List of changes in drug sales ranking in 2019: who fell from the peak, who still dominates the screen? How will the pattern of drug use change in the future?

Recently, Fujian released the top 20 ranking data of sales amount of sunshine purchased drugs in November and December 2019 Fujian Province is a rare province that regularly publishes the drug sales ranking Since January 2018, Fujian has continuously published the drug sales ranking every month On the one hand, it can let the industry clearly see the change of drug sales pattern in Fujian Province On the other hand, as the pilot of medical reform and drug reform, Fujian can also be seen as the change of drug use pattern in the future to some extent The wind vane of In November and December 2019, Fujian's top 20 drug sales ranking of three medical linkage, drug price reduction, strict control of auxiliary drugs, cage lifting and bird changing are the key words of "Sanming medical reform" in Fujian, and one of the key actions is to focus on the monitoring of auxiliary drugs At present, it is difficult to see the shadow of drugs in the key monitoring catalogue from the top 20 drug sales in Fujian On May 21, 2019, Fujian made it clear that the province would follow up the centralized drug purchase, which would be implemented on June 1 After June, regular customers such as Lipitor, luohuoxi and Plavix have dropped out of the top 20 In addition, in the list of nearly one year, the products of multinational pharmaceutical companies have always occupied the vast majority, and antitumor drugs such as trastuzumab for injection and bevacizumab have always been at the forefront of the list, which reflects the drug use trend under the national medical reform In the background of encouraging innovation and further opening up, the high-speed growth of innovative products of multinational pharmaceutical companies will continue for a long time Sanming medical reform is regarded as a model of China's medical reform, and the State Council has repeatedly released signals to affirm the exploration of Sanming medical reform, and further promote it throughout the country Looking at the ranking from January to December 2019, we can see the changes of market drug use pattern after Sanming medical reform and policy evolution Looking from Fujian, 2019 is the 10th anniversary of China's new medical reform The policies of cracking down on drug rebate, reducing drug price, purchasing with volume, key monitoring catalogue and so on have been issued successively, which is the year with the deepest impact and the biggest change on China's pharmaceutical industry In fact, these medical policies can be found in the Sanming medical reform seven years ago The further promotion of Sanming medical reform mode has also been put on the agenda by the leading group of deepening medical reform of the State Council On November 15, 2019, the leading group of the State Council for deepening the reform of the medical and health system issued the notice on further promoting the experience of deepening the reform of the medical and health system in Fujian Province and Sanming City The notice reaffirmed the practice of the reform of the medical and health system in Fujian Province and Sanming City in recent years, proposed the key tasks for further promoting the experience of the reform of the medical and health system in Fujian Province and Sanming City, and made it clear The promotion schedule is set Before that, the general office of the State Council clearly summarized the reform experience of Sanming in Fujian Province and promoted it in Anhui, Fujian and other comprehensive medical reform pilot projects From the perspective of the top 20 drugs purchased by sunshine in December in Fujian Province, the top 10 are all occupied by multinational pharmaceutical companies The disease field is dominated by anti-tumor, cardiovascular disease and diabetes related drugs It can be seen that there are no original research drugs and chronic disease varieties of generic drugs in the future The products of local enterprises, such as Acarbose Tablets in China, the United States and East China, are all large varieties of generic drugs After "4 + 7", xinlitai and hausen, which were not originally listed in the list, began to appear There are no traditional Chinese medicine products in the list, and there is no "auxiliary drug" which has always been in the national drug sales list Under the influence of various policies, China's drug sales pattern is undergoing a significant change, and Fujian Province is a highly recognized sample of medical reform, which also represents the future drug use pattern of the country However, there are also voices that the situation is not the same everywhere, and the adequacy of health insurance funds is not the same Sanming model cannot be copied to the whole country It can also be seen from the list that the hottest "O medicine" and "K medicine" in 2019 are not included in the list, and the attitudes towards auxiliary drug policies vary from place to place Recently, Sanofi announced its 2019 results, with global annual sales up 2.8% year on year It is worth noting that Sanofi said that its sales in China fell by 21% in the fourth quarter due to the influence of "4 + 7" volume procurement, which put pressure on global profits Sanofi's products in the 4 + 7 procurement catalogue in 2019 mainly include ambroside (irbesartan), ambroside (irbesartan hydrochlorothiazide) and Plavix (clopidogrel), which once ranked the fourth best-selling drug in China in 2018 In September 2019, after the nationwide expansion of volume procurement, both Ambo and Plavix of Sanofi won the bid The performance impact was concentrated in the fourth quarter, with ambove / ambono's China performance down 40% and Plavix down 69.1% Olivier Charmeil, head of Sanofi's China and emerging markets division, said that sales in China for Plavix and ambrevi will continue to decline by about 50% in 2020 The classic products represented by Plavix have changed the treatment history of cardiovascular disease in China, and also represent an era of Chinese pharmaceutical industry From the perspective of the national hospital drug market, according to iqvia data, the sales volume of Plavix in the third quarter of 2019 ranked sixth among the top ten drugs used in hospitals nationwide This is because 4 + 7 is only implemented in some parts of the country, and in the long run, Plavix is bound to withdraw from the sales list From Fujian's drug ranking, we can see that: since June, Plavix has dropped out of the top 20 in sales, and civita's Taijia has taken over most of the markets with the same generic name of clopidogrel Similarly, Pfizer's classic Lipitor product has also been affected by volume purchasing, falling directly out of the top 20 since June On the one hand, the centralized procurement of drugs has made the past mature original research drug products go down the altar, on the other hand, it has accelerated the process of replacing the original research with domestic generic drugs, changing the status of multinational and local drug companies in the drug map On July 1, 2019, the national health and Health Commission officially released the national version of the list of "withdrawal" of auxiliary drugs, including 20 varieties, and stipulated that provinces should form the provincial key monitoring list of rational drugs In August, 2019 version of the national medical insurance catalog was published, and the first batch of 20 key monitoring and rational use drug catalogs were all transferred out of medical insurance At the same time, western medicine can not prescribe the relevant provisions of traditional Chinese medicine, which makes the former "auxiliary drug" products under attack By the end of November 2019, despite incomplete statistics, 24 provinces and regions including Tianjin, Hebei, Shaanxi and Inner Mongolia have issued policies on adjuvant drugs, and the so-called "big strangulation" of adjuvant drugs has started all over the country Such behavior is immediately reflected in product sales According to the national hospital medication data, in the third quarter of 2019, Xueshuantong for injection, the drug listed as the key monitoring directory by all regions, was still among the top 10 in sales, but the year-on-year growth rate of mat was almost zero Sanming, Fujian Province, was earlier to crack down on the key monitoring catalogue varieties In April 2012, Sanming City of Fujian province saved nearly 17 million yuan of medical insurance fund and saved 200 million medical insurance funds in the whole year by monitoring 129 key drugs The monitoring of auxiliary drugs and the subsequent "dragon for bird" to accommodate high-priced drugs such as tumor drugs are considered to be an important part of Sanming medical reform From the perspective of reform effect, there is no auxiliary drug in top 20 drug sales in Fujian Province From the perspective of the whole country, adjuvant drugs will experience a great reshuffle, and its position in China's pharmaceutical industry will be redefined in the future From the monthly list, it is not difficult to see that Roche's trastuzumab for injection, AstraZeneca's budesonide suspension for inhalation, and Pfizer's cefoperazone sodium and Sulbactam Sodium for injection are the top priority for many times Recently, Roche pharmaceutical released its annual report Driven by new products, Roche Group's performance increased by 9% in 2019, with strong growth of 36% in mainland China and Hong Kong In the hospital drug market in the third quarter of this year, Roche's mAb of trastuzumab for injection increased by 97.9% year on year After entering the medical insurance catalogue through drug price negotiation, Roche's "troika" became the biggest winner Budesonide suspension for inhalation is the largest variety of AstraZeneca in China The domestic sales scale in 2018 is about 5 billion yuan, and it is expected that the domestic sales will exceed 6 billion yuan in 2019 AstraZeneca has successfully established its position as the king in the field of respiration with its unique standard atomizing chamber all over the country However, budesonide suspension for inhalation has not been approved so far Zhengda Tianqing submitted the listing application of budesonide suspension for inhalation at the end of 2019, and Changfeng pharmaceutical, which focuses on the field of high-end inhalation preparations, also submitted the listing application of four new categories However, under AstraZeneca's unique disease diagnosis and treatment mode, it will take a long time for generic drugs to replace the original research Pfizer's cefoperazone Sulbactam Sodium for injection belongs to the third generation of cephalosporins, which has broad-spectrum anti gram negative bacteria and some gram positive bacteria According to the data of minenet, in 2018, the sales volume of cefoperazone sodium and Sulbactam Sodium for terminal injection in China's urban public hospitals, county-level public hospitals, urban community centers and township health centers (referred to as China's public medical institutions) was 2.498 billion yuan.