Conclusion of medical insurance Negotiation: restore the scene of negotiation, who enters and who leaves?

Source: e-medicine manager's 2017-06-23 high-profile game finally settled In addition to the curiosity about the negotiation process and the negotiation site, there are two aspects that are most concerned about the negotiation results First, which products successfully enter the medical insurance catalog through negotiation? What products have passed the medical insurance catalog in this process? The second is the price of products entering the medical insurance catalogue - price reduction range These problems are not only the embodiment of the negotiation ability of enterprises, but also the vane that will cause the change of the whole market pattern after the products enter the medical insurance catalogue 1 Negotiation site: helping the wall out "bargaining is particularly fierce, exceeding the expectations of the enterprise." "Sweating, holding the wall out..." This is the feeling of some business people involved in the negotiation According to the understanding of e drug managers, the preparation work of the enterprise has started in April The Ministry of human resources and social security issues the fixed format information, which is filled in and submitted by the enterprise The information includes the market sales of the negotiated varieties in the past few years, the bidding price of each province, etc The formal negotiations began at 10 a.m on 16 June It is reported that the whole negotiation rules are very strict, divided into four negotiation groups, temporarily randomly divided into groups and back-to-back negotiation At most 3 people from one enterprise participate in the negotiation, and 5 experts from the negotiation group As a whole, the negotiation team compares and negotiates the quotation of the enterprise with the "suggested price" of the product, and finally determines whether the product enters or exits It is reported that the proposed price is mainly estimated by multiple groups of review experts such as the Ministry of human resources and social security, pharmaceutical experts, local medical insurance experts, referring to the prices of surrounding countries and regions, as well as considering the domestic market situation (market capacity), such as the patent period of drugs, competitive products, innovative drugs, pharmacoeconomics and other comprehensive factors The price shall be kept strictly confidential in the Black Envelope until the negotiation site is opened by the negotiation team, and the whole process shall be kept confidential to the enterprise Enterprises only have two quotation opportunities, and only when they meet the expectations of the Ministry of human resources and social security can they be shortlisted, otherwise they will be out According to the representatives of the enterprises participating in the on-site negotiation, at the negotiation site, the negotiation team first describes the key information and considerations of the drug, then the enterprise makes a quotation, and then both parties further elaborate their reasons After the second quotation, the negotiation team will hold a meeting on-site to discuss (the enterprise avoids) and finally make a decision The negotiation of each variety is about half an hour, and the whole process is video monitored "This negotiation feels like a gamble It requires a high level of adaptability, on-site persuasion and professional knowledge." A business person said Previously, there was news in the industry: the Ministry of human resources and social security will release the final results of this round of negotiations on June 22, and will hold a signing ceremony with several representative enterprises on June 26 But the latest news is that all the enterprises that have successfully completed the negotiation will participate in the signing ceremony, and the time will be advanced to June 24 (this Saturday) It is understood that the approved enterprises have received the agreement from the Ministry of human resources and social security It is predicted that after the signing ceremony, the products successfully entered the national medical insurance catalog through negotiation will enter the provincial medical insurance one after another 2 As we all know, these 44 products, as an important supplement to the 2017 version of the medical insurance catalog, also have a very important position in the market Who's out? As for the final result of this round of negotiation, relevant people from the Ministry of human resources and social security said that they will not disclose any relevant information until all the results are officially announced According to the unconfirmed information that e drug managers have learned through various channels, the products out of the 44 negotiated varieties account for about 10% of the total At present, the products out of the negotiation include: Cetuximab injection of Merck xuelanuo, bosentan tablet of actalon, Yiqi Fumai (freeze-drying) for injection of Tianshili, and infliximab for injection of Janssen Ron's disease) four products failed in the negotiation and failed to enter the medical insurance In other words, for the price of these products, the enterprise's quotation did not meet the expectations of the Ministry of human resources and social security Take bosentan tablet, a pulmonary hypertension drug of Switzerland, as an example The price of this product has been reduced by 80% in 2016, from 19980 yuan / box to 3996 yuan / box At that time, the industry believed that this was not only to deal with the expiration of bosentan's patent, but also to prepare for entering the medical insurance But in this price negotiation, the government expects to reduce its price again, and icotalon may not be willing to reduce more It is worth noting that in January 2017, after J & J purchased actalon for us $30 billion, J & J obtained actalon's drug portfolio for the treatment of pulmonary hypertension, including bosentan There are three products in the negotiation catalogue of Janssen this time The final result is that bortezomib for injection and abitrone acetate tablets are successfully shortlisted The out product is infliximab (limited to Crohn's disease) Because Crohn's disease accounts for a small proportion in clinical practice, in general, the two in one out result is quite fruitful for Janssen Xi'an For Merck, another multinational pharmaceutical company, its negotiated product, cetuximab injection (trade name: ibital), has a significant effect on rectal cancer and head and neck cancer It was listed in China in 2006, and its patent expired in 2017 At this critical time point, the negotiation failed or was a blow In addition, Tianshili's Yiqi Fumai (freeze-dried) for injection also failed in the negotiation But there are two products in the negotiation catalogue of this healthcare negotiation From the understanding, the final result is one in and one out According to the people familiar with the matter, the price drop of the products shortlisted by Tianshili in recombinant human urokinase for injection (puyouke) is not very large, which is a good result 3 Most of the 44 varieties of the entrants passed the negotiation, and thus entered the directory of medical insurance reimbursement This means that, from the perspective of the product market, the final price of the products negotiated by the enterprise does not break through the cost and profit accounting of the enterprise at a certain level, but also meets the price range requirements of the government According to the principles of drug selection published earlier, the universality of these varieties is characterized by clinical urgent need, better curative effect, higher price and heavy burden on the masses Foreign pharmaceutical companies, including AstraZeneca, Bayer, Roche, GSK, Novo Nordisk, Janssen and MSD, have all made gains Earlier, it was reported that the three products of AstraZeneca, Belinda, furshide and sricom, all of which have been successfully negotiated, have entered the national health insurance catalog Roche, another multinational pharmaceutical company, has four products in the negotiation catalogue, namely erlotinib, rituximab, trastuzumab and bevacizumab injection If rituximab and trastuzumab, two of the best-selling targeted antitumor drugs, enter the market smoothly, there is no doubt that they will continue to grow in the future It is worth noting that in the 2015 drug price negotiation, Roche's erlotini was reluctant to accept more than 50% of the price reduction, while the two major competitors, Iressa and Kemena, are now covered by health insurance Based on this, the industry analyzes that the negotiation between human resources and social security on erlotini will be stronger this time Therefore, whether Roche chooses to make concessions this time still needs to wait for the final result of the Ministry of human resources and social security to be announced Local pharmaceutical companies have also achieved good results as a whole In particular, it is worth mentioning that there are 8 varieties of traditional Chinese medicine in the negotiation, including 6 varieties of traditional Chinese medicine injection In addition to Tianshili's injection Yiqi Fumai (freeze-dried) out, there is no other product out of the news A person familiar with the matter disclosed to the e-medicine manager that the recombinant human brain natriuretic peptide for injection of Tibet nodikang Pharmaceutical Co., Ltd and alisartan ester of xinlitai were also successfully shortlisted through negotiation It is worth noting that if the news of the entry of silitane's alishatin is true, this time it is also the wish According to the industry analysis, alisartan ester is the key to breaking the situation of the company's unique product The company has strong willingness to list alisartan ester in the medical insurance catalog, but the industry also analyzes that the price reduction should not be too large 4 Although the continuous game negotiation is generally smooth, it can be clearly seen that in these negotiation categories, the head-to-head competition among enterprises is very significant (the following competitive products do not exclude the possible outgoing products) In the field of tumor drugs, such as Bayer's sorafenib and Hengrui's apatinib are clinical competitors, mainly targeting at the multi-target TKI drugs of VEGF; bituozhumab and Merck's cetuximab are mainly targeting at the anti EGFR monoclonal drugs of colorectal cancer; moreover, sendu of Xiansheng pharmaceutical and bevacizumab of Roche have similar anti-tumor effects It is mainly used in the treatment of lung cancer and colorectal cancer In the field of Ophthalmology, most attention is paid to Novartis and conbercept The competition between them has been carried out at home and abroad Access to health care is crucial to competitiveness, so the two will not let go of the opportunity to access health care In fact, the price of Leizhu mAb was reduced by 20% earlier It can be seen that under the competition, enterprises are bound to win Some insiders have analyzed that this negotiation puts the main competitive products on the negotiation table at the same time, which not only further exerts negotiation pressure on enterprises, but also indicates that the competition in the medical insurance system will be further intensified in the future In fact, whether the national drug price negotiation led by the health and Family Planning Commission in 2015 or the medical insurance catalog negotiation led by the Ministry of human resources and social security, for enterprises, price for quantity is the starting point; and the price reduction of medical insurance for high price drugs is the original intention of the government negotiation system Some insiders pointed out that the obvious trend of both the drug price negotiation in 2015 and the medical insurance negotiation is: first, for the imported original research drugs with high price, learn from the international negotiation method, reduce the price to a reasonable range, and improve the access of patients to medication Second, for domestic innovative drugs, encourage innovative drug products to enter the medical insurance as soon as possible Indeed, nowadays, the drug price negotiation has become an important breakthrough in the reform of China's medical insurance and drug price Under the condition that the dynamic adjustment mechanism of the medical insurance catalog is ready, I believe that this round of negotiation is only the beginning It can be clearly seen that in the future, national drug price negotiation will become a normalized means and mechanism, whether it is market access of high price original research drugs or encouraging domestic innovative drugs to enter the market quickly Of course, according to the information e drug managers have learned, many products in this negotiation have a large price cut, which is very difficult in the negotiation game, because it is not necessarily a good thing to reduce the price into the medical insurance catalog A person involved in the negotiation told e pharmaceutical managers that if the price reduction is too large, it is not good for the enterprise, because it is not a commercial truth to fight for profits by volume, especially in the field of medicine, who has the lowest price reduction is the biggest winner Attachment: 44 varieties negotiated in 2017 national medical insurance catalogue (marked with red as possible out varieties)