The mystery of the shortage of influenza "miracle medicine": you can't buy it at a collection price, and you have to add money?

Per reporter Jin Zhe Chen Xing

The ferocity of this year's influenza A has made many provincial medical institutions difficult to overcome, triggering local medical insurance to purchase oseltamivir.

On March 3, the Gansu Provincial Public Resources Trading Center issued a notice to urgently purchase oseltamivir (21mg×130 capsules) produced by Dongguang Pharmaceutical and Beite Pharmaceutical at 127 yuan / box and 75 yuan / box, with a total daily supply of about 10,6000 boxes. In addition, Hunan Province and Henan Province have also included oseltamivir in emergency procurement drugs.

The reporter of "Daily Economic News" noted that the oseltamivir purchased by the Gansu Provincial Medical Insurance Bureau was produced by Yichang Dongguang Changjiang Pharmaceutical Co., Ltd., and the price of 13 yuan / capsule was comparable to that of the out-of-hospital platform, but it was 0 times the bid price of oseltamivir capsules (999.13 yuan / capsule) of Guangdong East Sunshine Pharmaceutical Co., Ltd. (hereinafter referred to as Guangdong East Sunshine Medicine).

Last year, oseltamivir was included in the national drug collection, Guangdong Dongguang Medicine (75mg×30 capsules) won the bid price of 29.97 yuan / box (0.999 yuan / capsule), other brands of 75mg × 10 capsules The bid price was 14.96 yuan / box ~ 27 yuan / box (1.496 ~ 2.7 yuan / capsule).

As a common drug for influenza, oseltamivir is in frequent shortages this flu season. The exclusive investigation by the reporter of "Daily Economic News" found that: on the one hand, there was an emergency procurement by medical insurance bureaus in many places; On the other hand, some winning companies behaved incomprehensibly.

According to the results of centralized procurement, Zhongshan Wanhan Pharmaceutical Co., Ltd. (hereinafter referred to as Zhongshan Wanhan) was supposed to supply Hunan Province, but there was a shortage of oseltamivir in Hunan Province; Guangdong Zhongrun Drug R&D Co., Ltd. (hereinafter referred to as Guangdong Zhongrun) was supposed to supply Gansu, and Gansu was in short supply. In other words, the products of the two companies can no longer meet the centralized procurement supply provinces. But at the same time, these two "out of stock" companies appeared on the emergency online bargaining list of oseltamivir of the Henan Provincial Medical Insurance Bureau, intending to supply to Henan. On the bargaining list in Henan Province, the supply price promised by the company is several times higher than the price selected in centralized procurement.

Medical insurance in many provinces urgently sought medicine, and some purchase prices exceeded the collective procurement price by 10 times

The peak of Flu A has an inflection point, but it is not over. According to the weekly report of the National Influenza Center, from March 3 to March 13, the positive rate of influenza virus tests in the southern provinces showed an increase and slowed down, while the northern provinces declined. A total of 3 influenza-like outbreaks were reported that week.

Every time there is an outbreak of influenza, oseltamivir will be out of stock and the price will increase. After being included in the national drug collection in 2022, this phenomenon has not been alleviated.

At the end of February this year, the "Daily Economic News" reporter called a number of pharmacies in Beijing, and the other party said that there was currently no oseltamivir in the store. According to an employee of one of the pharmacies in Dongcheng District, more than 2 boxes arrived on February 2 and sold out on the same day, "Usually there will be a little more (arrivals), but now there are too many people."

In March, the "Daily Economic News" reporter searched a takeaway platform in Chengdu and found that only a few local merchants had oseltamivir drugs for sale, and most of them needed to wait 3~3 days for delivery.

In the non-high incidence period, the retail price of 50 yuan ~ 70 yuan "Kewei" (oseltamivir drug produced by Yichang East Sunshine Pharmaceutical, 75mg× 6 capsules/box, capsules), the recent price of more than 100 yuan, and even the quotation of more than 200 yuan. According to data from the pharmacy online mall, from March 3 to 12, the average price of "Kewei" was 18.135 yuan, an increase of 42.3% from the average price of 5.11 yuan from March 121 to 07.

Some industry insiders revealed to reporters that the 75mg specification oseltamivir produced by Yichang East Sunshine Medicine and Guangdong East Sunshine Pharmaceutical are both "Kewei", but Yichang Dong Sunshine Medicine did not participate in centralized procurement, 10 capsules sold for 130 yuan, Guangdong East Sunshine Medicine participated in centralized procurement, 30 capsules for 29.97 yuan.

According to media reports, through intermediaries and distribution channels to raise prices, the purchase price of oseltamivir in some regions has exceeded the previous retail price.

Recently, the relevant departments of Henan, Hunan and Gansu Provinces have issued documents to urgently purchase oseltamivir.

Among them, the Hunan Provincial Medical Insurance Bureau said in a notice issued on March 3 that the backup guarantee mechanism was activated for oseltamivir phosphate capsules, and the oseltamivir phosphate capsules (21mg×75 capsules/box) of the reserve enterprise (Zhejiang Huahai Pharmaceutical Co., Ltd.) will be converted to the selected product from now on.

On the same day, the Gansu Provincial Public Resources Trading Center released the "Provincial Shortage Early Warning Drug Oseltamivir Emergency Listing Results", and oseltamivir capsules produced by Yichang Dongsunshine Pharmaceutical and Beite Pharmaceutical won the bid. Among them, Yichang Dong Sunshine Medicine supplies oseltamivir (130mg× 75 capsules) at 10 yuan / box, and the company promises a daily supply of 2000,127 boxes; Beite Pharmaceutical supplies oseltamivir (75mg× 10 capsules) at 4000 yuan per box, and the company promises a daily supply of <>,<> boxes.

If according to the collective price, the price of oseltamivir of Guangdong Dongguang Medicine is 0.999 yuan per capsule. Converted, the emergency purchase price (13 yuan / capsule) participated in by Yichang East Sunshine Medicine is 13 times the collective procurement price of Guangdong East Sunshine Medicine.

The reporter of "Daily Economic News" learned from relevant channels that oseltamivir in medical institutions in Gansu Province has a shortage, and this emergency procurement is mainly to meet the needs of public medical institutions in the province.

Henan Province temporarily hung 42 drugs in short supply, including oseltamivir capsules. The reporter noticed that the oseltamivir capsules temporarily hung on the net came from Zhongshan Wanhan, Guangdong Zhongrun, Shuanglu Pharmaceutical and other production enterprises. These companies all successfully won the bid in last year's oseltamivir centralized procurement, and in the temporary network (procurement) in Henan Province, the quotations of these companies also exceeded the bid price in last year's centralized procurement by more than several times.

Out of stock in the province where the bid is won in centralized procurement, but participate in emergency procurement in other provinces?

In the reporter's interview, the staff of public resource trading centers and provincial medical insurance institutions in Gansu, Henan and other countries all said: they have communicated with the original winning enterprise, but the supply volume of the original enterprise cannot keep up, indicating that it is "out of stock".

Taking Zhongshan Wanhan as an example, the company was originally a supplier of oseltamivir capsules in three provinces including Hunan. According to the notice released by the Hunan Provincial Medical Insurance Bureau on its official website, Zhongshan Wanhan's recent supply in Hunan Province is relatively tight, which cannot effectively guarantee the current clinical demand for influenza treatment.

The Hunan Provincial Medical Insurance Bureau exclusively replied to the "Daily Economic News" reporter interview: After entering the high incidence period of influenza in February this year, medical institutions, pharmaceutical distribution enterprises, municipal and prefectural medical insurance departments in the province frequently reflected that the seventh batch of national drug centralized procurement selected products oseltamivir phosphate capsules (selected enterprise: Zhongshan Wanhan) was in insufficient supply, and the supply was intermittent.

The Hunan Provincial Medical Insurance Bureau further said: "To this end, we have repeatedly contacted the selected enterprises to understand the situation, urge them to fulfill their main responsibility of guaranteeing supply, and supply our province in a timely and sufficient quantity." However, it is reported that because the provinces supplied by the enterprise are in the period of high incidence of influenza, the demand for drugs has increased explosively at the same time, the amount of drugs reported is insufficient, and the production capacity of the enterprise is limited, which is difficult to stably supply enough of the selected provinces. ”

However, Zhongshan Wanhan, which is "difficult to stabilize and sufficient supply" in the Hunan market, appeared in the negotiation list of oseltamivir of the Henan Provincial Medical Insurance Bureau on March 3, and participated in the negotiation of five batches of oseltamivir supply by the Henan Provincial Medical Insurance Bureau.

The reporter interviewed the Henan Provincial Medical Insurance Bureau about this. The staff of the bureau said on the phone that the original oseltamivir winning enterprise in Henan Province was in short supply, so the oseltamivir capsules of other enterprises were supplemented and hung on the net. The promised supply price is self-reported by the enterprise. The specific transaction price is negotiated and coordinated by the medical institution and the enterprise, which will not exceed the promised supply price of the enterprise, and the purchase volume is also negotiated by the medical enterprise and the supplier enterprise in demand in the province.

According to the above, the collective price of Zhongshan Wanhan oseltamivir (75mg×10 capsules) is 21.77 yuan / box. However, in the list of hanging nets in Henan Province, the price of oseltamivir of the company's "75mg, conversion coefficient of 10" (the same specification as 75mg×10 capsules) is 123 yuan / box, which is nearly 6 times the bid price.

Why is this the case? Zhongshan Wanhan is difficult to meet Hunan in sufficient quantities, is it to transfer to Henan to sell a "better price"? In addition, Zhongshan Wanhan is still a backup enterprise in Gansu Province, why did it not enter the latter's emergency procurement list?

According to the data, Zhongshan Wanhan was established in 2013 and is a holding subsidiary of Besunyen, a Hong Kong listed company. At present, the company has 3 product approvals for oseltamivir, the specifications are 75mg, 30mg and 45mg. According to the results of collection, the winning price of Zhongshan Wanhan oseltamivir (75mg×10 capsules) was 21.77 yuan per box, which was supplied to Hunan, Qinghai and Yunnan provinces.

The reporter noticed that on an e-commerce platform, the merchant named "Wanhan Pharmacy Flagship Store" has oseltamivir capsules (75mg×10 capsules) on sale, with a price of 88.9 yuan / box, and express delivery within 48 hours. The monthly sales volume of this product is displayed as "70,3+", and the shipping address is shown as Zhongshan City, Guangdong Province, where Zhongshan Wanhan is located. User Wang Xi (pseudonym) was told in Beijing on March 9 this year that many third-class hospitals did not have oseltamivir, but placed an order through an e-commerce platform to sell oseltamivir phosphate capsules at the flagship store of Wanhan Pharmacy, and received the goods three days later.

On March 3, the reporter contacted a staff member of Zhongshan Wanhan through an open telephone, who said that he would transfer the reporter's information to relevant people in the company, but as of press time, there was no further contact. On March 23, the reporter again called a number of public calls announced by Zhongshan Wanhan, but no one answered. Since then, the reporter has repeatedly sent interview outlines to Zhongshan Wanhan and its affiliated enterprise Zhongshan Wanhan Pharmaceutical Co., Ltd. (the enterprise investigation shows that the controlling shareholders of the two are the same) in the form of emails and official website messages, but no response has been received by the other party as of press time.

Later, the reporter tried to contact Zhongshan Wanhan as a pharmaceutical company, and a staff member said: "We have capsules, but now they are out of stock." Stocked is also available to the selected area first. The staff member also said that the company already had insufficient supply in the selected areas.

When the reporter asked why the company appeared in the temporary online negotiation list in Henan Province, the person said that the company has a special bidding colleague responsible for this part of the business, but the other party said frankly: "This kind of emergency temporary hanging net is our own doing, after entering the list, the product can be used as the selected emergency drug for normal supply." ”

Some insiders told reporters that many oseltamivir manufacturers have centralized and non-centralized procurement varieties, the price of centralized procurement is low and the profit is small, but the supply is carried out, after the flu outbreak, the amount reported by the hospital is far from enough, and then the one without the amount can be supplied. The hospital has been overpurchasing the share of centralized procurement, and the company is definitely not willing to supply it in large quantities. The reporter noticed that Zhongshan Wanhan only has 3 batch numbers, and the company also has products of 75mg, 45mg and 30mg, and one product can only correspond to one batch number.

It is worth noting that this situation is not a single case, and another collection of winning bidders, Guangdong Zhongrun, originally won the bid at a price of 24.80 yuan per box (75mg×10 capsules) to supply Hebei, Heilongjiang and Gansu provinces. However, Gansu Province also launched an emergency network due to the shortage of oseltamivir and purchased oseltamivir from Yichang Dongsunshine Medicine and Beite Pharmaceutical.

In the list of hanging nets in Henan Province, Guangdong Zhongrun also appeared, and the company supplied oseltamivir capsules (127mg×75 capsules) at a price of 10 yuan / box.

On March 3, the reporter of "Daily Economic News" contacted Guangdong Zhongrun Pharmaceutical Co., Ltd. through an open phone, and the other party said that "knowing that the company oseltamivir won the bid and did not need to be interviewed", and then hung up the phone.

Jin Chunlin, director of the Shanghai Health and Health Development Research Center, told reporters that centralized procurement is the bottom of medical insurance funds, while emergency or temporary online drugs are local financial funds. Therefore, the price of emergency or temporary online drugs is more determined by market supply and demand, and is not restricted by centralized procurement.

The number of API enterprises is small, and the temporary expansion of "no rice under the pot"

Since the current flu outbreak, many people have been discussing why oseltamivir is so hard to buy? The reporter learned that this is closely related to the change in the market pattern of oseltamivir.

In the market competition of oseltamivir, Dongguang Pharmaceutical used to be "the largest company", and since 2013, it has become the largest manufacturer in the domestic oseltamivir category. In 2019, the company's turnover of oseltamivir capsules and granules approached 60 billion yuan. After July 2022, with the opening of the seventh batch of national drug centralized procurement bidding, the lowest price quoted by Dongguang Pharmaceutical was 7.0 yuan / capsule, which directly compressed the profit margins and market scale of all enterprises.

According to the purchase volume of 75,1446,66 capsules of oseltamivir capsules (10mg) agreed in the seventh batch of centralized procurement, the 80 winning enterprises will be responsible for supplying 1157% of them, that is, 33,<>,<> capsules.

According to the Shandong, Hubei, Guangdong and Chongqing markets allocated by Guangdong East Sunshine Medicine, the total agreed purchase volume of 80% of these four regions is 505.78 million capsules, accounting for about 43.7% of the overall procurement volume, which is already the largest share of oseltamivir selected pharmaceutical companies in the seventh batch of centralized procurement. However, because the unit price is less than 1/10 of the previous one, the corresponding sales of about 500 million yuan are not even a fraction of Dongguang Pharmaceutical's revenue in 2021.

The remaining purchase volume of 75mg oseltamivir capsules is 651.55 million capsules, even if calculated according to the highest price of 2.7 yuan / capsule, the total amount is 1759.19 million yuan, which needs to be spread to 9 enterprises.

A representative of a selected enterprise previously said in an interview with the "Daily Economic News" reporter: Before centralized procurement, "Kewei" made new enterprises basically have no market space, so even if some enterprises passed the consistency evaluation, they did not really put into production and sales.

After centralized procurement, in addition to ensuring the supply of output, production enterprises do not dare to increase production capacity rashly. Industry insiders said that the sales of oseltamivir are strongly correlated with seasonal influenza outbreaks, and if production capacity is rapidly expanded and there is no seasonal influenza outbreak in the future, it is difficult to recover the upfront investment cost. In the first two years, the number of influenza infections was not large, oseltamivir sales were low, and companies were relatively conservative.

Beite Pharmaceutical told reporters that the company adopts order-based production for oseltamivir products, and will arrange production plans according to market demand. Poinsettia has also said that the company adopts the principle of "production by sales". The unselected enterprises simply left the site or concentrated their firepower on the production of other dosage forms of oseltamivir. In the case of abnormal outbreak of oseltamivir market demand, the supply capacity of enterprises is difficult to meet.

On the other hand, hospitals are also very careful about reporting before collection. An industry insider cited the hospital he was responsible for as an example, when the flu did not break out, 100 boxes could not be opened a month, and as a result, the amount of 1000,100 boxes was reported throughout the year, and the following small hospitals only reported 1000 boxes. But when the outbreak occurs, 3000~<> boxes are needed a month.

At the same time, there are few domestic API manufacturers, which also makes many companies "no rice under the pot" when this wave of influenza peak transit. The data shows that there are currently 27 oseltamivir API enterprises registered in China, 16 domestic production, 4 overseas production, 4 imports, and 3 domestic products; The API approved for use in the marketing dosage form involves 12 enterprises.

Among the pharmaceutical companies that won the bid for oseltamivir in the seventh batch of national centralized procurement, Dongguang Pharmaceutical, Zhongshan Wanhan and Nuotai Biotech have raw material production qualifications.

The relevant person in charge of Beite Pharmaceutical said in an interview with the "Daily Economic News" reporter that in this round of oseltamivir guarantee, striving to ensure the procurement of APIs is one of the company's important tasks.

The person said frankly: "The company's APIs of oseltamivir phosphate are purchased. At the beginning of the flu outbreak, the company has procured the API of this variety and increased the purchase batch. However, due to the certain supply cycle of APIs and the large growth of market demand this year, difficulties have indeed been encountered in the procurement process of APIs. In the face of this difficulty, the company has actively solved it, such as considering adding new API suppliers. However, whether to achieve new additions still needs to be subject to strict investigation, screening and verification of drug stability, as well as regulatory approval. ”

Because the number of influenza people has declined in the past two years, the use of oseltamivir APIs has plummeted, and many companies have not recovered this year, which has also led to a tighter supply of APIs this year.

In the upstream market, API prices are also "watching the rise".

On March 3, the "Daily Economic News" reporter called a number of manufacturers that said that oseltamivir APIs could be provided. Some manufacturers said that they can only supply scientific research institutions. Some manufacturers said that the company could produce APIs for export, but due to the epidemic, production has stopped. Another upstream company said: "If you don't want much, we can send you APIs for the lab." But the company's price opened to 22,2 yuan / kg, and its staff admitted that this price was about 4,4000 yuan / ton higher than before the flu outbreak.

With the resurgence of influenza, more oseltamivir manufacturers see the importance of APIs. In the 2022 half-year report, Poinsettia said that in order to enhance the stability of the company's supply chain, the company applied for the development of oseltamivir phosphate API, and the project has been declared. In March this year, Jincheng Pharmaceutical also said that the company's oseltamivir API products have been declared and are in the review and approval stage.

The reporter also noted that after oseltamivir capsules, the upcoming eighth batch of national drug centralized procurement will include oseltamivir dry suspension in the centralized procurement list. A total of 7 enterprises participated in the competition, including Dongguang Pharmaceutical, Borui Pharmaceutical, Beite Pharmaceutical, etc., both enterprises integrating raw materials and preparations, and enterprises that did not have raw material production capacity for the time being.

After the collection of dry suspension, what kind of disturbance will occur in the oseltamivir market, and whether oseltamivir will appear in the peak of influenza "one box is difficult to find", it is worth paying attention to. How to solve the problem of shortage after winning the bid at a low price, Daily Economic News will continue to pay attention.