After four rounds of medical insurance negotiations, why can't hospitals still buy innovative drugs?

At the end of 2020, Mr.

No medical institutions and pharmacies submit purchase requirements on the platform.

Repeated negotiations with hospitals and pharmacies were unsuccessful, leading to court cases, demanding a claim for medical expenses of 440,000 yuan.

The inclusion of "life-saving medicine" in medical insurance is useless.

Hospital admission rate is only 15%

Hospital admission rate is only 15% admission rate is only 15%

The sharp price cut failed to get the market

Substantial price cuts failed to exchange for the market Substantial price cuts failed to exchange for the market

The entry of innovative drugs into medical insurance is very smooth.
At the end of 2020, the latest round of medical insurance negotiations ended.
119 new drugs were shortlisted, with an average drop of 50.
64%.

After medical insurance negotiations, the price of innovative drugs was drastically lowered, and the annual treatment cost of the three domestically-made PD-1 products shortlisted was reduced from 300,000 yuan to less than 100,000 yuan.

After the three pharmaceutical companies of Junshi, Hengrui, and Baekje reduced their prices and entered the medical insurance, they coincidentally suspended the drug donation plan , which put some patients who received product discounts through the donation into trouble again: medical insurance can only reimburse for designated indications, which is not for the widespread existence.
For super-indication medications, medical insurance does not reimburse, and companies do not give preferential treatment .

Unanimously, the drug - giving plan for super-indication medication was suspended , medical insurance does not reimburse, and the company does not give discounts

According to a statistical survey of 1,420 domestic hospitals by the Chinese Pharmaceutical Association, taking the innovative drugs included in the national medical catalog from 2018 to 2019 as an example, the hospital admission rate by the third quarter of 2020 is only 15%-25%.

By the third quarter of 2020, the hospital admission rate is only 15%-25%.

In order to enter the hospital, innovative drugs must be discussed and discussed by the hospital's pharmacy committee, and only after approval can they enter the hospital's drug list.
Due to the differences in economic levels across the country, each hospital has a different attitude towards innovative drugs, and most hospitals are relatively cautious in using innovative drugs.

Lu Xianping, Chairman of Microchip Technology, is quite distressed about this: Some of the Pharmaceutical Affairs Committee holds a meeting every six months, while others hold a meeting every two years.
Even if a meeting of the Pharmaceutical Affairs Committee is held, it does not mean that innovative drugs will definitely enter the hospital.

Even if a meeting of the Pharmaceutical Affairs Committee is held, it does not mean that innovative drugs will definitely enter the hospital.

Because the price is too low, the hospital is still suspicious of pharmaceutical companies.
"Some hospitals suspect that after the price of the product is cut, pharmaceutical companies will reduce their supply due to cost control.
" An insider of the pharmaceutical company said that this has led to hospitals simply not using innovative drugs.

In addition, if companies want to sell more products in hospitals, they also need to deploy a sales team to promote drugs to the greatest extent.
For many innovative pharmaceutical companies, everything is blank, and hospitals are so difficult to enter.
How many people are appropriate to recruit? Different companies have different choices, which to a certain extent also restricts the speed at which new drugs can enter the hospital.

For many innovative pharmaceutical companies, everything is blank

In an increasingly competitive market environment, pharmaceutical companies are thinking about laying out commercial networks as soon as possible, sinking county areas and grassroots markets, activating the untapped medical market, and strengthening interaction and communication with doctors and patients.
However, it is easy to talk on paper, and how to implement it is the key, which undoubtedly tests the comprehensive capabilities of each pharmaceutical company.

Hospital losses lack motivation

Hospital loss lacks motivation Hospital loss lacks motivation

The second bargaining makes the company unable to bear

The second bargaining makes the enterprise unable to bear the second bargaining makes the enterprise unable to bear

In fact, at the level of medical institutions, there are deeper barriers to the admission of innovative drugs, at least three barriers.

Since 2017, after the implementation of the "zero drug markup" policy of medical institutions in various provinces, hospital pharmacies have changed from a profit center in the past to a non-profitable department in a blink of an eye: the more medicines you buy, the more you sell, and the more you lose.
Many innovative biological drugs need to be stored frozen, which has higher storage requirements and higher costs than ordinary chemical drugs.
There is no "benefits" for pharmacies to accept innovative drugs , resulting in a lack of motivation for the introduction of new drugs.

There is no "benefits" for pharmacies to accept innovative drugs

The total prepayment of medical institutions and the proportion of medicines are the second obstacle to the entry of innovative medicines into hospitals.
In May 2015, the General Office of the State Council issued a notice requesting that by 2017, the proportion of medicines in public hospitals in pilot cities (excluding Chinese herbal medicines) will drop to about 30%.

The "drug share" effectively controls the unreasonable use of drugs by medical institutions, but for innovative drugs with excessive unit prices, doctors prescribing drugs means occupying the entire amount, otherwise they will face administrative penalties .
This is not very fair to doctors or patients.

The doctor prescribing medicine means taking up the whole amount, otherwise it will face punishment from the administrative department

More importantly, regardless of whether it is an innovative drug or an ordinary generic drug, the doctor's remuneration is calculated based on the number of prescriptions , and cannot be increased income due to the high unit price of the innovative drug.
After the price of 4 domestic PD-1 models was reduced in medical insurance, the cheapest 80mg teriprizumab was also 906.
08 yuan each.
After Bayer's Baitang Ping entered the centralized procurement, the market retail price dropped to only 5.
42 yuan per box of 30 pieces.

The doctor’s remuneration is calculated based on the number of prescriptions

For every 80mg Tuoyi PD-1 prescribed by the hospital, nearly 200 boxes of Baitangping can be prescribed for the expenses involved.
More patients means that the hospital has more income from registration and other medications.
If the limited total cost is spent on products such as PD-1, the hospital cannot treat a few patients in a year , and its own "life" will be blocked by several large varieties of high money.

If the limited total cost is used for products such as PD-1, the hospital will not be able to treat a few patients a year

Zhang Shu, director of the Cardiac Arrhythmia Center of Fuwai Hospital, Chinese Academy of Medical Sciences, believes that medical insurance wants to pay less and hospitals want to generate more income.
This contradiction puts patients' interests aside.
Good policies have changed in the process of implementation.

Medical insurance wants to pay less and hospitals want to generate more income.
This contradiction puts patients' interests aside.

In order to introduce innovative drugs while preserving profits, many hospitals adopt the method of "second bargaining" of innovative drugs entering the hospital.
A person from a pharmaceutical company once said that when his company entered the southern market, some hospitals would ask for an additional 10%, and some would directly offer a 20% discount, otherwise it would not be discussed.

Ding Lieming, chairman of Betta Pharmaceuticals, once publicly stated in 2017 that the company’s lung cancer treatment drug "Kamena" also encountered a second bargaining price from provincial hospitals after passing medical insurance negotiations.
The hospitals required 3%, 5%, 10%, Rebates ranging from 20% .

The hospital requires rebates ranging from 3%, 5%, 10%, and 20%

Health regulatory authorities in many places across the country explicitly prohibit "secondary bargaining", but after canceling drug additions and strictly limiting the proportion of drugs, hospitals have to think of various ways to make money in order to maintain their operations when government subsidies are not in place.

Enterprises also quickly had countermeasures.
After the medicine enters the price negotiation and centralized procurement, if it cannot be admitted to the hospital, it means that the effort to reduce the price is wasted.
In order to cope with the "second bargaining" of hospitals, companies set a higher price in the negotiated price of drugs or in centralized procurement, leaving room for it.

In order to cope with the "second bargaining" of hospitals, companies set a higher price in the negotiated price of drugs or in centralized procurement, leaving room for it.

This is obviously contrary to the original intention of the country to reduce the price of medicines and increase the availability of medicines.

Deadlock pending

Deadlock to be resolved Deadlock to be resolved

Are there too many innovative drugs?

Are there too many innovative drugs? Are there too many innovative drugs?

As a result of the current status quo of innovative drugs entering hospitals, hospitals, enterprises, and patients are all responsible, and all parties need to work together to manage and "combine blockages" to achieve results.

In fact, it is not realistic to hope that a large number of innovative drugs can enter medical institutions all at once.
Nearly 150 innovative drugs have been shortlisted in the four batches of medical insurance negotiations since 2017.
However, in the assessment of public hospitals, the Health Commission has clear restrictions on the number of drugs: tertiary hospitals ≤ 1500, and secondary hospitals ≤ 1200.

There are ≤1500 tertiary hospitals and ≤1200 secondary hospitals.

If a large number of innovative drugs enter the hospital catalog, this means that many drugs will be eliminated, and may involve chronic and frequently-occurring clinically commonly used drugs.
The number of patients with hypertension in China currently exceeds 300 million, and the number of diabetes patients exceeds 130 million.
The choice of medication for these chronic patients needs to be guaranteed.
Innovative drugs need to be encouraged, but in light of the current national conditions, swarming is not all a good thing.

In a limited scope, the hospital is working hard to mobilize the enthusiasm of doctors and pharmacists to apply innovative drugs.
In February this year, the Sanming Municipal Medical Insurance Bureau and the Municipal Health Commission of Fujian Province jointly issued a notice to adjust the service fee for pharmacists in public hospitals at level two and above : increase the service fee for western medicine (outpatient) from 10 yuan per person to level three Hospitals are 15 yuan per person, and second-level hospitals are 13 yuan per person; inpatient pharmacy service fees will be adjusted from 30 yuan per person to 50 yuan per person for tertiary hospitals and 45 yuan per person for second-level hospitals.

Adjustment of service fees for pharmacists in public hospitals at level 2 and above

In Sanming, known as the "weathervane of medical reform," the increase in pharmacist service fees has undoubtedly taken another big step forward in the medical improvement process.
The Health and Knowledge Bureau was informed that the pharmacist legislation has been included in the national health legislation plan, and the status of hospital pharmacies is expected to be further improved.

Pharmacist legislation has been included in the national health legislation plan, and the status of hospital pharmacies is expected to be further improved.

On the other hand, pharmaceutical manufacturers should increase the expansion of hospital channels and patient education, and at the same time walk on "two legs", and develop social pharmacies to become the future sales channel of innovative drugs.
It cannot put all treasures on hospitals.

At the same time, "walking on two legs" and developing social pharmacies to become the future sales channel of innovative drugs cannot put all treasures on hospitals.

The "last mile" problem of medical institutions is still difficult to solve for a while.
Most experts believe that while hospitals, companies, and patients work together, retail pharmacies and commercial insurance are another option.
But this requires the support of a series of supporting policies, so that all patients will be able to get medical treatment in the end.