** Change the model will affect the pharmaceutical company

Since the State Council issued a directive on the reform of drug prices, the relevant reform process has been markedly accelerated.

Judging from the current actions of the Health and Family Planning Commission and Shanghai, Fujian and Chongqing, the reform of the medical insurance price, which focuses on drug price reform, will mainly proceed from three aspects: single-disease payment, medical insurance settlement price, and liberalization of self-pay drugs. the price of. These three price reforms will have different impacts on pharmaceutical companies. Some drugs will be excluded from medical insurance. Some drugs will enter low-profit channels, and some will gain higher market share and maintain better profits.

Single disease payment

Drug treatment plan

In the reform of medical insurance prices, the most certain direction is the single-disease payment. Single-disease payouts clearly specify how much money a certain disease should cost. The purpose is to prevent medical units from abusing medical service projects, repeating projects and dismantling projects, and prevent hospitals from making minor illnesses and major injuries.

In 2011, Anhui Rural Insurance had already paid for single-disease trials. It started in September this year and piloted 181 sickle-point fixed-rate charges in nine county-level hospitals. In August 2013, Xuzhou, Jiangsu Province was also piloting single-disease pay for urban medical insurance. After the State Council clarified the reform of drug prices, Chongqing immediately made a decision to expand the scope of the single-disease payroll trials, extending the disease category from 15 in October to 50 at the end of the year. On November 20 and 21, the Health Development and Planning Commission Health Development Research Center held a "Seminar on Promoting Price Reform of Medical Services" in Beijing. The information that was uploaded showed that single-species payment is imperative.

Chen Wei, a researcher at the Center for Drug Policy and Management at Tongji Medical College of Huazhong University of Science and Technology, believes that under this model, medical institutions must take into account the efficacy and cost, and choose drugs with reliable curative effect under the control of cost targets.

Xiao Liming, chairman of Chongqing Hanrui Enterprise Management Consultancy Co., Ltd., who has 23 years of experience in the medical and pharmaceutical industry, believes that the single-disease model will increase competition among drug companies, drugs must enter the treatment plan before they are sold, and most of them cannot enter the program. Drugs are faced with delisting, transferred to OTC drugs, or sold through e-commerce.

Medicare payment price model

Determine the success or failure of pharmaceutical companies

Medicare payment price is the second focus of the current reform, its essence is the medical insurance compensation for patient payment, the object of application is the medical insurance list of drugs. At present, there are mainly three modes of Sanming and Chongqing.

The National Health and Family Planning Commission has repeatedly promoted Fujian Sanming's practice. Sanming City, Fujian Province Propaganda Department Minister Zhan Jifu at the Health Commission announced that a regular press conference, Fujian Sanming pilot benchmark price, and this price setting standards is based on "the lowest price of domestic generic drugs as the standard." Some industry sources believe that although Sanming is still in the pilot, Sanming's practice will be widely followed.

Chen Hao analyzed that the new list of future medical insurance may be smaller than the existing catalog. At the same time, for most low-level repeat generic drugs, Medicare will choose a price that is close to the lowest price in the country or even lower to pay the price. This will have a greater impact on those manufacturers that do not have exclusive quality products, and those that suffer the most are those who The original research drug with expired patents and no price reduction.

Chongqing also recently solicited internal opinions on the “Implementation Plan for Medicare Drug Settlement Price”. The key point is that Medicare pays according to the average price. If the price of medicine purchased by a medical institution at the city drug exchange is lower than the average price, the balance will be returned to the medical institution; if the price is higher than the average price, the excess will be borne by the medical institution itself. At the same time, the Chongqing medical insurance payment scheme allows the hospital to benefit from the second bargaining.

Chen Hao believes that Chongqing’s plan is to take into account different levels and industries of drug use in the context of real medical insurance funds pools, and to adopt different levels and graded compensation to take care of the most stakeholders. He believes that the original research drugs with limited number of imitations, effective patent protection, and imitation of domestic high-quality, low-priced drugs will receive relatively high payment prices.

There is also a third type of Medicare payment price, which is intended to support the innovation of pharmaceutical companies and the manifestation of intellectual property rights. During the patent period, imported drugs, domestic innovative drugs, and drugs that have significant exclusive effects will be priced separately. The government will determine the price through negotiation.

Self-funded drug market or expansion

On November 19, at the Shanghai Medicines Bidding Fair, officials in charge clearly stated that Shanghai will soon release its own drug prices. That is, the government only controls the price of medicines paid by Medicare, and the price of the self-paid medicine is given to the market. This is good for high-quality, premium drugs that do not enter the list. Even high-quality, high-priced drugs that have already entered the list will benefit from single-disease payments.

Taking Chongqing as a case of paying for single-disease cases, the government-guided price for cesarean section is 3,700 yuan. Many patients enjoy better services and require the use of anti-adhesion drugs. This is a few hundred yuan and two thousand Yuan's medicine is not within the single-disease treatment plan. Patients need to pay for themselves if they want to use it. In addition, in some hospitals in Chongqing, there is basically no natural choice for the government to guide the price of 1800 yuan.

The people in the industry interviewed by reporters generally believe that the reform of medical insurance prices will have a negative impact on pharmaceutical companies. Drug companies with no characteristics will suffer a greater impact, while pharmaceutical companies focusing on R&D, exclusive, and high-quality, high-priced drugs will not be affected very much. Big, it will even benefit.