At 0.98 yuan, the talk was done.
Although the drug price was only cut off at the medical insurance negotiation site by 2 cents, for Wu Maoyou, the CEO of the pharmaceutical company, it has broken the limit psychological price several times.
"We are mainly calculating whether there is still profit margin for this price."
Wu Maoyou's small abacus was temporarily operating rapidly, and the unit price was finally concession in the expected sales market.
He calculated an account: successfully entered the medical insurance catalog, the company's sales of this drug can roughly rise from 600,000 boxes to 1 million boxes.
On the contrary, it means that this drug has a slim chance of survival.
The “soul bargaining” that is indispensable for every cent makes medical insurance negotiations out of the circle, which is also regarded as bargaining by the people.
Behind this, the minute changes in price negotiations and the superimposition of a huge patient base all mean adjustments to huge benefits, and the difficulty can be imagined.
In recent years, the price reduction of medicines has become a major trend. On the road of tit-for-tat game, patients are looking forward to more good medicines entering the medical insurance catalog.
An interviewee frankly said in an interview with a reporter from the Beijing News, "What is saved is real money, and what is saved is a living life."
Game
Price cut 2 mao "clearance"
Starting in mid-December 2020, the three-day fourth medical insurance drug catalog negotiation has not only become the scene of entry, but bargaining is also difficult to hide the "flavor of gunpowder."
In order to get its Xiongdan Shugan Lidan capsules into the market, Wu Maoyou, deputy general manager of Yunnan Mingyang Pharmaceutical Co., Ltd., and the company's financial manager and sales manager did their homework, especially the hit rate of drug prices.
"Our psychological price at the time was around 1.18 yuan. In order to negotiate smoothly, the first quotation had already been voluntarily reduced on this basis and reported 1.14 yuan." Wu Maoyou told the Beijing News reporter.
But the reality is far more "skinny" than expected, and the first quotation is higher.
The medical insurance negotiation rules are almost the same as in 2019. The National Medical Insurance Bureau determines the expected price of medical insurance, puts it in the envelope, and the company makes two quotations on its own. If both quotations exceed 15% of the expected price of the National Medical Insurance Bureau , The drug is out of the negotiation.
The nervousness during the second offer made Wu Maoyou unforgettable.
"I want to take a bottle of wine (to be bold)."
Among the five experts at the negotiation site, apart from a staff member of the National Medical Insurance Bureau, the rest were from the provincial medical insurance bureaus.
In Wu Maoyou's mind, there are four or five negotiation rooms, and multiple groups are conducting simultaneously.
"The experts who negotiated with the Medical Insurance Bureau did not know the'bottom line' of the drug price at the beginning. After the first offer, the negotiation expert opened the envelope and saw the price, indicating that our price exceeded 15% of the reserve price." Wu Maoyou was responsible for the sales of the company on the spot. The person in charge of finance and the person in charge of finance calculated the production cost again before starting the second quotation. After the price was reduced by 10%, it was successfully entered into the expected price of the Medical Insurance Bureau. After that, the third quotation continued to be lowered while controlling the cost. 5%.
"In fact, we are mainly calculating, after the price is reported, whether there is still a profit margin combined with the estimated sales volume, so the final successful price is 0.98 yuan (0.5g/grain)." Wu Maoyou said.
This price is 2 cents lower than Wu Maoyou’s psychological price, “but this ratio is also very large, because our price is very low.” After the incident, he did not shy away from talking about the worst result. With medical insurance, the chance of survival of this drug is almost zero, and the sales market will be "small and small."
Nowadays, Yunnan Mingyang Pharmaceutical Co., Ltd. has new expectations for the sales of Xiongdan Shugan Lidan Capsules: last year, the sales volume of this medicine was 600,000 boxes, and it is expected to reach 1 million boxes this year.
It is reported that many drug distribution companies have actively contacted Mingyang Pharmaceutical to seek relevant cooperation.
"In terms of production capacity, we are sure to be able to support the estimated sales." Wu Maoyou told reporters.
Ups and downs
Small pharmaceutical companies rush to take the test, seeking low prices for the market
Medical insurance negotiations have always been called "life and death" by some industry insiders: companies that successfully enter the national medical insurance catalogue will have a broad market and be able to "change prices by volume"; failure to negotiate means that they missed the opportunity to open up the market, especially For some companies with weak sales capabilities, they are struggling.
"Negotiating failed" "too low".
Unlike most pharmaceutical companies stepping out of the secretiveness of the medical insurance negotiation scene, Wang Haopeng directly announced the end of the national medical insurance catalog.
Although he did not want to disclose the final bid too much, he told the Beijing News reporter that he made two quotations, which fell by more than 60%, but it was still 20% higher than the reserve price expected by the Medical Insurance Bureau.
Jin Shikang, led by Wang Haopeng, is an enterprise hoping to win the market with lower prices.
After more than ten years of research and development, he took the company's only listed new drug into the medical insurance negotiation scene.
"Very difficult," Wang Haopeng told the Beijing News reporter when talking about the drugs participating in the medical insurance negotiations. This Chinese patent medicine for rheumatoid treatment was launched in 2017, but it did not enter the local medical insurance and national medical insurance. The sales scope can basically only go to individuals. Outpatient.
In Xinjiang, where the pharmaceutical industry is underdeveloped, Xinjiang Jinshikang has been a role model for local new drug manufacturers in Urumqi many years ago, and this has not changed its survival dilemma.
"The reference product that the Medical Insurance Bureau looks for should be compared with the old drugs already on the market, or between new drugs and new drugs. You can't compare new drugs with old drugs." "Especially small companies, they have difficulty in the market and need some room for survival." Companies can only let others participate in shares or sell them"...
Before the medical insurance negotiations, he said that before preparing to sprint the medical insurance catalog this time, the company was already connecting with the capital.
However, a reporter from Shell Finance and Economics noticed that among the rheumatoid Chinese patent medicines brought by Wang Haopeng, many drugs have already entered the national medical insurance.
According to the "2020 National Medical Insurance Drug Catalog Adjustment Work Plan", the 2020 catalog adjustment is divided into five stages: preparation, enterprise application, expert review, negotiation access, and announcement of results.
After passing the expert review, negotiation access has become the most important link, and how to determine the price has become the focus of many enterprises to think carefully.
In order to win more room for price reductions, in recent years, my country has begun to use professional tools such as pharmacoeconomics to evaluate the value of drugs. At the same time, there is a payment standard calculation team that comprehensively evaluates the negotiation of drugs based on domestic and foreign conditions, substitutability, and medical insurance affordability. The real value is measured and calculated after entering the medical insurance, and finally an expected reserve price is determined.
Medical expert Shi Lichen told the Beijing News reporter that the key to whether a company can enter is the price reduction. "Anyone that comes to the negotiation link is to compete in price. Some companies have spent millions of dollars in the early stage to do a lot of work, but because No quotation strategy ended up being out."
Lighten up
"Soul bargaining", the average price of a hundred medicines dropped by 50%
According to public reports, negotiators will not only use words and gestures, but also use eyes and expressions to continuously guide companies to make profit and then make profit again, until it reaches the expected bottom price of medical insurance.
"The lowest price in the world is nothing new." "7 and 4 are really not good to be connected together. For patients, it is really not auspicious." "Can you not drop another dollar?"...
The health insurance party's counterattack at the negotiation site has become the latest version of "soul bargaining" circulating in 2020.
This joint targeted tumor drug for the treatment of melanoma was negotiated at the scene. After three quotations, the negotiation was finally successful at 739 yuan.
For patients, concessions are obviously the gospel.
It is understood that although the incidence of melanoma is extremely low, the drug has about a thousand patients in my country, but when it was first launched in China, the annual cost was about 800,000.
Wu Ming, assistant to the director of Peking University Medical Department, and professor and director of the Department of Health Policy and Management of the School of Public Health, told reporters that the most important function of medical insurance is actually "how to use medical insurance funds to buy the most services and the best services."
Through a series of measures, the funds for medical insurance can be used effectively, the compensation level of the common people is improved, and the self-payment is relatively small.
On the other hand, the cost is controlled and the medical insurance funds make room for more services, which is most beneficial to the insured.
"The update of the medical insurance catalogue is to include some medicines with better effects that are not in the medical insurance catalogue into medical insurance, and it is also an effective use of medical insurance funds." Wu Ming said.
At the end of last year, the results of the negotiations on the "2020 Drug Catalog" were announced, and this new catalog will be implemented from March 1.
Compared with previous years, an important feature of this adjustment is that the number of medicines negotiated for price cuts is the largest, and the treatment fields benefited the most.
After this catalog adjustment, there are a total of 2,800 drugs in the final catalog, including 1,264 in the western medicine part and 1,315 in the Chinese patent medicine part. The proportion of Chinese and Western medicines is basically the same.
According to the National Medical Insurance Administration, a total of 162 drugs were negotiated and 119 were successfully negotiated (96 out of the list and 23 in the list), with a success rate of 73.46% and an average price reduction of 50.64%.
A total of 119 new drugs (including 96 exclusive drugs and 23 non-exclusive drugs) were added to this catalogue adjustment. These drugs involve a total of 31 clinical groups, accounting for 86% of all clinical groups, and patients benefit from a wide range of products. The patient's sense of gain will be stronger.
The Beijing News reporter noted that there are also some "old varieties" that have been in the catalog for a long time.
According to information from the National Medical Insurance Administration, these 14 drugs are all drugs that have not been negotiated during the early access catalogue and have been assessed for significantly higher prices or costs.
After negotiation, the 14 drugs were successfully negotiated and kept in the catalog, with an average price reduction of 43.46%.
From the perspective of patient burden, through negotiation of price reduction and medical insurance reimbursement, it is expected that the cumulative burden of patients will be reduced by about 28 billion yuan in 2021.
effect
Some pharmaceutical companies cut prices on their own, and anti-cancer star drugs are reduced by 10,000 yuan
"We are very happy to see more and more drugs entering the medical insurance catalog." A breast surgeon told the Beijing News reporter: "Many drugs for breast cancer have already entered the medical insurance catalog, and there are still some targeted drugs because of different Various reasons are not included. Some patients spend more than 100,000 yuan on a medicine each year, which will definitely increase the financial burden."
In the past ten years, the incidence of breast cancer has been increasing year by year due to the influence of bad lifestyle habits, radiation and hormone drugs.
According to the latest global cancer data released by the International Agency for Research on Cancer (IARC) of the World Health Organization, in terms of the type of cancer distribution, the number of new breast cancers reached 2.26 million, surpassing lung cancer (2.21 million) for the first time, becoming the "world's largest cancer" .
A reporter from the Beijing News searched the Post Bar and found that many patients hoped that the star breast cancer drug Aiboxin (generic name piperazil) could be covered by medical insurance.
In this regard, Pfizer told reporters that the company has also been striving for Aiboxin to enter the medical insurance catalog, and it is "very regrettable" for this failure to succeed.
However, with the conclusion of this round of medical insurance negotiations, on January 18, 2021, Pfizer announced that the price of Aiboxin will be reduced, and the price per bottle will be reduced from 29,799 yuan to 13,667 yuan, a 54% price reduction.
According to the calculation of patients taking medication, if according to the common dosing schedule, the 125mg of Aiboxin will be taken once a day for 21 consecutive days, and then the medication will be stopped for 7 days. 28 days is a treatment cycle.
Before the price reduction, the patient's monthly treatment cost was about 30,000 yuan. If there is a charity donation, the monthly treatment cost is about 17,000 yuan.
After the price cut, the monthly treatment cost was further reduced to about 13,000 yuan.
On January 22, Pfizer told reporters that the company decided to lower the price of its products. The purpose is: "In order to improve the accessibility of targeted drugs for patients, help patients reduce their medical burden and reduce medication expenditures... This substantial price cut will help Patients and families suffering from breast cancer will benefit more, and the five-year survival rate of patients with advanced breast cancer will be further improved."
Pfizer revealed that Zhuhai, Shenzhen, Suzhou, Hunan, Hangzhou and other places have included the innovative oncology drug Aiboxin into the catalog of supplementary medical insurance for major diseases and local commercial insurance.
In November last year, Pfizer reached a strategic cooperation with Magnesium and China Re Life, and this year it will gradually start active cooperation with interested local governments to promote the implementation of commercial insurance.
In this regard, some industry insiders analyzed to reporters that the domestic pharmaceutical market will be more complicated due to the influence of national medical insurance negotiations and national centralized procurement policies. "Pfizer, such as Pfizer, has not entered the medical insurance but actively reduced prices. The more, the greater the price reduction will be."
The price reduction of anti-cancer drugs saves patients’ life-saving money, while breast cancer drugs are only a microcosm of the price reduction.
On January 25, the director of the oncology department of a hospital in Henan told the Beijing News that Hengrui's PD-1 drug was previously priced at 19,800 yuan per tube, but after entering the medical insurance, it was reduced to 3,000 yuan per tube. There are already patients waiting for the drug.
In 2018, when the National Medical Insurance Agency was established, it organized special access negotiations for anti-cancer drugs. In the end, 17 drugs were successfully included in the list through negotiations, and the agreement expired at the end of 2020.
Among these 17 anti-cancer drugs, 3 drugs have generic drugs on the market and are included in Class B management.
The 14 exclusive drugs were renewed or negotiated again in accordance with the rules, with an average drop of 14.95%, of which some first-line anticancer drugs dropped by more than 60%.
According to the National Medical Insurance Administration, the price reduction of 14 anti-cancer drugs is estimated to save more than 3 billion yuan for cancer patients in 2021.
At the same time, 17 new anti-cancer drugs were added in this adjustment, including PD-1, lenvatinib and other new drugs and good drugs. The level of protection for cancer drugs in the catalog has been significantly improved.
pattern
Mergers and reorganizations of enterprises have occurred, and the market structure has changed
In fact, price cuts over the years have long been the general trend.
Last year, the "benchmark" drug dapagliflozin (Anda Tang) for the treatment of type 2 diabetes was cut from "5.62 yuan" to "4.40 yuan", and was finally sold at the world's lowest price of 4.36 yuan.
In that year, a total of 97 global imported drugs were successfully negotiated to be included in the scope of category B drugs. Among them, the price of 70 drugs fell by an average of 60.7%. "Noble drugs" became "civilian prices", and most drugs entered the medical insurance list at the lowest prices in the world.
As for the first batch of medical insurance negotiations, it can be traced back to 2016. There are 3 varieties that are finally negotiated, and the negotiated drug price cuts are 67%, 54%, and 55% respectively.
In April 2017, 36 drugs were successfully negotiated. Compared with the average retail price in 2016, the average drop of negotiated drugs reached 44%.
The "Interim Measures for the Administration of Medications for Basic Medical Insurance" clarifies that the medical insurance catalogue will be adjusted once a year in principle.
According to the information released on the official website of the National Medical Insurance Administration in November last year, in order to adapt to the advancement of clinical medicine technology and the changes in the needs of insured personnel, the country has carried out 5 large-scale medical insurance catalog adjustments. The number of drugs in the catalog has increased from 1,535 to 2,709. One.
For patients, it is regarded as a kind of hope that more drugs can be included in medical insurance.
A parent of an SMA (spinal muscular atrophy) patient in Shanghai told a reporter from the Beijing News that the SMA specific drug Nosinasana injection that his child needs is expensive, 699,700 yuan per tube, and it will be taken in the first two months of treatment. 4 injections, 1 injection every 4 months thereafter, life-long medication is required.
"At the end of 2020, the pharmaceutical company applied to enter the national medical insurance catalogue, but did not enter into the negotiation." The parent said that at present, local medical insurance in Anhui and other places has issued relevant rescue policies, and he is very much looking forward to the implementation of relevant policies in Shanghai and other regions.
The medical insurance catalog is updated. The patient's drug price is a problem in front of the stage, while behind the scenes it is related to the medical landscape.
During the interview, Wu Maoyou told reporters from the Beijing News that the fact that drugs can enter medical insurance is of great help to companies. On the one hand, sales channels have opened up and the popularity of drugs has also increased. The R&D costs of companies investing in this drug will vary. The gradual decrease in profit growth is conducive to the long-term development of this drug; in addition, after the company obtains profits, it will also have R&D funds for other product projects, so it is also conducive to product innovation, and the company itself will also get better development of.
Regarding the impact of centralized procurement and medical insurance policies on production companies or sales companies and circulation companies, Wu Ming, assistant to the director of Peking University Medical Department, and director and professor of the Department of Health Policy and Management of the School of Public Health, said in an interview with a reporter from the Beijing News that centralized procurement can Play a role in regulating the pharmaceutical market and form orderly competition.
It is expected that in the future, the concentration of the pharmaceutical market will increase, and corporate mergers and reorganizations have already occurred.
In the future, the market structure and market share will change. This change is definitely going in a good direction, with higher efficiency and higher quality.
"Overall, the escalation of medical insurance funds has been further deepened, and the medical insurance catalogue has been adjusted to highlight clinically needed varieties, especially high-quality innovative drugs with high clinical value, which will continue to benefit in the future." An analyst at Industrial Securities said, referring to the results of medical insurance negotiations, we can find that Differentiated and innovative products often have a higher possibility of obtaining greater bargaining space, and tend to be included in the medical insurance catalog at a lower rate during the negotiation process to benefit more patients.
Judging from historical data, medical insurance negotiations have become an important channel for increasing the volume of innovative drugs, and the willingness and speed of innovative products to participate in medical insurance negotiations has continued to increase.
For drugs that do not have a comparative advantage in clinical value or are economically unsatisfactory, even if they have entered the medical insurance list, they will face the pressure of re-negotiation or recalling the list, thereby making room for more drugs with high clinical value to enter the list. It will also be the trend of future medical insurance catalog adjustments. The drugs in the catalog will be continuously optimized and upgraded to ensure the economy and higher clinical benefits of the medical insurance catalog drugs, and reduce the pressure on the payment of medical insurance funds.
It is understood that the current balance of the National Basic Medical Insurance Fund in 2020 will be about 270 billion yuan, and the cumulative balance will exceed 3 trillion yuan for the first time.
In 2019, the total income and total expenditures of the basic medical insurance fund for the whole year were 2,333.487 billion yuan and 1994.573 billion yuan respectively, and the accumulated balance at the end of the year was 2,691.211 billion yuan.
Xiong Xianjun, Director of the Medical Service Management Department of the National Medical Insurance Administration, said in an interview with the media at the beginning of this year, “We use the principle of importing and exporting some medicines and negotiating some high-priced medicines to reduce medical insurance fund expenditures. At the same time, In recent years, drug prices have been greatly reduced through centralized procurement and the expenditure of medical insurance funds has also been saved. Part of the saved fund space is used to expand the scope of the drug catalog. The purpose is to optimize the catalog structure, improve the efficiency of the use of medical insurance funds, and make those who have real curative effects Drugs that are relatively good and reasonably priced are widely used in clinics, thereby expanding the insured’s sense of acquisition of new drugs and good drugs."
"From the perspective of this adjustment, the reduced fund expenditures and the increased fund expenditures in the catalog are basically the same, so there will be no great pressure on the medical insurance fund." Xiong Xianjun said.
"The purpose of the medical insurance catalogue adjustment is not to save money, but to improve the level of medicine used by the people, so that the people can live healthier and longer lives."
Beijing News reporter Yan Xia Li Yunqi