Whose cheese was picked by the Medicine Equipment Collection?
On January 21, the Third People’s Hospital of Gansu Province, the centralized procurement of coronary stents has been implemented in the hospital for 10 days, and Zhang Yongzheng, the deputy chief physician of the coronary care unit, has successively implanted seven or eight coronary stents. surgery.
"Previous coronary stents cost about 8,000 yuan, and after centralized collection, it is generally between 600-700 yuan," Zhang Yongzheng told the Shell Finance reporter that families in difficulties will benefit greatly.
On November 5, 2020, the results of the country’s first centralized procurement of high-value medical consumables were announced. The traditional metal stent products with mature domestic substitution levels became the first centralized procurement target products, and the final 10 winning products, the average price from The price dropped from about 13,000 yuan to about 700 yuan, and the price cut was as high as 94.6%.
Among them, the price of the 10 winning bidders did not exceed 1,000 yuan, and the lowest was only 469 yuan.
According to data released by the National Medical Insurance Administration, in this centralized procurement, it is estimated that 10.9 billion yuan will be saved based on the amount of intended purchases.
On January 1, 2021, the first batch of "price reduction" brackets will be implemented in 18 provinces, autonomous regions and municipalities, and then gradually cover the whole country.
Behind the large price cuts of high-value medical consumables such as coronary stents brought by centralized procurement, doctors' income, hospital income, manufacturer profits, and stent quality have also become hot topics in the industry.
The centralized procurement of medical consumables has just landed, and on January 15, the fourth batch of countries organized centralized procurement of drugs also kicked off.
The country began to launch a pilot drug centralized procurement at the end of 2018, and then gradually deepened it vertically to cover the whole country.
In the context of the gradual and comprehensive roll-out of centralized procurement, the entire medical system has begun to restructure. How can hospitals, channels, manufacturers, and investors find their place in the re-running of the value chain?
patient:
"Families in difficulty benefit a lot"
As the deputy chief physician of the Coronary Intensive Care Unit of the Third Hospital of Gansu Province, Zhang Yong is performing implantation operations for patients with coronary stents purchased in quantities for the first time on January 10.
One patient Zhang Yongzheng treated recently came from Dongxiang County, a poverty-stricken area. Three centralized coronary stents were used for the entire treatment.
"After using the centralized coronary stent and reimbursed by medical insurance, all his expenses were 3,000 to 4,000 yuan. If he had to pay at least 20,000 yuan for himself before," Zhang Yongzheng said, "For a very complicated condition, it may be a stent. The situation where multiple stents are not enough, and the situation where the patient is in a difficult family, will benefit greatly. This is a real benefit."
Li Ziying (pseudonym), a doctor in a tertiary hospital in South China, took the coronary stent for surgery from the hospital equipment department as usual. He was told that the brand used last year had been changed. Since January, the main stocking of the hospital is the brand of centralized procurement. There are more than 200 Jiwei with the cheapest bid price. Heart stents have been developed for many years and are very mature. Domestic and imported stents are about the same. For doctors, there is nothing wrong with changing the brand."
"We will recommend patients to use the current cheap stents." Li Ziying told reporters, "However, there are also patients who want to use brands other than centralized procurement, and the ratio is about 20%."
Regarding the quality problem after the price reduction, Li Ziying said that there is no difference in quality at present, because the existing products are still produced before. "It is hard to say in the future, it may take half a year to observe."
According to regulations, there are certain requirements for hospital usage after centralized collection.
"Generally speaking, other products can only be used after the prescribed amount is used up. However, from the previous implementation of drug purchases with volume, the purchase volume of bid-winning products will exceed the original amount." Senior market investor Huo Xiaoyun (pseudonym) told reporters.
Huo Xiaoyun said that the original price does have moisture. The domestic stent costs about four to five hundred, and the ex-factory price is 2500-3000 yuan. It is sold in the hospital for 10,000 yuan, and the price is doubled after leaving the factory.
After the centralized procurement of coronary stents has landed, Zhang Yongzheng can directly enter the national centralized procurement platform from the hospital backstage to submit requirements. The stent delivered by the distribution company to the hospital is already a centralized procurement stent. The corresponding price is only 700 yuan, and the use of this coronary stent It is also 100% reimbursed by medical insurance. "Previously, coronary stents were reimbursed under category B (medical insurance). In this case, every place is different, and each patient pays basically 10,000 to 20,000 at his own expense."
hospital:
"Doctors' technical fees have increased slightly"
On the other hand, when the price of high-value medical consumables is reduced by centralized procurement, how doctors' income will change has also attracted much attention.
Zhang Yongzheng said that this will indeed bring about a change in his income. "The Health Commission has also issued some documents one after another, but there is a process for implementation. It will not be so fast. The total price of consumables will drop, but the doctor’s technical fees will be slightly less. If there is an increase, there will be no problem of a significant decrease in income, and there will be a balance. There are documents in this regard, but they have not been implemented."
In terms of doctors’ income, Blue Sail Medical (002382.SZ), a listed company, recently responded to investors’ questions on the interactive platform and stated that the company recommends that while reducing the price of consumables, it can focus on reforming the price of medical services so that doctors’ wisdom, Medical technology can reflect its due value, allowing medical workers' services to obtain a reasonable price level, because the quality of stent products is a guarantee of safety, and the medical level of doctors is a more important guarantee.
It is recommended that the national medical insurance, health, drug supervision, and industry and information technology form a joint force of top-level design, and systematically optimize supporting policy reforms.
In addition, the doctor's income is also affected by the hospital's own profit and loss.
"From the perspective of business, the price reduction of centralized procurement has no effect on hospitals. Since the beginning of the past few years, medical consumables have begun to have zero markup. The price of the manufacturer will be the same as the hospital. In the past, there was a 10% increase. This increase had a relatively large impact on hospitals, and I am used to it now. After the price reduction, from the perspective of medical insurance rewards, it may be a good thing for hospitals, but this policy is different from place to place and needs to be looked at in detail." Li Ziying said The reporter said.
What should I do if the number of centralized procurement exceeds the actual consumption of the hospital?
Will the hospital incur an additional burden?
"This is based on the total amount of surgery you performed last year to assess the approximate demand for this year. This assessment only accounts for a part of all the needs." Zhang Yongzheng said that the hospital needs to report as many consumables as needed. "You also report this amount. You need to be responsible, as long as you are rigorous in reporting requirements, there will be no burden."
Zhang Yongzheng said that the price reduction of such high-value medical consumables through centralized procurement is also very effective in reducing medical insurance expenditures. "According to the previous conventional state, a coronary stent is 7000 yuan, and the cost of 3 stents implanted by a patient is 21,000 yuan, which is reimbursed by medical insurance. Part, part of the patient’s own expenses. Medical insurance reimbursement is also very expensive. For example, if you pay for 50% of medical insurance, you have to pay more than 10,000. The current stent is 700 yuan, and the full medical insurance reimbursement is only 2,100 yuan. There is also pressure on medical insurance. Obviously eased".
Manufacturer:
"If you don't win the bid, you may not be in this market"
"No matter what product it is, in this environment, there may be a risk of substantial price cuts. You can only run forward and maintain innovation. It depends on whose products have more products. At this time, the company can better promote new products. Products, occupy the market." A related person of a listed medical company who did not want to be named told reporters.
On the second day after the results of the collection of coronary stents were announced on November 5, 2020, listed companies in the medical device sector generally closed down on November 6, and the total market value of the sector evaporated more than 70 billion yuan on that day.
Huo Xiaoyun said, "The annual domestic sales of stents is about 1.5 million, and the amount is about 20 billion. After centralized procurement, it will probably shrink to 1 billion."
A person in charge of a medical device company who did not want to be named told the Shell Finance reporter: “The stent is a rigid demand, and patients must use it when they get sick. The medical insurance expenditure is huge. After the price is reduced, the medical insurance can save a lot of money. It must be admitted that more than 50% of the dealers are Services that are not necessary, but can they be reduced slowly, 20% or 30% is fine, and now the price is reduced by 90%, which is too fast.
However, regarding the industry’s concerns, both Lepu Medical and Lanfan Medical, which have won the bid, have conveyed a more positive attitude to the outside world.
The product that Lepu Medical won the bid was a cobalt-based alloy rapamycin eluting stent system. The winning price was 645 yuan, which was the fourth lowest price among all the products that won the bid. It was 77% lower than the previous national lowest price. The declared volume was 120.56 million. .
Will this product that won the bid still have a profit after the price cut?
A reporter from Shell Finance and Economics called Lepu Medical as an investor, and the other party said: "Because it has just entered the first quarter, the specific situation is not clear. I understand that this product will not lose money. At least we did not lose the bid. If we do not win the bid, it may be No longer in this market, the core of the company in the future is to make new products."
"Centralized sourcing may have an impact on traditional products in stages, but it also provides more opportunities for new products. The company's growth needs to be promoted more through new products. Centralized sourcing has not impacted our core motivation, namely innovative medical care. A related person from Lepu Medical said, “Strateically, in order to hedge the impact of centralized procurement, we will push innovative products. From 2019 to now, four new products have been launched. At the same time, we will gradually increase the Opening up overseas markets."
According to data, the winning stent will account for less than 3% of Lepu Medical's estimated total revenue in 2020 and less than 5% of the company's estimated total gross profit.
At present, Lepu Medical intends to apply for the issuance of convertible corporate bonds to unspecified objects. Among them, it plans to invest 1.15 billion yuan in the “R&D project of important innovative devices without implantation in the coronary and peripheral fields”.
In the recent response to the issuance of convertible bonds, Lepu Medical stated that all the products of the fundraising project are important innovative medical device products.
It has the advantages of high-tech barriers and technological industry leadership. After it is approved for listing, it will promote sales in a relatively long period of time, mainly relying on the patient’s own expenses or commercial insurance payments. At the same time, there are few or few competitors, so it will not be in a long time. Will be included in the medical insurance reimbursement payment.
Lepu Medical said that since 2019, the company has made every effort to promote and sell innovative device products such as bioabsorbable stents (NeoVas), coronary drug balloons (Vesselin) and the cutting balloon system (Vesscide) approved at the end of 2020.
At the same time, a large part of this fundraising project is the clinical research and development of major innovative devices facing overseas.
The new product will effectively make up for the decline in revenue brought about by the purchase of traditional metal brackets.
Another listed company that won the bid was Blue Sail Medical. Its subsidiary Shandong Jiwei Medical, which indirectly holds 93.37% of its shares, won the "lowest price" for the centralized procurement of coronary stents. The target product was a drug-coated stent system ( Rapamycin), the declared volume is 10,069, and the proposed bid price is 469 yuan, which is 84% lower than the previous national lowest price.
After the results of the centralized procurement were announced, many investors raised questions to Lanfan Medical on the interactive platform. Most of the questions focused on "what is the impact of centralized procurement on the company's net profit?" and "whether the substantial price reduction of the bracket will affect the company's performance".
In response, Blue Sail Medical stated that the volume procurement mechanism has given clear sales commitments and expectations, which has increased the company’s sales. At the same time, it is equivalent to directly meeting supply and demand, saving intermediate sales expenses; and shortening the payment time. Improve the operating efficiency of bid-winning enterprises.
At the same time, Blue Sail Medical stated that centralized procurement will help increase industry concentration, and that leading companies with more innovative strength and willingness to innovate will accelerate their rise in the future.
channel:
Manufacturers began to vigorously expand retail channels
The implementation of centralized drug procurement has also changed hospital procurement.
Wang Ling (pseudonym) is a pharmacy purchaser in a tertiary hospital in Henan. The changes in the centralized procurement of medicine are also relevant to Wang Ling's work.
It said that the hospital will complete the purchase volume according to the requirements in the centralized procurement notice. "After the notice is received, we will sign a contract with the company. Basically, medicines can be delivered by specific drug sales companies. Some are limited to one company, and some are limited. There are several companies."
In Wang Ling's view, there will be differences between the agreed quantification of centralized procurement and the actual amount of medicine used by doctors, and there may be situations in which the agreed purchase amount may not be completed. "We had a drug that did not meet the standard and was notified by the city." .
Medical companies are beginning to expand their sales channels.
Lepu Medical (300003.SZ) recently announced that after the company's clopidogrel bisulfate and atorvastatin calcium won the bid for collection, the sales of the two products in medical institutions have increased rapidly, but due to the collection, they have been in medical institutions. The sales price dropped significantly, resulting in a significant decrease in operating income in medical institutions.
In response, Lepu Medical has expanded the sales of two products outside of medical institutions, and the above two products have achieved steady growth in retail pharmacies across the country.
In addition, the investment of investment institutions in the field of medicine has also changed.
"After centralized procurement, pharmaceutical companies have indeed paid more attention to pharmacy channels, and several pharmacy companies have responded like this. Innovative drugs, innovative devices, medical services, pharmaceutical consumer products, etc., are areas that we will focus on in the future." Huo Xiaoyun told reporters, " In the past, the scope of investment was much wider, but now we will focus on innovative drugs and innovative devices in medical insurance, and some are not affected by medical insurance policies, because as long as they are in medical insurance, there is more or less risk of price reduction."
market
The fourth batch of centralized drug procurement "the arrow is on the string" "price war" is about to start
On January 15, 2021, the State Organizes the Joint Procurement Office for Drug Centralized Procurement and Use to issue the "National Drug Centralized Procurement Document", and the fourth batch of centralized drug procurement "battle" is about to start.
Judging from the "Catalogue of Procurement Products", the centralized drug procurement involves 45 types of drugs, and many listed companies have production approvals for some drugs, such as Yuandong Bio (688513.SH)'s ibuprofen injection and Lyme The oral dosage form of voriconazole (300006.SZ) and sodium hyaluronate eye drops of Xingqi eye medicine (300573.SZ).
For this reason, the Shell Finance reporter called Yuandong Biotech as an investor. The other party stated that Yuandong Biotech is positive about preparations for centralized procurement, mainly preparing prices. "The company is evaluating what price can win the bid. It is definitely necessary to prepare. If you do not prepare and fight, the original volume will be divided by the market a lot, so this work must be done."
It is understood that in the field of centralized drug procurement, for unsuccessful products, medical institutions can only continue to purchase and use other unsuccessful drugs on the basis of guaranteeing the amount of the winning product, and the purchase quantity shall not exceed the winning product after conversion.
In this regard, Huo Xiaoyun, a senior investor in the pharmaceutical industry, believes that because the price of the winning drug will drop sharply, the end result may be that some drugs that have not won the tender choose to actively reduce their prices to fight for the initiative in market competition. Therefore, there are varieties included in the centralized drug procurement catalog. The risk of a substantial drop in the price of a product's winning bid.
Take Yuandong Bio’s bisoprolol fumarate tablets as an example. The product was confirmed to have won the bid for Shanghai’s centralized drug procurement in October 2019, and in January 2020, it was confirmed that it won the bid for the national centralized drug procurement. The price of the winning bid was higher than before the centralized drug procurement. The drop was 69%.
In the prospectus disclosed in August 2020, Yuandong Biotech stated that the impact of the price drop on operating profit is relatively small.
According to the company's sensitivity analysis and calculation results, if the company's sales of bisoprolol fumarate tablets in 2020 does not increase by 10% year-on-year, the company's operating profit of this product will decline year-on-year, which will adversely affect the company's operations.
However, in the case of a substantial increase in sales, bisoprolol fumarate tablets finally contributed to Yuandong's 2020 net profit growth.
On January 10 this year, Yuandong Biological disclosed an announcement on the pre-increasing performance. It expects that the net profit attributable to the owners of the parent company in 2020 will be 170 million to 185 million yuan, a year-on-year increase of 56.52% to 70.33%.
Among them, "bisoprolol fumarate tablets ranked first in the bidding of national drug concentration purchases leading to increased sales" is one of the reasons.
"The company's bisoprolol fumarate tablets were previously selected for centralized procurement, and revenue has declined slightly, but net profit has increased, but only for this product." The aforementioned Yuandong Bio-related person said that for the company's two How will the profit of the products participating in the fourth batch of centralized procurement change? He said that it is difficult to judge, "We have to see, it is too early to discuss this issue, because I don’t know how many companies have won the bid, such as There are two bisoprolol fumarate tablets in total, and we are the number one, and our share is relatively large."
At the same time, Yuandong Bio is also adjusting its business strategy, and the proportion of innovative drugs will increase in the future.
"The company is also working hard to increase the proportion of biological drugs and innovative drugs. These two items are relatively unaffected by the cost of medical insurance. At present, the company has more than 50 research projects, 20% of which are innovative drugs. The current strategy will increase." The aforementioned Yuandong Bio-related person said, "Our company's strategy is to first use generic drugs to keep profits, and then use these profits for research and development."
Beijing News Shell Finance reporter Xiao Wei Li Yunqi Yan Xia