The change rebate of pharmaceutical sales has not disappeared
Under the medical representative registration system, anti-corruption efforts have been intensified, and medical representatives claim to be "risky"
"Being a hospital (market) is now strictly investigated by the country, and after catching a red envelope to the doctor, you will all be in jail." Liu Xiaorong talked about the current pharmaceutical sales industry and kept emphasizing risks.
As a medical representative for more than ten years, Liu Xiaorong witnessed the changes in this industry with his own eyes.
Since 2016, some places have issued policies that medical representatives are not allowed to enter the diagnosis and treatment area.
Later, "medical representatives are prohibited from entering" was clearly posted on the hospital wall.
In December 2020, the registration system for medical representatives was officially implemented. What medical representatives can do and what is a restricted zone will be regulated again.
On the other hand, there is constant standardization of hospital-related systems, medical payment reforms, and hospital anti-corruption efforts have also been stepped up.
Since the implementation of the "two-invoice system", the circulation of drugs from pharmaceutical factories to hospitals has decreased, drug prices have dropped, and many small drug distributors have been eliminated.
The introduction and implementation of policies such as "4+7", centralized drug procurement, drug negotiation, and medical payment reform have also continued to affect the pharmaceutical and medical markets.
Stubborn illness
Undisappeared rebates and strict anti-corruption
"The risk is high." Liu Xiaorong, a regional sales manager of a listed pharmaceutical company in East China, emphasized: "The big risk I mean is not the amount of money in the salary, but the fact that some people are prone to illegal operations after poor performance. It's not going to go long."
On December 1, 2020, the administrative measures for the filing of medical representatives began to be implemented.
The system has been drafted since 2017, and it has taken two years for public comments.
Its express requirements prohibit drug marketing license holders from assigning drug sales tasks to medical representatives, and encourage sales behaviors such as implying that medical representatives violate laws and regulations.
The filing method of the medical representative system clearly stipulates 7 prohibitions such as conducting academic promotion activities without filing, conducting academic promotion activities without the consent of medical institutions, and participating in the statistics of the number of drug prescriptions issued by individual doctors.
Wang Ling has worked in the pharmacy of a tertiary hospital for many years and has also witnessed various changes in the hospital's drug procurement.
"There was a clean government inspection some time ago, and it came to check whether the doctors are using the medicines well. Many doctors told the medical representatives not to come here recently," said Wang Ling.
On January 22, Wu Ming, assistant to the director of Peking University Medical Department, and professor and head of the Department of Health Policy and Management of the School of Public Health, told the Shell Finance reporter: "The biggest problem in the medical field in the past was rebates. Because of the existence of rebates, from purchasing behavior to doctors. There are problems with prescribing drugs, such as purchasing high-priced drugs, prescribing more drugs, etc., and there is behavior that excessively provides services."
Wang Xiaofei, general manager of Xingyin Pharmaceutical Retail Marketing Center, said that for pharmaceutical companies, the main body of drug sales in hospitals is individuals. “For example, in a hospital in Beijing, the sales target is mainly for doctors. The dominant one is on the doctor’s signature pen."
From the perspective of the industry, the existence of rebates is also largely due to the influence of the salary structure of medical representatives: some pharmaceutical companies regard sales performance as the only assessment criterion for medical representatives, which also prompts many medical representatives to get lucky and violate the law. This is also called "sale with gold".
When asked by a Shell Finance reporter recently whether medical representatives will still appear in the hospital, Wang Ling said: "Medical representatives are not allowed in, but they wear ordinary clothes. Who knows when they come in. The doctor closes the door and is a consulting room. No one knows that this is a medical representative."
Under the medical representative registration system, it is clear that the work tasks of medical representatives are to formulate plans and plans for the promotion of medical products, deliver medical product-related information to medical staff, and assist medical staff in the rational use of the company’s products. Medical representatives are no longer sales. Is a professional engaged in information transmission, communication and feedback.
Under the filing system, academic promotion has become the most important task of medical representatives.
However, in Wang Ling’s view, the rebate problem has not been cured. Whether you can enter the hospital to conduct academic conferences depends on the relationship. "Sometimes medical representatives want to go to the hospital to give lectures to doctors, just to remind doctors that this disease can be Use our medicine, use our medicine more. Whether you can come to the department to hold a presentation meeting depends on the director of the department. The director will tell you if you want to."
reduce
Price-cutting pharmaceutical market and reformed sales channels
Under the strict record management system of medical representatives, medical representatives are still facing the challenge of market shrinking.
On January 23, a pharmaceutical company broke out from the media that another pharmaceutical company announced the abolition of the sales team of antibiotics. One of the reasons is: the online sales representative of the product is mainly responsible for two products, one of which has been purchased.
"There must be layoffs," Liu Xiaorong told the Shell Finance reporter that the current pharmaceutical sales work generally goes to two types of companies. One is the pharmaceutical production company where he works for sales. The company will give a higher basic salary. The salary model is "basic salary plus assessment. : How many tasks are completed and how many bonuses".
There is another type of sales model for the contract system.
Liu Xiaorong said: "Giving you a fixed sales area is equivalent to contracting this area. All markets in this area belong to your sales area. On this basis, the company will negotiate with you the base price, such as the base price of a certain medicine. It’s giving you 10 yuan. You can choose to sell for 20 yuan or 30 yuan. The difference is the money you make."
Pharmaceutical sales have a clear division of labor, and sales are also specifically divided into hospital medication and pharmacy medication (retail market). The former is mainly the sales target of prescription drugs, and the latter is the main sales target of OTC.
Since the implementation of the drug purchase policy, the circulation of drugs from manufacturers to hospitals has decreased, and many changes have taken place in these two types of sales paths.
“It’s even more difficult to do after the collection, and the prices of medicines are also reduced,” Liu Xiaorong said. Now hospitals are particularly difficult to run, especially the top three hospitals.
Affected by policies in the past two years, Liu Xiaorong's work has long been focused on the sales of chain pharmacies: If the sales of a certain drug sold in an offline pharmacy hit a record high, it is something to celebrate.
Liu Xiaorong introduced that in terms of contracted sales, many drugs will have "listed prices" after entering medical insurance or participating in centralized procurement. The prices are open and transparent, so that the part that makes the intermediate price is no longer profitable. "Now there are many (sales) All quit."
At work, Liu Xiaorong also witnessed the turnover of many people in the industry. “There are many companies with good profits that are expanding (sales teams), but most companies are laying off staff. For example, there were 10 people before, but now they are reduced to 6. , 5 people."
In the industry, companies have announced adjustments to their sales teams from time to time starting in 2019.
In the first half of 2019, the listed company Watson Pharmaceuticals announced the adjustment of the company's organizational structure, the establishment of a new marketing center, and the cancellation of the sales department.
In 2020, industry leader Hengrui Pharmaceuticals also began to directly reduce its sales companies.
In April 2020, Yuheng Pharmaceutical, a listed company, also stated that it will integrate the sales team of its subsidiaries into a sales team, and manage the province as a unit.
Retail terminals such as offline pharmacies are also undergoing changes. Wang Xiaofei, general manager of Xingyin Pharmaceutical Retail Marketing Center, believes that the layoffs of pharmaceutical companies are a "false proposition". The real situation is that the drug sales channels are undergoing changes.
"For example, because a certain product of a pharmaceutical company is covered by medical insurance or centralized procurement, some people may be laid off, but it only lays off people in this department. If the pharmaceutical company wants to increase the market share of the product normally, it will definitely Expanding other channels, such as retail pharmacy channels and county-level medical markets, may have to increase staff at this time."
reform
Future medication under changes in medical payment
Professor Wu Ming told reporters that the centralized drug procurement measures have solved many problems and effectively regulated the pharmaceutical market. "In the past, the pharmaceutical market was not competitive price and quality in economics, but competitive'rebates', which severely damaged the pharmaceutical market. This order has led to serious market failures. Under centralized procurement, whoever has good quality and who has a low price can sell their medicines, and sell more, instead of those who give more "rebates" in the past, whoever gets the medicine. Good sale."
Professor Wu Ming introduced that the medical payment reform in the past two years is also reducing the cost of medication in hospitals.
Through the reform of payment methods, a cost control mechanism for public hospitals can be established, and problems such as the rapid growth of medical expenses and unreasonable medical expenses under the profitable operation mode of "increasing service volume and income" in public hospitals can be solved.
“Inflated drug prices and excessive provision of services will occupy a considerable proportion of medical insurance funds. Now that the prices have come down and excessive services have been reduced, the space for medical insurance funds can be freed up, which can increase the compensation ratio of insured persons and also have room for inclusion New technologies and drugs that are in great demand and have good health-improving effects are also an incentive for innovation," said Wu Ming.
Wang Ling also told the Shell Finance reporter that whether doctors use drugs rationally is now very strict.
If you need to use drugs that are not in the hospital's catalog, you need to approve the levels before the purchasing department makes purchases.
The Shell Finance reporter noticed that many places have successively issued relevant implementation opinions to promote the rational use of drugs in medical institutions.
Take the implementation opinions of Henan Province on strengthening the pharmaceutical management of medical institutions in Henan Province to promote rational use of drugs issued in November 2020 as an example, which has corresponding requirements for medical institutions’ drug equipment, drug procurement and supply systems, and rational use of drugs.
In addition, drug prices at the retail end will also be reduced.
Wang Xiaofei introduced that the biggest feature of retail pharmacies is convenience and can quickly meet the needs of patients.
Drug prices in retail pharmacies are generally not higher than about 15% of hospital drug prices. “The business model of retail pharmacies is very different from that of hospitals. Because of the patient flow, some products that lose money will also be sold.”
Wu Ming said that in the future, the plan for centralized drug procurement will be expanded as soon as possible. "Because too few varieties are not enough for the entire market, including the promotion of public hospital reforms, and the people will not benefit enough. Of course. There are also medical insurance negotiations, and prices have also been drastically reduced."
"A combination of multiple methods is actually aimed at lowering the falsely high drug prices under the premise of improving the overall quality of drugs, so that the prices return to a reasonable range. This will benefit the people first. Then the second will help the reform of public hospitals. At the same time, it reduces business transaction costs, purifies the circulation environment, improves the industry ecology, and also helps promote pharmaceutical innovation."
Beijing News reporter Li Yunqi