Centralized purchases, reducing the falsely high prices of pharmaceuticals and consumables, compressing the living space of red envelope rebates
The source of positive trends in the field of pharmaceutical purchase and sales
Recently, the General Office of the State Council issued the "Fourteenth Five-Year Plan for National Medical Security", which clearly stated that "by 2025, all provinces (autonomous regions and municipalities) will purchase more than 5 types of high-value medical consumables at the national and provincial levels."
Not long ago, the national organization of centralized procurement of artificial joints officially opened bids in Tianjin.
According to the results of the proposed selection, the average price of hip joints has dropped from 35,000 yuan to about 7,000 yuan, and the average price of knee joints has dropped from 32,000 yuan to about 5,000 yuan, an average price reduction of 82%.
Artificial joint is the second high-value medical consumable product that is collected by the country.
More than medical consumables, the centralized and normalized drug procurement is pushing the pharmaceutical market to reshuffle.
With the introduction of “heavy punch” policies one after another by the regulatory authorities, the profession of pharmaceutical representatives has ushered in a special moment of “transformation or disappearance”, and the era of “middlemen earning the difference” is coming to an end.
1 With the increasingly fierce competition in the pharmaceutical industry, medical representatives once deviated from the track, exacerbating medical chaos
The once brilliant "medical representative" is facing tremendous changes in the industry.
Public information shows that Hengrui, a well-known pharmaceutical company, has successively merged or divested several sales companies. Huizhi and Green Valley have also reported that they have laid off their sales teams to achieve cost reduction and transformation and upgrading.
"For medical representatives, transition or unemployment is the problem that many people are facing now." A medical representative told reporters that with the start and implementation of centralized procurement and medical insurance negotiations, industry trends and competition patterns are changing at an accelerated pace.
A medical representative refers to a professional who is engaged in drug information transmission, communication, and feedback on behalf of the drug marketing license holder within the territory of the People's Republic of China.
In the 1980s, when multinational pharmaceutical companies entered the Chinese market, pharmaceutical representatives from foreign companies became active.
The interviewee told reporters that the medical representative is mainly responsible for delivering the core information of the product to the hospital, and collecting feedback from the doctor on the product they are responsible for.
In addition, medical representatives will also communicate with doctors about the latest developments and research in the field of related diseases, and sponsor the organization of academic conferences in various professional fields.
According to industry insiders, the conditions for these multinational pharmaceutical companies to recruit medical representatives were very demanding. They were either doctors with clinical experience or practitioners in pharmacy. They must be able to read medical literature and communicate with first-line doctors without barriers. Many are doctors who have obtained the qualifications of attending physicians.
"It is undeniable that, out of competitive considerations, they also hope that doctors will use their own company's drugs more."
However, with the increase in the number of pharmaceutical companies and the increasingly fierce competition for medicines, some medical representatives have distorted the nature of their professions and formed a "community of interests" with unscrupulous medical practitioners, which has boosted the price of medicines to higher and higher prices, which has caused strong enthusiasm from all walks of life. Concerned, the society’s negative evaluation of medical representatives has gradually emerged.
2 "Unspoken rules" such as red envelopes and rebates sent by medical representatives are rampant, and "selling with gold" boosts the falsely high prices of medicines
In August of this year, China Procuratorate released an indictment from the People's Procuratorate of Zhenping County, Henan Province.
According to the indictment, in order to increase the sales volume of medicines sold by him, the medical representative Zhang Moumou gave a total of 215 people to the People's Hospital of Sheqi County, Traditional Chinese Medicine Hospital of Sheqi County, and Sheqi County Maternal and Child Health Hospital between 2012 and 2019. Doctors have large cash rebates.
Zhang Moumou was prosecuted on suspicion of bribery to non-state personnel and illegal business operations.
It is not uncommon for medical representatives to be held liable for bribery in the industry.
With the continuous deepening of corruption in the field of rectification of pharmaceutical purchases and sales in various places, "hidden rules" such as "sales with gold" have surfaced.
"Sale with gold" refers to the improper behavior of pharmaceutical companies to seek trading opportunities or competitive advantages by giving rebates to prescribing doctors, people with decision-making power and influence on drug purchases.
The "sale with gold" of pharmaceutical companies is one of the root causes of pharmaceutical representatives becoming corrupt promoters.
One party is willing to send it, and the other party is willing to receive it.
According to the statistics of publicly available court judgment documents, from 2016 to 2019, more than half of the 100 compulsory drug companies nationwide were found to have directly or indirectly given rebates. Among them, the most frequent companies involved more than 20 cases in three years.
Commercial bribes paid by pharmaceutical companies to bidding agencies, hospital leaders, medical representatives, doctors, etc., must be included in the "cost" and ultimately reflected in the price of drugs.
In the view of industry insiders, "sales with gold" have been repeatedly banned. On the one hand, because of the remarkable performance it has brought, medical representatives are driven by profits and resorted to improper means to obtain hospital "tickets" for medicines.
On the other hand, from the hospital's point of view, there is also a need to "reserve medicine with medicines" and increase income through various medicine rebates.
Some medical staff who cannot resist the temptation are likely to prescribe more drugs, prescribe expensive drugs, and prescribe designated drugs in order to obtain generous rebates.
The network of interests and relationships hidden in the field of medicine is not just "representatives give red envelopes and doctors get rebates."
The corruption case of Yi Lihua, former deputy secretary of the party committee and dean of the Second People’s Hospital of Wuxi City, Jiangsu Province, opened a more complete chain of interests-doctors in the hospital information system sold the unified data to medical representatives for accuracy Public relations with doctors and bribery.
Wang Wei, a staff member of the Information Department of Wuxi People's Hospital, has also sold the system directly to many medical representatives over the years, earning more than 1.6 million yuan in profits.
"In some hospitals (information departments), the entire department is done together. Everyone knows in their hearts and knows in their hearts that the law does not blame the public." Wang Wei said.
Wang Zhen, deputy director of the Public Policy Research Center of the Chinese Academy of Social Sciences, believes that “to return the medical representatives and the entire medical system to the value standard, a comprehensive and comprehensive and strict supervision system needs to be improved. Only by increasing the cost of violations of laws and regulations can they play a real deterrent effect. ."
3 Concentrated and volume purchases break the vicious circle, and the era of "middlemen earning the difference" is coming to an end
The change in the situation of medical representatives is a microcosm of the changes in the wind direction and competitive landscape of the medical industry, and behind it is the actual effect of the national medical recruitment reform "combined boxing".
The price of esomeprazole injection for the treatment of acute gastric ulcer has dropped from RMB 65 to RMB 4 per bottle, the price of saxagliptin, a new-generation diabetes drug, has been reduced by 62%, and the monthly cost has dropped from RMB 225 to less than RMB 90... this year Starting in October, the results of the fifth batch of national centralized drug procurement were officially implemented, and the sixth batch of national centralized procurement is expected to start at the end of the year.
Purchase with quantity, exchange price with quantity, low price and high quality. Since 2018, the state has implemented five batches of centralized drug procurement, covering a total of 218 drugs. The average price of selected drugs has been reduced by 54%. The lowest price has dropped by 2 to 3 times to a comparable level, and the cost of medicines has been saved as much as 150 billion yuan. Commonly used high-value medical consumables such as heart stents, artificial joints, and ophthalmic intraocular lenses are also being included in the collection in batches. Among them, After the nation’s first batch of “coronary stents” were collected, the price of the winning products was reduced by more than 90% on average.
What comes down is the false high space of circulation links and layers of agents.
The person in charge of the Joint Procurement Office for Centralized Drug Procurement and Use of the National Organization once mentioned that from the perspective of absolute price levels, a considerable part of the drug prices have long been falsely high. The price level of some generic drugs is more than twice the international price, and the cost of circulation accounts for the price. The main part in.
Water infiltrates the "grey area" of the circulation link, and ultimately is paid for by patients and medical insurance funds.
As more drugs and consumables are included in the scope of centralized procurement, the living space for illegal activities such as medical rebates has been greatly reduced.
“In the past, there was no quantity in procurement. Although we won the bid, there are still barriers to entry into the hospital, leading to alienation of procurement and service behavior.” According to Wu Ming, assistant to the director of the Medical Department of Peking University, the national organization’s centralized procurement has clarified the huge amount of national consumption in order to be fair. Open market rules carry out bidding purchases, and the lowered price space is the moisture of the intermediate links, which is conducive to forcing the development of the industry in a standardized way.
"The vicious circle was broken by the centralized procurement model, and the era of'intermediaries earning the price difference' is coming to an end." Chen Jianliang, head of the Discipline Inspection and Supervision Group of the Changshu Municipal Commission for Discipline Inspection and the Municipal Health Commission, told reporters that the state directly bids for pharmaceutical companies , The successful bidding pharmaceutical company is linked to volume and price, with small profits but quick turnover, which is equivalent to a direct meeting between supply and demand.
In fact, the high sales expenses and insufficient R&D investment of pharmaceutical companies have always been common problems in the industry. The volume purchase reform has not only released room for price reductions, but also led companies to shift from the traditional re-sales concept to cost and quality competition.
According to statistics, in 2020, the sales expenses of listed A-share pharmaceutical companies have shown a downward trend for the first time in nearly five years, with a decrease of 6% compared with 2019, and R&D expenses increased by 22% compared with 2019, indicating that pharmaceutical companies are shifting from focusing on sales to focusing on research and development.
"Since the reform of volume procurement, the number of pharmaceutical representatives in many companies has been reduced. This is what we hope to see. Companies should focus on how to promote rational use of drugs, and develop around R&D and improving product quality." Professor, School of Social Development and Public Policy, Fudan University Liang Hong said.
4 Supervision must focus on the supply side as well as the demand side, cutting off the gray interest chain in the field of pharmaceutical purchase and sales
"All medical practitioners should file relevant information in the Department of Pharmacy." "From now on, we will no longer accept unfiled medical representatives."... From December 1st last year, the "Administrative Measures for the Recordation of Medical Representatives (Trial)" came into effect. Major hospitals have successively issued announcements, and the sales function mainly undertaken by medical representatives before has also been explicitly prohibited.
In the new edition of "The Occupational Classification Code of the People's Republic of China" released in 2015, "medical representatives" are classified under the general category "professional and technical personnel", which also puts forward requirements for the professional skills of medical representatives from one aspect.
"With the introduction of a series of policies, the special group of medical representatives is evolving to high standards." Wang Zhen believes that China's medical representatives once deviated from the track, but the existence of standardized medical representatives is still necessary.
Internationally, medical representatives are widely recognized and accepted. On the one hand, they bring more drug-related information to physicians and medical institutions, provide more clinical treatment options, and assist physicians in rational use of drugs. On the other hand, they collect post-marketing drugs. The use of the drug, especially including adverse reaction information, is fed back to the relevant pharmaceutical companies, and improvement measures and treatment methods are proposed, and patients will also benefit.
The root cause of standardizing the pharmaceutical industry and restoring the essence of the pharmaceutical industry is to regulate the management of the pharmaceutical industry and build a "pro-clean" medical-business relationship.
Since last year, the National Medical Insurance Administration has explored the establishment of a medical price and recruitment credit evaluation system, including medical commercial bribery and other acts of untrustworthy items, and effectively restricting the sales behavior of pharmaceutical companies through measures such as trustworthy commitments, credit ratings, and tiered disposal.
The reporter learned from the National Medical Insurance Bureau that at present, nearly 70 companies have been subject to restraint measures due to breach of trust and breach of contract.
"Pharmaceutical companies are often insensitive to the fines of kickback cases, but giving kickbacks will cause them to lose the opportunity to enter the centralized procurement market, which will have a powerful deterrent effect." The relevant person in charge of the National Medical Insurance Bureau's Price Recruitment Department said.
Supervision must be focused on the supply side as well as on the demand side.
On August 12, the National Health Commission issued a clean practice action plan for medical institutions and their staff-starting from this year, the next three years will focus on rectifying "red envelopes" and special actions for rebates.
The "Internet + Supervision" trend reporting platform is also being built, and the direct reporting channels for corruption issues in the pharmaceutical purchase and sales field will be smoother.
To cut off the gray interest chain in the field of pharmaceutical purchases and sales, we must adhere to systematic governance, legal governance, comprehensive governance, source governance, multi-sectoral linkage, and comprehensive policy implementation. Dare, can’t, don’t want to take back the deduction governance system.
Deepen the reform of medical recruitment and procurement, squeeze the price of drugs and consumables in a centralized and high-volume purchase; actively promote the reform of the "two-invoice system" in the purchase and sale of drugs to effectively reduce circulation; promote medical institutions to improve the hospital access mechanism for drugs, consumables, and equipment , Strengthen the power restriction on the “top leaders” of hospitals and departments... The Disciplinary Inspection and Supervision Group of the National Supervision Commission of the Central Commission for Discipline Inspection and the National Health Commission insists on promoting the prevention of corruption, no corruption, and no desire to corrupt, and promotes the National Health Commission, Departments such as the National Medical Insurance Administration and the State Administration of Traditional Chinese Medicine have effectively performed their industry regulatory responsibilities, and strengthened and improved the governance of corruption in the field of pharmaceutical purchases and sales.
"Corruption in the field of pharmaceutical purchase and sales involves a wide range of issues, involves large interests, has complex causes, and is difficult to manage. More powerful and effective measures must be taken to achieve a comprehensive and comprehensive management in order to achieve ecological reshaping in this field." The relevant person in charge of the Disciplinary Inspection and Supervision Group of the National Health Commission said that the next step will be to actively promote the construction of a joint disciplinary mechanism for disciplinary inspection and supervision agencies, judicial agencies, and administrative law enforcement agencies to coordinate and manage joint disciplinary action, and to improve consultation and coordination of major cases, joint disciplinary enforcement, and law enforcement. Information reporting, clue transfer and other systems have realized the seamless connection of party discipline and government sanctions, administrative penalties and criminal penalties.
Strengthen the use of digital and intelligent supervision in the prevention of hospital corruption risks in many places, and put the purchase and sale of medicine in the "sunshine" with the help of technical means such as real-time data sharing.
The Commission for Discipline Inspection of Hangzhou Municipal Commission for Discipline Inspection of Zhejiang Province pays close attention to the areas with high risk of clean government such as medical equipment procurement and medical core data management, and promotes the city's health system to launch 7 related scenarios in the first batch of digital reform integrated application projects, and strengthens the medical representative Domestic sales behavior control.
As one of the first pilot projects of digital reform projects, Fuyang District, Hangzhou City, relying on the Zhilian Hospital platform, established the integrity management of the district's medical representatives, and realized the big data supervision of the marketing behavior trajectory of the medical representatives in the hospital.
Our reporter Chai Yaxin and Li Yunshu