When you talk about Internet + Medical, what comes to mind first? Maybe the registration of medical treatment has become an online appointment, maybe it is the various medical and health science content that is often brushed in the mobile phone, or it may be a number of Internet hospitals that have been urgently activated during the epidemic in Xi'an... In fact, the most recent incident related to the Internet and medical treatment that has aroused explosive attention in the public eye is the Wei Zexi incident, which occurred in 2016.
In just 5 years, the industry ecology and public impression in the field of Internet + medical care have undergone earth-shaking changes, and there is no doubt that the Internet is reshaping the medical and health industry.
Why has the industry changed? Combing through the influencing factors, there are the far-reaching impacts brought about by the epidemic, the high-standard transformation brought about by the entry of Internet capital, the promotion and standardization of regulatory policies, and the comprehensive embrace of the Internet by hospitals and doctors.
The Internet and medical care are two fields with different temperaments, and their integration is whether the doctor opens his arms first, or the Internet hands out an olive branch first? There are all, but different opening postures cast different corporate genes, and a variety of trial and error incisions also bring different trial and error postures.
Today, two years after the outbreak of the new crown epidemic, what is the current situation of the Internet + medical and healthcare industry? What are the biggest challenges facing the industry? In 2021, what kind of innovative attempts have you made? Where will the industry go in 2022? The "Internet + Medical" research group of nandu health alliance will launch a series of thematic inventory to observe the latest development of the Internet + medical industry in 2021.
The fourth special topic launched today focuses on Internet pharmaceutical companies with pharmaceutical e-commerce business as the mainstay.
In the current environment where the electronic prescription circulation platform has not yet become a scale, pharmaceutical e-commerce companies have built their own Internet hospitals and created a huge online drug sales market with the help of capital. However, in recent years, the field of online prescription drugs has repeatedly exposed the problems of lax trial parties and online drug rebates, and the regulatory policies that are in the making have targeted many industry ills.
The pharmaceutical e-commerce industry of "making a fortune with muffled voices" is about to usher in regulatory upgrades, when will electronic prescriptions achieve safe and standardized circulation online and offline? Many places are exploring systems, and the pilot reform of hainan free trade port to liberalize the sale of prescription drugs on the Internet has especially added confidence to the industry.
status quo
The pharmaceutical e-commerce business is the revenue pillar of the head enterprise
In 2021, data such as the financial reports of listed companies and the double eleven war report show that the growth of head pharmaceutical e-commerce companies is gratifying.
The turnover of Jingdong health genetic testing category increased by more than 16 times year-on-year, the turnover of HPV vaccine appointment service increased by more than 7 times year-on-year, the order volume of online family doctor service "Jingdong Family Doctor" service package increased by 630% year-on-year; the transaction volume of Traditional Chinese medicine-related drugs on tmall platform increased by 16 times year-on-year, the physical examination products for young and middle-aged people increased by 230% year-on-year, and the sales volume of 4 brands in the field of beauty pupils and medical masks exceeded 100 million... In 2021 Double 11, more and more people are spending money on "health".
How much income does pharmaceutical e-commerce "selling drugs" have? From the financial report data of listed companies, it can be seen that their commodity sales revenues range from billions to tens of billions in half a year, which basically exceeds the company's other service business revenues such as medical treatment, platforms, and advertising. Although various platforms are vigorously developing online medical services, pharmaceutical e-commerce revenue is still the backbone of revenue.
Of JD Health's total revenue of 13.6 billion yuan in the first half of 2021, 11.8 billion yuan was from the sales revenue of its "JD Pharmacy", accounting for 86.8%, an increase of 52.9% over the same period last year.
From April to September 2021, Alibaba Health's pharmaceutical e-commerce business revenue was 9.12 billion yuan, accounting for more than 97% of the total revenue (9.357 billion yuan), an increase of 31.1% year-on-year, of which the drug revenue of self-operated pharmacies operated under the "Ali Health" brand accounted for 64% and the revenue of prescription drug business increased by 127.3%.
Ping An Health's online mall operated an operating income of 1.908 billion yuan in the first half of 2021, accounting for about 50% of the total revenue, an increase of 28% over last year.
The revenue of the US-listed company 1Pharm.com exceeded 10 billion yuan in the first three quarters of 2021, which has caught up with the whole year of 2020.
In China, traditional online pharmacies are mostly transformed from the expansion and transformation of offline pharmacies and pharmaceutical companies, in recent years, Internet e-commerce is optimistic about the B2C business model, and has attacked the city and grown rapidly in the form of online self-operated pharmacies. With the listing of JD Health, which has received large financing for two consecutive years, at the end of 2020, the entry of Internet manufacturers in the pharmaceutical e-commerce industry has been basically completed.
By 2021, domestic pharmaceutical e-commerce has revealed a diversified development trend, according to the "Global Internet Pharmaceutical E-commerce Value Trend Report 2015-2021 H1", the pharmacist help of the B2B model, the Dingdang fast medicine of the O2O model, and the grapefruit health that focuses on the DTP (direct-to-patient) + DTC (direct-to-consumer) model have all been successfully financed.
malady
Prescription drugs circulate online with "cat grease"
Regulation has targeted industry ills
Due to the particularity of the pharmaceutical industry, the development and expansion of pharmaceutical e-commerce is always accompanied by various "embarrassments": because prescription drugs cannot be sold online, pharmaceutical e-commerce has no advantage over ordinary e-commerce; because it cannot use medical insurance cards, pharmaceutical e-commerce has no advantages over offline pharmacies; offline pharmacies run e-commerce, which inevitably avoids the embarrassment of "left and right hand fighting".
It can be said that the online sale of prescription drugs and medical insurance access are the two major "card neck" problems of pharmaceutical e-commerce. In 2019, the Drug Administration Law was amended to delete the clause that "prescription drugs shall not be sold through the Internet" to "open the floodgates" for the legal online sale of prescription drugs. Since then, policies for Medicare payments and prescription drug sales channels have also been gradually relaxed.
How common is it to shop for prescription drugs online right now? Nandu Internet + medical research group conducted a big data survey in early 2021, and found out the ten best selling drugs on the e-commerce platform in 2020, of which the ED treatment drug sildenafil citrate tablets, tadalafil, PE treatment drug dapoxetine hydrochloride tablets are in the top five in the market share, these three drugs together account for about 40% of the market share of online drugs, they are prescription drugs.
The premise of letting go of prescription drug online sales is the need to have a real prescription from the source, but in recent years, from time to time, the media has exposed the "catty", for example, some platforms sell prescription drugs online to review the prescription submitted by consumers perfunctory, and pet photos can also pass the review; some platforms do not need to submit prescriptions, confirmed diseases are checked by consumers themselves, backstage doctors basically do not have the consultation process and "seconds to open" prescriptions; backstage physicians, pharmacists' practice qualifications are difficult to confirm, and so on. The current operation of online drug sales is more convenient for consumers, but it also contributes to the abuse of prescription drugs and hides huge security risks.
Regulatory principles have come out, but the operating rules are still lacking, and the e-commerce platform has exploited loopholes and rubbed the edge ball, resulting in this situation today. In this regard, in November 2020, the State Food and Drug Administration issued the Measures for the Supervision and Administration of Online Drug Sales (Draft for Comment), which proposed more detailed regulatory measures for online sales of prescription drugs. In 2021, the measures have been consulted for many rounds in the industry, but a year has passed and has not yet been officially introduced. According to industry insiders, in the process of drafting and revising the measures, detailed regulatory measures have been formulated according to the exposed problems, which will be a very targeted regulatory measure.
In 2021, another regulatory rule that will have a profound impact on the pharmaceutical e-commerce industry has also surfaced, that is, the "Internet Diagnosis and Treatment Supervision Rules (Draft for Comment)" released in November, although most of the provisions regulate the Internet diagnosis and treatment behavior, but also target the online drug sales problem that is closely related to the diagnosis and treatment behavior, clearly stipulating: Prohibit the occurrence of problems such as unified parties and supplementary prescriptions, and the personal income of medical and health personnel must not be linked to the income of drugs and medical examinations.
Industry self-discipline
Industry associations organize and explore the standardized process of online review parties
Advocate boycotting the online of drug rebates
Under the trend of standardizing pharmaceutical e-commerce services, online trial will become a very important part of online drug sales. How should the online reviewer be judged? Is there a standard process? The industry is already groping.
Zhao Ning, deputy pharmacist of the Department of Pharmacy of Peking University First Hospital and chairman of the Pharmaceutical Affairs Committee of Yinchuan Internet + Medical and Health Association, introduced that the Pharmaceutical Affairs Committee of the Association has opened a "test field" on the Good Doctor Online to jointly explore the Internet pharmaceutical management model, and the results of the later output will be shared with the Internet hospitals of the Association.
They are trying to split the review process into 10 steps, name, gender, age, allergy history, diagnosis, dosage, etc., pharmacists need to review one by one, after the review of the prescription can flow to the next link, for drugs prone to adverse reactions, establish a high-warning drug directory, when the doctor prescribes the drugs in the directory to the patient, there will be a pharmacist to the patient to make a phone call to the patient one by one.
At present, the Pharmaceutical Affairs Management Committee of the Association has issued the "Regulations for the Administration of High-Warning Drugs in Internet Hospitals (Trial)" and the corresponding "Recommended Catalogue of High-Warning Drugs in China" of the Chinese Pharmaceutical Association. At the same time, the "Expert Consensus on Internet Pharmaceutical Services (Draft for Solicitation of Comments)" formed by the association organized by national experts is being opened to the public for comments, and the consensus puts forward detailed standards for the content and development form of Internet pharmaceutical services, the qualifications and requirements of pharmacists, the rights and obligations of relevant parties, and the supervision of Internet pharmaceutical services.
In view of industry ills such as "unified party" and "supplementary party", industry associations are also advocating industry self-discipline. In September 2021, in response to the undesirable phenomenon of "online drug rebates" publicly denounced by Good Doctor online, the Yinchuan Internet + Medical and Health Association issued the "Proposal for Resisting Online Drug Rebate Behavior", advocating that the industry boycott and stop online drug rebate behavior in various names, and carry out self-examination and self-correction work, and establish a long-term mechanism to prevent online drug rebates.
Companies have also made positive statements. 1 Pharmaceutical Network believes that the introduction of regulatory policies will actually bring a series of benefits to Internet companies, on the one hand, it puts forward higher requirements for the compliance operation of enterprises, so that enterprises can clearly "what can be done and what cannot be done", and has the effect of "good currency expelling bad money"; on the other hand, it will help accelerate the pace of access to medical insurance online payment, and with the liberalization of prescription circulation policies, it will bring huge market increments to the pharmaceutical e-commerce industry. In its latest financial report released in November, Alibaba Health said that the pharmaceutical e-commerce platform business will be "based on legal compliance", and the self-operated business will strive to become an all-scenario, all-category, all-channel pharmaceutical service platform.
explore
Explore the management measures for the online and offline circulation of electronic prescriptions in many places
Hainan Free Trade Port has made a breakthrough attempt
In the current environment, if pharmaceutical e-commerce companies want to sell drugs legally and compliantly, they must be closely related to and cooperate with Internet hospitals with the authority to consult and prescribe prescriptions, and many pharmaceutical e-commerce companies have developed Internet hospital business synchronously. However, under the reform direction of "separating medicine and medicine" of offline medical institutions, the online medical and pharmaceutical platforms are getting tighter and tighter, and "whether there is a conflict between the reform direction of pharmaceutical enterprises opening Internet hospitals and separating medicine should also arouse concern," Chen Qiulin, deputy director of the Health Industry Development Research Center of the Chinese Academy of Social Sciences, reminded.
In fact, this is related to the institutional design of prescription circulation. Prescriptions must come from medical institutions, professional physicians, and the sources of drugs are diverse, at present, most of the public hospitals and their Internet hospitals can only rely on a limited range of self-built pharmacies, so that there are prescriptions and drugs are difficult to buy; on the other hand, pharmacies build their own Internet hospitals to sell drugs, because of the lack of prescriptions and indiscriminate prescriptions, forming a polarization problem.
If there is a public prescription circulation platform with wide coverage and medical insurance access, or a set of standardized prescription circulation system, prescriptions can be safely and smoothly circulated between medical and pharmaceutical institutions, and medical and pharmaceutical institutions can operate independently and show their strengths.
At present, all localities are exploring a standardized new model of prescription circulation and online drug sales.
Classification and hierarchical management according to the pharmacy's pharmacy service capacity is a more innovative management model. At the beginning of December 2021, Hubei proposed in three documents, including the Measures for the Supervision and Administration of Social Pharmacies in Hubei Province (Trial Implementation), that "Internet drug retail" provisions should be made: if prescription drugs are sold, the source of electronic prescriptions should be ensured to be true and reliable; social pharmacies with Internet drug sales qualifications can set up remote drug cabinets to provide automatic drug sales services, of which only over-the-counter drugs can be sold with primary service capabilities; and prescription drugs can be sold at the same time with advanced pharmaceutical service capabilities. Only other eligible social pharmacies that undertake the business of "online ordering store pick-up" and "online ordering store delivery" are at least equipped with basic pharmacy service capabilities and are equipped with corresponding Internet drug sales information management systems.
The construction of a provincial-level electronic prescription circulation platform is a model that has been explored for many years. From the "Notice on Doing a Good Job in the Circulation of Medical Insurance Electronic Prescriptions and Real-time Settlement Related to the Circulation of Medical Insurance Electronic Prescriptions" in Chongqing for public comment in July 2021, the mode of operation of the medical insurance electronic prescription circulation platform is: patients first view their personal circulation prescriptions through the Chongqing Medical Insurance APP and fill in the address that needs to be delivered, and in the next step, they inquire about the drugs with the prescription and can provide the information of the designated pharmacies for distribution (including drug prices, inventory, delivery prices, etc.), after which the patients choose pharmacies independently. And through the mobile payment capability of Chongqing Medical Insurance APP, the settlement of prescription drugs and delivery fees is carried out.
It is understood that in recent years, many provinces in China have begun to explore the provincial electronic prescription circulation platform, and with the National Medical Insurance Bureau in May 2021 proposed the medical insurance "dual channel" system, some provinces have tried to incorporate the "double channel" into the electronic prescription circulation platform.
In November 2021, the Fujian Medical Insurance "Dual Channel" electronic prescription circulation platform was officially launched, taking the lead in the country to realize the "dual channel" electronic prescription circulation service based on the National Unified Medical Insurance Information Platform Prescription Circulation Center. Prescriptions can not only be circulated online, but also to "dual-channel" pharmacies, which means that patients can not only buy drugs according to prescriptions in the outer hospital, but also buy drugs that are in the medical insurance directory but the hospital does not have reserves in some social pharmacies, and can also be reimbursed according to medical insurance standards and used simultaneously in hospitals.
The medical insurance "dual channel" system will include qualified retail pharmacies in the scope of medical insurance drug supply, in order to solve the problem of "difficulty in entering the hospital" of negotiated drugs, and after docking with the electronic prescription circulation platform, the circulation scope of electronic prescriptions will be broadened, and at the same time, the medical insurance "bottleneck" of online drug sales will also have a new solution channel.
In 2021, the National Development and Reform Commission and the Ministry of Commerce issued the Opinions on Several Special Measures to Support the Construction of Hainan Free Trade Port and Relax Market Access on April 7, which attracted more attention in the industry.
Among them, the content on supporting the sale of prescription drugs on the Internet mentions that the Hainan Electronic Prescription Center (providing third-party information services for prescription drug sales agencies) has been established in the Boao Lecheng International Medical Tourism Pilot Zone, and for prescription drugs sold in China, except for drugs that are clearly managed by the National Drug Administration Law, all of which are allowed to rely on electronic prescription centers for Internet sales, and will not be approved separately.
Jiang Yi, deputy director of the National Development and Reform Commission, interpreted at the press conference that the above reform measures are "a breakthrough attempt to relax access restrictions in this field", and these measures promote the establishment of electronic prescription centers in response to the current liberalization of prescription mutual recognition, patient privacy protection, medical insurance settlement and other difficulties in the current liberalization of online prescription drugs, and break through the information barriers between medical institutions, sales platforms, medical insurance institutions and commercial insurance institutions in the form of Internet + medical treatment, and simultaneously strengthen the management of high-risk drugs.
The industry generally believes that the above-mentioned reform measures in Hainan have the significance of being the first to try first, and will accumulate experience for the subsequent full liberalization of online prescription drug sales. Since Hainan Province in 2019 issued the "Promote the "Internet + Medical Health" development implementation plan", the rapid development of local Internet hospitals, and attracted many Internet companies to register and set up Internet hospitals here, becoming another Internet hospital gathering place after Yinchuan, under the benefits of the above reform measures and supporting policies, the healthy development of Internet medical care in Hainan has added another fire, according to the statistics of "Seeing the Medical Community", only in April 2021, 55 Internet hospitals were registered in Hainan. Many of these are Internet hospitals set up by pharmaceutical retail companies.
In 2022, when the regulatory policy is about to be clarified, the pharmaceutical e-commerce industry that believes in "barbaric growth" will also explore a new path of high-quality and standardized development.
Producer: Nandu Health Alliance "Internet + Medical" Research Group
Coordinator: Yin Lai, Wang Daobin, You Mani
Written by: Nandu reporter Li Wen
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