100 yuan of medicine to the hospital 20 yuan, this time medical insurance finally started on chinese medicine

Text/ Xin Ying Wang Xiao

Editor / Wang Xiao

Photo/Pexels

Lianhua Qing plague granules folded in the local collection.

During the most tense period of the new crown epidemic in Wuhan, Lianhua Qingpeng was once out of stock in many pharmacies. As a drug selected for the "Diagnosis and Treatment Plan for Novel Coronavirus Pneumonia" (hereinafter referred to as the "New Coronavirus Diagnosis and Treatment Plan"), Lianhua Qingpeng is the manufacturer of Yiling Pharmaceutical, contributing 4.256 billion yuan in sales revenue in 2020, basically accounting for half of the total revenue of Yiling Pharmaceutical.

However, on the evening of April 8, 2022, the results of the proposed bid of the Traditional Chinese Medicine Alliance in Six Provinces such as Guangdong, Shanxi and Henan showed that the final price of 10 bags and a box of Lianhua Qing plague granules (6 grams per bag) was 2.3295 yuan / bag, because the price reduction was relatively small, it was not directly selected and became a proposed alternative enterprise.

Among the 53 varieties collected by the local alliance this time, 36 exclusive varieties of traditional Chinese medicine such as Lianhua Qing plague and brain heart communication were involved, and 29 exclusive varieties were finally planned to win the bid. Unlike chemical medicines, the bidding for proprietary Chinese medicines ultimately measures the price reduction.

"Finance and Economics Great Health" inquired on the online drug sales platform, the same specifications even flowers qing plague granules, a number of pharmacies retail price of 2.36 yuan / bag. It can be seen that the price in the collection is almost the same as the current retail price of the pharmacy, which is different from the cliff-like price reduction of the previous collection and harvest.

"Finance and Economics Great Health" even called Yiling Pharmaceutical for Hua Qingyi's quotation strategy this time, and as of press time, Yiling Pharmaceutical has not commented.

For the exclusive varieties of proprietary Chinese medicines, a small price reduction does not necessarily mean a significant reduction in sales. According to the rules, exclusive varieties are not selected, and the purchase amount will not be allocated to other varieties. If the hospital has the willingness to purchase, for every 1% price reduction of the proposed alternative variety, the order of 5% of the purchase volume will be increased. This also means that a 20% price reduction may lead to 100% orders. According to Fengyun Pharmaceutical's calculations, the average price reduction of this exclusive variety is about 21%.

Even if the price reduction of more than 1% can obtain the proposed candidate qualification, there are still four exclusive varieties that are not included in the list, including Jiren Pharmaceutical's "New Crown Diagnosis and Treatment Plan" drug - Wind Detoxification Capsules, Pediatric Soyothermic Clearing Granules, Buchang Pharmaceutical's fist products - Brain Heart Capsules and Youbo Pharmaceutical's Blood Dredging Injection.

"If the price reduction is not enough to win the bid and not bid, you can continue to hang the net and sell, but it will be limited by medical insurance and hospitals, which is more difficult." If the enterprise does not bid, the product will be directly treated as a key monitoring variety in Guangdong Province. A pharmaceutical industry analyst said.

Exclusive, and there are no similar products, is the basis for many Chinese medicine companies not to reduce prices, but also a major difficulty in the collection of Chinese medicine.

The solution to the problem of national medical insurance is to find competitors for exclusive varieties and then put them into the same group of bidding. Hubei Province once led the collection of proprietary Chinese medicines in the 19 provincial alliances, and all 18 exclusive varieties were included in the same group.

This plan in Hubei was formulated under the guidance of the National Medical Insurance Bureau, and is also regarded as a pioneering test to pave the way for national collection and procurement. Dai Wei, a second-level inspector of the Hubei Provincial Medical Insurance Bureau, told "Finance and Economics Health" that the collection and collection of proprietary Chinese medicines should "emphasize quality and light price", and take the inclusion of proprietary Chinese medicines in the collection as an opportunity to improve the production process and quality level of traditional Chinese medicine enterprises through healthy competition in the market.

It is difficult to stop the determination of the national medical insurance to reduce the price of chinese medicine

The activity of pharmaceutical representatives is regarded by the industry as an indicator of the "thinness" of drug profits.

"In the past two years, the number of medical representatives of chemical medicines has decreased significantly, probably because of low profits, and the number of medical representatives of traditional Chinese medicines has not changed." An obstetrician and gynecologist at a third-class hospital in Guangdong Province told Finance and Economics Great Health.

Hospitals are now more welcoming of traditional Chinese medicines, because the profits of chemical drugs and biological drugs have become thinner after collection. The hospital where the above-mentioned obstetricians and gynecologists are located encourages the prescribing of traditional Chinese medicine, and it is directly linked to the performance of the doctor, and the more it is prescribed, the higher the performance. "Like the biochemical soup that promotes uterine contractions after pregnancy, it may be possible to prescribe 100 yuan of drugs to give the hospital a 20 yuan rebate." said the above-mentioned obstetrician and gynecologist.

One of the functions of the national drug collection is to squeeze out the drug "rebate". One of the reasons for entering the field of Chinese medicine after three years of promotion is that the quality evaluation of Chinese medicine lacks standardized evaluation criteria and the pricing basis is insufficient.

At the beginning of September 2021, Guangdong Province took the lead in setting up the Interprovincial Alliance of Proprietary Chinese Medicines to collect and collect varieties with large quantities and high purchase amounts in the list of basic medical insurance drugs in 53 countries.

"The objections of various Chinese medicine enterprises and industry associations were raised, and at that time, they were the most intensive." A person from the medical insurance system introduced it to "Finance and Economics Big Health".

Because there are pillar products of the revenue of Chinese medicine enterprises in this collection, including six new crown diagnosis and treatment plan drugs as exclusive varieties, they are in a dilemma.

In addition to Lianhua Qingpest, Xiyanping Injection (5ml: 0.125g) of Jiangxi Qingfeng Pharmaceutical, which is the recommended drug for the clinical treatment of severe/critical illness of new crown, has also become a proposed alternative variety. From the market point of view, it ranks among the top three in the market sales of detoxification and detoxification chinese medicine injections, with an annual sales volume of about 200 million pieces. In this collection, the price of Xiyanping injection was 49.005 yuan / piece, which was about 12.61% lower than the highest effective quotation of 56.075 yuan / piece.

In the same "New Crown Diagnosis and Treatment Plan", the higher decline is the ginseng injection of China Resources Sanjiu (Ya'an) Pharmaceutical, and the price to be selected is 14.4949 yuan / stick, which is 19 yuan / piece compared with the highest effective declaration price, a decrease of 23.71%.

Among the exclusive varieties, Jiangsu Kangyuan Pharmaceutical cosmeter capsules or large strains of Rhodiola rosea capsules or the highest decline, the proposed price of 0.7673 yuan / capsule, compared with the highest average daily cost / maximum effective declaration price of 1.16 yuan / capsule, a drop of 33.85%.

There are many large varieties of traditional "ace" products that have sold more than 1 billion yuan in this collection. For example, Tasly's compound danshen drop pill will have sales of more than 3 billion yuan in China's public medical institutions and urban physical pharmaceutical terminal box machines in 2020. The compound danshen drop pill was successfully selected, the price was 0.1232 yuan / pill, compared with the highest effective declaration price of 0.14489 yuan / pill, the drop of 14.97% is not high.

Yangzijiang Pharmaceutical also won the qualification to stay in the market, and its exclusive variety of Suhuang cough capsules won the bid price of 3.0089 yuan / capsule, compared with the highest effective declaration price of 3.102 / capsule, the drop was only 3% to become a proposed alternative variety. The terminal sales of this drug in China's public medical institutions reached 1.576 billion yuan in 2018, and the terminal sales of retail pharmacies in China's cities exceeded 300 million yuan in 2019.

The most lonely is Buchang Pharmaceutical, whose exclusive pillar variety, Brain Heart Tong, has not been selected and has not entered the proposed alternative variety. "Finance and Economics Great Health" called Buchang Pharmaceutical about the impact of the results of this collection on the subsequent sales of Brain Heart, and the relevant person in charge of its securities department responded, "It is inconvenient to reply, and the specific situation will be announced." ”

In view of the national medical insurance directory negotiations since 2020, the price reduction of six exclusive proprietary Chinese medicines has been promoted through "soul bargaining", and at that time, a number of corporate negotiators revealed that the price reduction range was 30%-40%. By February 11, 2022, at the State Council's regular policy briefing, Chen Jinfu, deputy director of the National Medical Insurance Bureau, said that proprietary Chinese medicines should be further expanded in an orderly manner this year.

It can be seen from the above that the National Medical Insurance Bureau is determined to reduce the price of traditional Chinese medicine.

Exclusive, not necessarily exclusive market

"How to make exclusive varieties of drugs with large market share participate, while ensuring the needs of patients, while promoting the reduction of prices as much as possible, is a test for rulemakers." The above-mentioned health insurance system person said.

When the Guangdong Collection and Gathering Alliance is grouped, the exclusive varieties are preferentially grouped according to the varieties and prescriptions, and if they cannot be merged into the group, they are divided into three large groups according to the highest daily average fee/ the highest effective declared price, and then, the same group is bid according to the price reduction range.

As a result, there are nine exclusive varieties, which are divided into the same group of bidding of similar varieties, and if they are not selected, the market will be divided. Previously, the Hubei Alliance collected proprietary Chinese medicines, and all exclusive varieties were divided into groups according to common names and main functions.

The above-mentioned medical insurance system sources pointed out that although the consistency evaluation cannot be carried out like chemical drugs, the opinions of clinicians and other professionals on the quality and classification of drugs can be used as a grouping standard.

At the same time, in order to ensure the quality of drugs, before the final comparison of the price reduction range, Hubei Jicai also set a shortlisting threshold, comprehensive price reduction range, medical institution recognition, enterprise ranking, supply capacity, innovation ability, pharmaceutical price and procurement credit evaluation level, drug quality and safety and other factors to score, determine the shortlisted enterprises, comprehensive score of enterprises with high scores.

Grouping standards are also a major concern for businesses. "Also used for the treatment of cardiovascular diseases, Buchang Pharmaceutical's Steady Heart Granules and Yiling Pharmaceutical's Ginseng Pine Yangxin Capsules are exclusive varieties, but usually doctors will only choose one of the two prescriptions, and they are also direct competitors in hospitals, and whether they will be placed in a group of collections will have a great impact on this enterprise." A chinese medicine company source said.

In fact, although there is a difference between even flower qing plague and wind detoxification capsules, they can generally be replaced by each other. In this regard, an attending doctor of reproductive medicine and a doctor of traditional Chinese medicine analyzed that even the flower Qing plague and heat removal also have a detoxification effect, and the double solution in the surface is used when the fiery qi is relatively large; the wind detoxification capsule can also be detoxified, but it is mainly aimed at the wind and heat gas. Usually only one prescription is prescribed, and if the hospital can only enter one variety, it will not have much impact on diagnosis and treatment.

Is there still room for gathering outside?

"Finance and Economics Great Health" learned that the next step in the collection of Traditional Chinese medicine should be expanded to Chinese medicine tablets.

At the beginning of 2022, the 12 provincial alliances led by Shandong Province added Chinese medicine tablets and Chinese medicine formula granules.

These two are also chinese medicine varieties that were once considered "exempt from collection", and are not subject to the restriction of "zero addition", which can bring benefits to hospitals and are quite popular in the market. The pharmaceutical and biological analyst team of Everbright Securities Research Institute believes that the "policy + market" two-wheel drive is expected to usher in a rise in quantity and quality, which is good for industry leaders and upstream enterprises in the industrial chain, and Chinese medicine tablets (including Chinese medicine formula granules) are expected to continue to grow at a high rate.

However, "because there are still many markets outside the collection, the overall anxiety of the Chinese medicine industry for the collection is not particularly strong." "Analysis of a person involved in the collection of proprietary Chinese medicines in Guangdong.

On the one hand, the hospital's most profitable "Chinese medicine injection" has been restricted in the national multi-round key monitoring of auxiliary drugs, and enterprises have long been prepared; on the other hand, the market for Chinese herbal medicines (APIs) outside the collection, over-the-counter drugs sold outside the hospital market, and traditional Chinese medicine products with strong consumer attributes is still quite broad.

Among the traditional Chinese medicine enterprises, Yunnan Baiyao and Guangzhou Pharmaceutical Group have long begun to transform like consumer products. Yunnan Baiyao has a number of business lines at the same time, and will steadily promote medical aesthetic related businesses in addition to traditional businesses. It is also due to the loss of nearly 2 billion yuan in investment in 2021. However, overall in the 2021 financial report, the annual operating income was 36.374 billion yuan, an increase of 11.09% over the same period of the previous year.

Traditional Chinese medicine enterprises such as Buchang Pharmaceutical and Yiling Pharmaceutical have also opened up business lines such as biological drugs and vaccines. However, this step is too difficult.

A biological drug research and development personnel who left from a domestic listed Chinese medicine company admitted frankly, "The genetic background of Chinese medicine is too strong, and it is very limited to want to do biological drug research and development internally." ”