Recently, on search engines and social platforms, related topics such as "a cold costs 2,000 yuan", "the price of drugs in pharmacies is three or four times more expensive than those sold online", and "pharmacies are bundled and sold a bunch of drugs when buying medicines" and other related topics have frequently aroused discussions.
On December 26, 2023, Shandong Radio and Television Station's comprehensive broadcast "Front-line Survey" column paid attention to this issue and conducted a walk-through visit to a local pharmacy. The reporter came to a Fangcheng pharmacy in Huaiyin District to understand the situation, and chose three kinds of commonly used drugs for residents, 10 bags of sunflower brand Baohe granules, 10 ml of shining naphthalene minwei eye drops, and 24 tablets of Guizhou Bailingwei C Yinqiao tablets double-layer tablets, the unit prices of offline pharmacies were: 25 yuan, 19.8 yuan, and 13.8 yuan, but the reporter entered the online store of the same Fangcheng pharmacy in Meituan on the same day, and found that the unit prices of drugs were 24.25 yuan, 9.61 yuan, and 13.5 yuan respectively, which were cheaper than offline pharmacies.
▲Source: Shandong Radio and Television Station
Among them, the price of eye drops is ten yuan different, and offline stores are twice as expensive as online. The clerk explained: "I don't know what the price is online, but today our members are discounted for 16.8 yuan. ”
▲Source: Shandong Radio and Television Station
"It's nine dollars online. Isn't it the same thing?"
"It's the same thing, but we can't get the price online. ”
The clerk explained that the online drug price is not the pricing of a single pharmacy, but the docking between the company's operation department and the online platform. "I can't explain to you why the price of online drugs is low, I can't explain it all to you, there are platform discounts and the like online, which are operated by the company, not controlled by our store, but drugs can be shipped from the store. ”
▲Source: Shandong Radio and Television Station
The reporter also asked the same question at the Shuyu Civilian Pharmacy, and the clerk said that the online price of drugs is cheaper than the price of offline stores in many cases. "Online is relatively cheaper, and when we buy medicine ourselves, we also place orders online, because there are platform discounts that are really cheap, and the price of medicine in the store cannot reach that price. In addition to the above daily medicines, many respondents said that the price of buying blood pressure medicine in pharmacies is more than three times higher than that of the same type on the Internet, and that it costs only 8 yuan to buy licorice tablets online and 19 yuan in pharmacies......
Why are online medicines "cheaper" than physical pharmacies?
Liu Xin (pseudonym), a manager of a chain pharmacy in Hunan, told the Legal Daily reporter that the first is that the operating costs are different, and in order to attract more consumers, physical pharmacies will generally choose to be in a location with more foot traffic, and they also need to recruit staff with drug knowledge, and the store rent and labor costs will be relatively high. Selling drugs online does not require excessive costs, only the normal operation of the store is required, and sometimes one person can complete multiple tasks.
"The second is that there is serious competition from online platforms. There are many stores selling the same medicine, and in order to attract customers, many stores will adopt various preferential methods, such as full reduction, rebates, newcomer coupons, etc. Liu Xin said that at the same time, online is generally the direct hair of manufacturers, most of which take the way of small profits and quick turnover, and in this marketing model, the price will also be depressed.
"In the mainland, due to the lag in the development of the pharmacist profession, the professional survival of pharmacists does not depend on the compensation mechanism of service fees, that is, it refers to the international use of 'prescription dispensing fees, prescription review fees or cognitive judgment fees, patient education fees and drug treatment management fees' and other forms of compensation, generally by the national medical insurance or insurance companies to purchase pharmacist services. Therefore, although pharmacies have GSP certification, they are only the attributes of ordinary stores and do not undertake medical service work, and pharmacies can only rely on the commodity buying and selling model to make a profit with a mark-up model, and they also need to sell more, otherwise it is difficult to survive. Kang Zhen, executive deputy director of the Rational Drug Use Committee of the China Association of Traditional Chinese Medicine, said.
▲ Source: Kale Pictures Photography / Ning Ying
According to the latest data released by the Licensed Pharmacist Qualification Certification Center of the National Medical Products Administration, as of the end of November 2023, there were 782683 licensed pharmacists within the validity period of registration nationwide, with 5.5 licensed pharmacists per 10,000 population, and 708883 licensed pharmacists registered in pharmaceutical retail enterprises, accounting for 90.6% of the total number of registered pharmacists.
According to data from the National Medical Products Administration, the number of pharmacies in mainland China has continued to grow in recent years, with a total of 623,000 pharmacies by the end of 2022.
Zhang Yu, who has been working as a pharmacist in Shandong for more than 10 years, feels the same way. He said that the salary of store pharmacists is composed of post salary, performance salary, sales commission, single product commission, etc., and the performance appraisal of pharmacies is mainly sales and gross profit margin. "When a licensed pharmacist working in a store gives a drug to a customer, the primary consideration is not which drug is more symptomatic, but which drug is the task variety, the gross profit margin is higher, and the pharmacist with more professionalism will take into account both profit and effect. ”
Strengthen supervision and improve legislation
Regulate the sales behavior of pharmacies
The interviewed industry insiders believe that in the face of the chaos of pharmacy sales, it is necessary to increase industry legislation and law enforcement. The pharmaceutical regulatory authorities should also strengthen supervision, standardize the sales behavior of pharmacies, return pharmacies to the correct positioning, and avoid them going further and further on the wrong road of excessive commercialization.
"The current business model is to turn a pharmacist into a businessman, so this model needs to change urgently, and the profit point must also change. Kang Zhen said that foreign prescription drugs need to rely on the cost of dispensing and auditing, and also extend some professional services to manage patients' drug safety and drug effect monitoring, that is, the so-called pharmaceutical services, which is to solve patients' drug management problems.
▲ Source: Kale Pictures Photography / Ning Ying
"The work done by pharmacists will affect the change in the outcome of the disease, is it valuable? But now that stores are full of free services, free means that there may be a trap to induce consumers to buy all kinds of drugs through free. Kang Zhen said that for the long-term development of the pharmacist industry, the most important thing is to establish a standardized pharmacist service model, and not be trapped by the current business model.
It is understood that in order to ensure the safe use of drugs by patients, on June 6, 2023, the General Office of the State Council issued the "2023 Legislative Work Plan of the State Council", which mentions that "it is ready to be submitted to the Standing Committee of the National People's Congress for deliberation on the draft of the Pharmacist Law".
Industry insiders believe that the promulgation of the Pharmacist Law will clarify the responsibilities, rights and obligations of pharmacists from the legal level, provide more complete legal protection for the pharmacist industry, and allow the majority of pharmacists to have laws to follow.
In Kang Zhen's view, the introduction of the pharmacist law will bring great changes to the licensed pharmacist industry, but for social pharmacies, it is also necessary to equip the corresponding pharmacy law.
"The function and attribute positioning of pharmacies are very important, and only by clarifying the main responsibility of pharmacies can we fundamentally change the problem of pharmacist sales. Kang Zhen said that first of all, a reasonable service business model can be adopted to replace the mark-up model of goods, and the corresponding cost compensation for the pharmacist's service through medical insurance and commercial insurance should be given;
He said that the mainland's medical reform fully implements the drug zero difference rate system, the medical insurance payment model is also being reformed, and the medical insurance payment and compensation for medical service fees have also begun to include pharmacies in the scope of outpatient co-ordination and reimbursement. However, medical institutions can be reimbursed for medical insurance costs despite the zero difference rate.
"In the future, we can consider social pharmacy as an extension of the medical service system, so that the majority of licensed pharmacists can give full play to their true value, and can also promote the healthy development of the entire medical system. Kang Zhen said that medical reform needs to be systematically considered to build a new benefit distribution mechanism, not only considering the interests of medical institutions, but also community pharmacies should be included in the construction of public health and service systems.
Source: China Xiaokang Network WeChat public account Comprehensive Rule of Law Daily, CCTV News, Shandong Radio and Television Station
Editor-in-charge: Wu Jinyang
Review: Wang Fang