigation found that "some drugs have two sets of prices, namely 'bottom price' and 'ticket price'". "Pharmaceutical companies first sell drugs to distributors according to the 'ticket price', and then distributors sell them to medical institutions. After the transaction is completed, pharmaceutical companies return the difference between the 'ticket price' and the 'bottom price' to distributors." "The huge price difference is' whitewashed 'and' withdrawn 'through false invoicing, becoming a source of funds for illegal distributors to profit from and engage in commercial bribery, resulting in some drug prices being inflated from the source. The report pointed out that "a drug called 'Ginkgo Leaf' has a base price of 8.5 yuan per tube and a selling price of 25.28 yuan per tube, and doctors can get a commission of 4 yuan per tube used; a drug called 'Cefotaxime Sodium' has a base price of 6.5 yuan per tube and a selling price of 16.5 yuan per tube, and doctors can get a commission of 2.5 yuan per tube used. According to calculations, the commission amount of the drug generally accounts for more than 20% of the difference between the invoiced price and the base price.

The "two sets of prices" provide a source of funding for pharmaceutical bribery, but in fact, they are exploiting the loophole of the "two invoice system" for pharmaceutical purchase and sales. In the past, drugs were frequently resold between agents at different levels, with each transaction resulting in an invoice and an additional price. Throughout the process, it was common for drugs to be resold seven or eight times from the manufacturer to the patient, and the "cabbage price" could also be added to the "golden price". In order to address this chaos, the "two vote system" emerged. The "two ticket system" refers to the situation where only two tickets can be issued in the drug circulation process, namely one ticket for leaving the factory and one ticket for entering the hospital. In the middle stage, invoices and price increases cannot be issued, and many pharmaceutical representatives can only "roll up and leave" as a result. However, if pharmaceutical companies set the ex factory price too high, making it contain "corrupt elements", the source of funds for sales with gold will once again be compromised.

The "two sets of prices" have rendered the "two vote system" partially ineffective, indicating that the loopholes in the "two vote system" urgently need to be plugged. Since the difference between the factory invoice price and the base price is so significant, it indicates that the cost investigation of drugs is not thorough and accurate enough. Since the invoiced price is not the transaction price, it indicates that there are loopholes in invoice management and other aspects. By further strengthening intelligent auditing and other methods, abnormal phenomena such as discrepancies between cash flows and invoice books can be detected in a timely manner. In the past, the "two vote system" played a good regulatory role, but now that there are countermeasures in place, it is necessary to quickly upgrade regulatory measures.

In fact, not only has there been a new tactic of pharmaceutical bribery fundraising, but there have also been many new methods of bribery. Regulatory oversight has a keen eye, while pharmaceutical corruption has a hidden law, and the two are in a dynamic competition. For example, rebates based on drug sales to hospitals cannot be implemented due to strict inspections, but pharmaceutical companies can sponsor hospital research projects; Distributors dare not directly give kickbacks to doctors, so they organize academic conferences in high-end hotels and popular tourist attractions. If the trend of pharmaceutical corruption and innovation is not curbed, there will be more tricks like "two sets of prices" emerging.

We must resolutely investigate and punish illegal and irregular behaviors such as selling with money, and take a long-term perspective to build and improve a new anti-corruption system for the pharmaceutical industry. No matter how the methods are updated, bribery in the pharmaceutical industry cannot escape the strict supervision of the anti-corruption system. Only in this way can we address both the symptoms and root causes, ensure that the achievements of medical reform such as a significant decrease in drug prices are not eroded by medical corruption, and further protect the "money bag" of ordinary people's medical treatment.