In 31 provinces across the country, centralized insulin procurement has been implemented, reducing a certain economic burden for "sugar friends" and enhancing medication compliance
What is the impact of centralized insulin collection on patients?
At seven o'clock in the morning, Lin Qing got up on time, skillfully tore open a bag of alcohol cotton pads and wiped it on his middle finger, then took out a medical needle and stabbed his fingertip sharply, dripping blood on the test strip of the blood glucose meter, The screen of the blood glucose meter showed 5.1, and within the normal range, he was relieved to prepare breakfast.
According to the doctor's request, as a type 1 diabetic, Lin Qing measures blood sugar before meals every day, and then measures again 2 hours after meals. Based on the blood sugar level, he can judge whether he needs to supplement insulin or sugar.
In addition, take a test every day before going to bed, and then inject insulin.
Before the centralized collection of insulin, for Lin Qing, the monthly cost of insulin and injection needles cost seven or eight hundred yuan, which is a lot of expenditure for him, who earns more than three thousand yuan a month.
In order to save some money on blood sugar test strips, he will only take a test when he is not feeling well.
In his view, insulin cannot be avoided, but blood sugar can be assessed by itself "by feeling".
In November 2021, the national special centralized procurement of insulin was launched. It is estimated that the procurement demand for the first year of national insulin centralized procurement will be 210 million, involving an amount of 17 billion yuan, and the price of the selected products will drop by an average of 48%.
After the centralized collection, the annual cost of insulin is saved by about 9 billion yuan, which relieves a certain economic burden for patients who need insulin injections.
On July 4, the Shanghai Sunshine Pharmaceutical Purchasing Network announced that from now on, Shanghai will implement the sixth batch of national centralized procurement (insulin special) selection results.
So far, 31 provinces (autonomous regions and municipalities directly under the Central Government) across the country have begun to implement centralized insulin collection.
After the centralized collection was completed, Lin Qing began to measure blood sugar before and after meals as required by the doctor every day. Because buying medicines was cheaper, he saved two or three hundred yuan a month. The money could just be used to buy test strips and urge himself to measure blood sugar on time.
A number of industry insiders said that after the centralized procurement of insulin was implemented, not only the medication would be cheaper for patients, but also better drugs could be used for less money, enhancing the patients’ compliance with monitoring blood sugar and medication according to the doctor’s orders; for pharmaceutical companies, the centralized The market structure of Chinese and foreign companies will change after the harvest, which will help the selected companies to reduce production costs and new drug research and development, and promote the optimization and upgrading of the industry. It can also objectively reduce the cost of drugs for medical institutions and the expenditure of medical insurance funds.
Insulin centralized procurement not only benefits patients economically, but also greatly squeezes the “water” that is inflated in drug sales.
There are also clinicians who question whether the company can supply with high quality after the profit is compressed.
Jiang Changsong, Assistant to the President of the National Medical Insurance Research Institute and Director of the Price Recruitment and Procurement Office, believes that the mode of purchasing with volume will also bring about a change in the sales model after the company's drug prices are reduced.
Some enterprises will develop in the direction of scale and intensification, and actively transform and upgrade to do innovation and research and development.
“Really save money”
Lin Qing is 31 years old and has a history of diabetes for more than 20 years.
According to the official website of the National Health Commission, diabetes is a metabolic disease characterized by elevated blood sugar caused by defective insulin secretion.
The typical symptoms of diabetes are "three more and one less", that is, polydipsia, polyphagia, polyuria, and weight loss.
Long-standing hyperglycemia can lead to chronic damage and dysfunction of body tissues, especially the eyes, kidneys, heart, blood vessels, and nerves.
At present, there is no cure for this type of disease, only through timely treatment to relieve symptoms and delay the development of the disease.
Common drugs for diabetes are mainly insulin and hypoglycemic drugs.
Insulin is an essential drug for the treatment of type I diabetes (insulin-dependent diabetes mellitus) and some type II diabetes mellitus (non-insulin-dependent diabetes mellitus).
According to the time of action, insulin is divided into fast-acting meal insulin, long-acting basal insulin and premixed insulin in between.
Because of type 1 diabetes, Lin Qing's blood sugar control is inseparable from insulin injections.
If strictly follow the doctor's requirements, his daily treatment mainly consists of two parts, one is blood sugar monitoring, and the other is to inject insulin according to the blood sugar level.
Based on the introductions of many doctors and patients, the routine expenses of patients with type 1 diabetes mainly include test strips for measuring blood sugar, insulin drugs and injection needles.
The price of blood glucose meters ranges from tens of yuan to hundreds of yuan, which are durable goods. The main consumables are test strips. The price of a test strip ranges from a few cents to a few yuan.
If using a dynamic blood glucose meter, the main consumables are probes with sensors. This probe can be "affixed" to the arm, eliminating the pain of taking blood from the patient's fingertips, but the service life of the probe is generally two weeks, and the unit price is concentrated at 200 yuan to 500 yuan.
Blood sugar measurement is for insulin injection.
The conventional method is to inject subcutaneously through an insulin pen. The main cost is insulin medication and injection needles. Ordinary insulin medication costs about 500 to 600 yuan per month, and an injection needle costs about 2 yuan.
Because of its low cost, most patients are given the drug in this way.
The other is the use of insulin pumps. The advantage of this type of equipment is that it can continuously provide insulin 24 hours a day, avoiding the pain of frequent subcutaneous injections, but it is expensive, generally requiring tens of thousands of yuan for a single.
Lin Qing used a relatively cheap method, measuring blood sugar with fingertips, and injecting insulin with an insulin pen.
Because of the combination of meal insulin + basal insulin, four insulin injections are required per day.
He estimated that in the case of occasional blood sugar testing, it would cost seven or eight hundred yuan a month.
At the end of June, Lin Qing went to the hospital to prescribe medicine as usual, and when he checked out, he found that the price of the medicine was cheaper, "I use the meal insulin produced by Novo Nordisk. Use three per month; Sanofi's basal insulin, the original price of 180 yuan, is less than 70 yuan after centralized procurement, and two per month are used, and the rough monthly cost has been reduced from 570 yuan to 260 yuan, saving at least 300 yuan. Yuan. The actual cost after medical insurance reimbursement is even lower.”
The reporter learned from random interviews that as of mid-July, patients in Hubei, Jiangxi, Zhejiang, Guangdong, Inner Mongolia and other regions recently went to the hospital to prescribe medicine or buy medicine at designated pharmacies, and the price of commonly used insulin has been reduced to varying degrees. "It really saves money. ”.
According to the results of the proposed national centralized procurement of insulin on November 26, 2021, the average price of the products to be selected is reduced by 48%, with a maximum reduction of nearly 74%.
The prices of the selected insulins were all reduced to below 80 yuan per vial, and some of the selected products were below 20 yuan per vial.
"After centralized procurement, each patient can save thousands of yuan a year on average. According to the purchase volume of the insulin agreement, the country is expected to save more than 9 billion yuan every year." Jiang Changsong told reporters.
Why insulin?
According to the 10th edition of the "Global Diabetes Map" released by the International Diabetes Federation in December 2021, by the end of 2021, there will be 537 million people with diabetes among adults aged 20 to 79 in the world, including 141 million people with diabetes in China. No. 1 in the world.
"The state's centralized procurement generally gives priority to diseases with a heavy burden on the common people. There is a large population of diabetes in my country, and the annual cost of diabetes treatment is relatively high. Whether it is an individual or a medical insurance fund, the cost is relatively large." Peking University International Research Center for Pharmaceutical Management Director Shi Luwen said.
According to data provided by the National Medical Insurance Research Institute, insulin injection is 20,000 yuan per liter, known as one of the most expensive liquids in the world.
Among the hundreds of millions of diabetic patients in China, more than 10 million people are dependent on insulin. According to the price of 35 to 50 yuan per second-generation insulin and 70 to 240 yuan per third-generation insulin before centralized procurement, the average annual per patient Insulin costs between 2,000 yuan and 10,000 yuan.
The country spends more than 20 billion yuan on insulin every year, and medical insurance also bears a large expenditure.
The inclusion of insulin in centralized collection also benefits from the conditions that can be achieved.
"Before launching the procurement of insulin with quantity, the state has carried out 5 batches of centralized procurement of chemical drugs and accumulated rich experience in the reform of centralized procurement." Jiang Changsong said.
Guo Xiaohui, chief physician of the Department of Endocrinology, Peking University First Hospital, told reporters that in recent years, domestic insulin production enterprises have grown rapidly and have developed rapidly, making domestic insulin self-sufficient. If you don’t want to sell it, we also have domestic drugs to replace, which can meet the needs of patients.”
Insulin centralized procurement is the first biological drug in the country to be included in centralized procurement.
Jiang Changsong introduced that the earliest brewing began in the second half of 2019. In November of that year, Hu Jinglin, director of the National Medical Insurance Administration, conducted research on related work in Wuhan.
In January 2020, Wuhan launched the pilot work of negotiating local centralized insulin procurement.
In July 2021, Chen Jinfu, deputy director of the National Medical Insurance Administration, held a symposium with experts and enterprises on the centralized procurement of insulin-related biological drugs.
"Through the pilot centralized procurement in Wuhan, multiple rounds of clinical and procurement expert discussions, on-site investigations by multiple companies, and production capacity evaluation, the national centralized procurement negotiation will be completed in Shanghai in November 2021, resulting in the selection result." Jiang Changsong said.
Jiang Changsong emphasized that in view of the complex manufacturing process of biological preparations, drugs and consumables are generally used together, and it is difficult to expand production capacity in the short term. In order to maximize the protection of patients' diverse drug needs, the medical insurance department has explored a set of centralized procurement mechanisms for biological drugs.
The speciality of this mechanism mainly refers to the classification of drugs, not according to the common name of drugs commonly used in the past chemical drugs, but the second generation (human insulin) and the third generation (insulin similar to insulin) according to the efficacy characteristics and mechanism of action of insulin. Items), divided into three categories: mealtime insulin, basal insulin, and premixed insulin, and 6 procurement groups compete for quotations.
Secondly, in terms of the weight rule after the selection, within the same group of products, the selected products are divided into three categories: A, B, and C according to the price from low to high. The lower the quotation, the more preferentially selected in terms of purchase quantity and purchase order. .
Judging from the selection of insulin centralized collection, 16 generic drugs and a total of 42 insulin products were finally selected.
"Because 95% of insulin products on the market have been selected, almost all commonly used drugs are covered, which basically meets the diverse needs of patients." Jiang Changsong said that for pharmaceutical companies, the price grouping in the above mechanism can also protect companies. The enthusiasm and competitiveness of participating in centralized procurement.
In January 2022, the Shanghai Sunshine Pharmaceutical Procurement Network announced that the first-year agreement procurement of insulin special centralized procurement will be implemented in May.
From May to July, 31 provinces across the country successively issued notices, and the special centralized procurement of insulin was officially implemented nationwide, with a procurement cycle of two years.
Changes in "Sugar Friends"
After the centralized collection of insulin, the changes brought to patients are not only saving money, but also a series of linkage effects.
"After the centralized collection, we will recommend insulin based on the patient's condition. In the past, in addition to considering the condition, we also considered the patient's economic affordability." said Zhan Deshang, chief physician of the Endocrinology Department of Youxi General Hospital in Sanming City, Fujian Province, and director of the Diabetes Management Center. .
Zhan Deshang said frankly that in Youxi County, patients are generally more sensitive to drug prices, and slight changes in medical expenses will affect patients' behavioral choices.
"It saves money to buy medicine, and the patient's medication compliance will be higher. When the price was high in the past, patients would 'cut corners' in order to save money. The cheaper the price, the more willing to follow a doctor’s order.”
The reporter searched various posts and forums for diabetic patients, and found that patients were more discussing the changes in health management of "sugar friends" after the price cut.
Lu Qi, a type 1 diabetic patient in Guangxi, said that after the price reduction of centralized purchases, in addition to following the doctor’s orders for medication, he is more willing to cooperate with some necessary physical examinations. Do it when urged."
Another obvious change is the use of consumables.
"I used to give myself injections, and the doctor said that the needles are disposable, but it costs two yuan for a needle, which is too expensive. I know that a needle is not good for several days, but it can save some money, and I use it myself anyway. A type 2 diabetic patient in Inner Mongolia said, but after the centralized collection, "the needles are thrown away after they are used up, and I don't feel too distressed. Anyway, the money spent every month is about the same as before."
Considering that he had fainted on the construction site due to low blood sugar before, Lin Qing would be more active in measuring blood sugar after the centralized collection.
Lu Qi plans to update the equipment.
She calculated that after the insulin price cut, she could save nearly 3,000 yuan a year, and she planned to use the money to buy a dynamic blood glucose meter.
"My finger has a thick layer of skin like calluses because of the needle sticking for many years to measure blood sugar, and it is full of pinholes. Sometimes I can't find a complete piece of skin after sticking the needle." Lu Qi said that she had thought about it for a long time. I bought a dynamic blood glucose meter, but because of the monthly cost of seven or eight hundred yuan, I have been reluctant to buy it. "If you buy it now, the psychological burden will not be so heavy."
Lu Qi also observed the changes of "sugar friends" in some patient groups mainly born in the 1990s after the collection, "The general reaction of everyone is not to save money, but to increase the cost under the previous level of expenditure. Willingness to cooperate with physician treatment, such as no longer 'savings' in insulin dose and frequency, such as changing needles as required, or better monitoring of blood sugar."
Price cuts may drive changes in the market landscape
According to the survey data provided by Gan & Lee Pharmaceutical, a leading domestic insulin company, by the end of 2021, the overall scale of the national insulin preparation market will be nearly 400 million.
The National Medical Insurance Research Institute has calculated that these 400 million insulins will cost more than 20 billion yuan every year.
In the past, the 20 billion yuan market was dominated by multinational drugmakers.
According to data from the China Business Industry Research Institute, an industry consulting service organization, by the end of 2021, among insulin manufacturers, multinational companies have formed a market-leading advantage due to their early mastery of advanced products and synthesis processes, and their market share in China will exceed 70%. %.
This market pattern may change due to centralized procurement.
According to the announcement on the Shanghai Sunshine Pharmaceutical Purchasing Network, the national procurement demand for insulin centralized procurement in the first year totaled 214 million, including 90 million second-generation insulin and 124 million third-generation insulin, accounting for about 56% of the total insulin market in China.
11 companies selected after centralized procurement, including 7 domestic pharmaceutical companies and 4 multinational pharmaceutical companies.
Specifically, among the domestic pharmaceutical companies, Gan & Lee Pharmaceutical and United Laboratories both won the bids for 6 products, Tonghua Dongbao, Hefei Tianmai, Sunshine Pharmaceuticals, Jiangsu Wanbang, and Hisun Pharmaceutical won the bids for 5 and 3 products respectively. , 2, 2, 1; among multinational pharmaceutical companies, 7 products of Novo Nordisk won the bid, Eli Lilly, Baitong, and Sanofi, 5, 3, and 2 respectively.
Among them, the products selected by domestic pharmaceutical companies mainly won the bids in category A or category B groups, and multinational pharmaceutical companies, except for a few products, mostly won the bids in category C categories.
According to the above-mentioned principle of bidding weight, this means that domestic enterprises have a comparative advantage in the weight of centralized procurement of products.
After the centralized procurement was selected, listed companies Gan & Lee Pharmaceuticals, Tonghua Dongbao, United Laboratories, etc. announced that the winning of the centralized procurement will help the company to expand the sales of related products and increase the product market share.
A number of securities institutions also mentioned in the research report that after the centralized procurement of insulin, the market share of domestic pharmaceutical companies will increase to a certain extent.
For enterprises, is there still money to be made after the price reduction of centralized procurement?
According to the statistics of the National Medical Insurance Research Institute, the price of insulin after centralized collection has dropped by an average of 48%, of which the average drop of second-generation insulin is about 45%, and the average drop of third-generation insulin analogs is more than 50%.
In terms of specific companies, Eli Lilly's insulin lispro has dropped from 67.72 yuan/piece to 18.89 yuan/piece, a drop of 73%; Gan & Lee's insulin aspart has dropped from 71.48 yuan/piece to 19.98 yuan/piece, a decrease Over 72%.
The impact of the price cuts was quickly reflected in the company's financial data.
On July 14, Gan & Lee Pharmaceuticals released a loss announcement for the first half of 2022. The company expects to lose nearly 200 million yuan in the first half of the year, and the company's main operating income comes from insulin.
Regarding the main reason for the loss, Gan & Lee Pharmaceutical stated in the announcement that in the first round of insulin special centralized procurement, the company's 6 products were all won the bid in high order. Only started to purchase, in the short term, the price of the product dropped greatly, and the sales volume was small. The two failed to offset, and there was a loss.
At the end of 2021, a research report from the China Merchants Bank Research Institute pointed out that in this round of centralized procurement, Gan & Lee Pharmaceuticals’ price reduction model is more aggressive, with an average drop of 65.36%, which is the company with the largest drop this time.
"In centralized procurement, although the price of the company's products has been greatly reduced, it has also brought a considerable number of agreements, covering many hospitals in various districts, counties and cities, ensuring the sales channels and sales of the winning products, and helping to improve the company's market. Share." The relevant person in charge of Gan and Lee Pharmaceutical responded to the reporter of the Beijing News.
The person in charge said that the company will focus on improving the efficiency of existing production lines in the future to control production costs, and will also integrate resources and improve R&D capabilities.
Before the centralized procurement of insulin, the national large-scale centralized procurement has gone through five rounds, and the enterprises have also been waiting, hesitating, and even resisting from the beginning, and now they are actively facing it.
A doctor from the medical insurance department of a tertiary hospital in Beijing revealed, "In the past, before each collection, medical representatives of pharmaceutical companies would go to major hospitals to lobby, for example, to prescribe as little as possible a certain drug, or not to prescribe it if possible. , because of the large amount of use, it is easy to be included in the scope of collection.”
Now medical representatives will not come to do this kind of work. After the medical reform, doctors' prescriptions have approached the actual needs of patients, and there is no room for change.
"Centralized procurement squeezes the moisture in the middle sales link, which saves a lot of public relations costs, sales costs, financial costs, and management costs for the company, and gains tangible benefits." Jiang Changsong said.
He revealed that at the end of 2018, the anti-tumor drug pemetrexed was in the first round of centralized procurement. In that year, the annual sales of the drug in a certain company was only 30 million yuan. After the centralized procurement was selected, the sales exceeded 1.5 billion yuan. Everyone sees this trend.”
The relevant person in charge of Eli Lilly, a well-known multinational insulin manufacturer, said: "The policy of purchasing with quantity is the general trend. For enterprises, we must consider whether to actively embrace and follow the trend." Regarding the changes in China's drug purchasing policy, Eli Lilly and Company It is believed that enterprises will improve work efficiency and accelerate the access of innovative drugs, which will have a positive impact on the market and patients.
The premixed insulin selected by Eli Lilly was the product with the highest drop in the first round of centralized procurement, and it was also the third-generation insulin with the lowest price.
It is also the only original research drug in Group A of mealtime insulin analogs.
In the opinion of the above-mentioned person in charge, "original drugs" and "innovative drugs" are Lilly's comparative advantages in the face of market changes, and are also the focus of the company's efforts to ensure profits and long-term development.
The above-mentioned person in charge of Gan & Lee Pharmaceuticals also said that the company is also using the price advantage presented by centralized procurement to actively expand its market share outside the hospital and increase the market share of retail and other channels, so as to promote a comprehensive exchange of price for quantity and achieve large-scale sales. .
The focus of an enterprise is profit, while doctors and patients are concerned about the company's follow-up production capacity and quality assurance.
Guo Xiaohui said that she is worried about whether the company can guarantee the quality of products in accordance with the requirements of regulations after the price cut. "Medication is a scientific thing, and low prices cannot be given priority."
A doctor from the medical insurance department of a tertiary hospital revealed to reporters that "after the centralized collection, many patients came to the hospital to prescribe medicines and reported that some medicines had defects on the outer packaging."
"I hope the relevant departments can unblock the post-collection feedback mechanism and collect feedback from patients on subsequent medication, such as the difference in efficacy before and after the product, adverse reactions to medication, etc., to provide a basis for later supervision, and objectively strengthen post-collection feedback. Quality supervision." Guo Xiaohui said.
As for subsequent quality assurance, external constraints may be particularly important.
At the end of April, the National Medical Insurance Administration and the National Health and Health Commission jointly issued supporting measures for insulin procurement and use, and stipulated that the medical insurance departments at all levels will work with the health and health departments to establish a feedback and evaluation mechanism for the efficacy of the selected products. Relevant issues were dealt with in a timely manner.
Medical institutions should actively cooperate with the efficacy evaluation, and timely report the problems in the use of the selected products.
However, on the user side, the nearly ten patients interviewed did not reflect the difference in the quality of insulin used before and after the collection.
The patients interviewed all expressed the hope that the prices of consumables related to diabetes diagnosis and treatment will also be reduced.
(At the request of the interviewee, Lin Qing and Lu Qi are both pseudonyms)
Beijing News reporter Wu Xiaofei and intern Feng Ping