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医药流通行业政策——“两票制”

  • 2026-02-05 22:03:03
医药流通行业政策——“两票制”
“两票制”改革前，药品流通大多实行“多票制”，即指药品从生产企业到终端医疗机构的流通过程中，存在多个中间环节，每个环节都可以开具增值税发票。在这种模式下，药品的流通链条较长，涉及多个代理商、经销商或批发商，每个环节都会加价， 最终导致药品价格层层叠加。为深化医药卫生体制改革，针对药品流通领域长期存在的环节冗余、价格虚高及“过票洗钱”等突出问题，国务院医改办等八部门于2016年末颁布《关于在公立医疗机构药品采购中推行“两票制”的实施意见（试行） 》（国医改办发〔2016〕4号） 。
01
推行两票制的行业背景
2010年，国家发改委药品价格评审中心对部分医保目录药品进行出厂价调查，结果显示，我国药品市场平均流通差价率高达215%（零售价是出厂价的3.15倍） ，远超规定中30%的平均标准。同时，药品流通领域贿赂现象严重，医药企业以现金形式支付给医疗机构和医生的费用约占药品销售额的40%。这些现金主要来源于“走票”行为，企业借此偷逃税款并获取大量流通现金。
02
药品流通企业的“走票”现象
药品流通企业以较低价格从药品生产企业购进药品，再以高价销售给医院。为掩盖实际交易中的高额差价，企业通过伪造购销环节、虚开增值税发票等方式，虚抵药品价格中的虚高部分，从而偷逃增值税和所得税，套取现金用于支付医药代表的薪酬及医院、医生的灰色收入。
这种模式在传统流通领域尤为常见，被称为“低开高返”，成本低、利润高。许多小型药品流通企业甚至仅依靠“走票”偷逃税款即可维持运营，这也部分解释了我国药品批发企业数量众多（曾达13000余家）且多数能够存活的原因。
03
药品生产企业的“走票”现象
药品生产企业为规避出厂价公开可能引发的监管质疑，部分生产企业选择抬高药品出厂价，直接向配送企业开具发票，自行承担“走票”的税务与法律风险，不再让流通企业介入此类操作。
在这种被称为“高开高返”的模式下，出厂价已包含生产成本及大部分销售费用（包括面向医院和医生的“回扣”） 。企业通过虚开原料、包材、餐饮、会议等各类费用发票来冲抵高开部分的成本，进而套取现金返还给相关利益方。该模式常见于大型制药企业或科工贸一体化集团，形式上虽符合“两票制”要求——从生产到流通、再从流通到医院各开一票——但其通过虚开发票偷逃税款的本质并未改变。
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  1. CONNECT:[ UseTime:0.001213s ] mysql:host=127.0.0.1;port=3306;dbname=no_mfffb;charset=utf8mb4
  2. SHOW FULL COLUMNS FROM `fenlei` [ RunTime:0.001555s ]
  3. SELECT * FROM `fenlei` WHERE `fid` = 0 [ RunTime:0.000608s ]
  4. SELECT * FROM `fenlei` WHERE `fid` = 63 [ RunTime:0.009782s ]
  5. SHOW FULL COLUMNS FROM `set` [ RunTime:0.001405s ]
  6. SELECT * FROM `set` [ RunTime:0.010062s ]
  7. SHOW FULL COLUMNS FROM `article` [ RunTime:0.001554s ]
  8. SELECT * FROM `article` WHERE `id` = 475919 LIMIT 1 [ RunTime:0.014939s ]
  9. UPDATE `article` SET `lasttime` = 1770409590 WHERE `id` = 475919 [ RunTime:0.036762s ]
  10. SELECT * FROM `fenlei` WHERE `id` = 64 LIMIT 1 [ RunTime:0.013567s ]
  11. SELECT * FROM `article` WHERE `id` < 475919 ORDER BY `id` DESC LIMIT 1 [ RunTime:0.129511s ]
  12. SELECT * FROM `article` WHERE `id` > 475919 ORDER BY `id` ASC LIMIT 1 [ RunTime:0.031064s ]
  13. SELECT * FROM `article` WHERE `id` < 475919 ORDER BY `id` DESC LIMIT 10 [ RunTime:0.024349s ]
  14. SELECT * FROM `article` WHERE `id` < 475919 ORDER BY `id` DESC LIMIT 10,10 [ RunTime:0.113692s ]
  15. SELECT * FROM `article` WHERE `id` < 475919 ORDER BY `id` DESC LIMIT 20,10 [ RunTime:0.057416s ]
0.606166s