New thinking on medical insurance negotiations: Is the medical insurance bureau bound to lose out on the leverage of pharmaceutical companies?

Recently, a new round of national health insurance negotiation was held in Beijing The negotiation not only attracted the attention of medical industry practitioners, investors, clinicians and patients, but also some financial and medical media warmed up for several consecutive days, which has become a hot topic of common concern in the whole medical industry According to the current information, there are PD-1 products of MSD, JSB and Cinda biology that have been included in the medical insurance catalog in this medical insurance negotiation It is worth noting that on the same day of PD-1 variety negotiation, domestic media reported that CDE has also completed the technical review of Baiji Shenzhou PD-1's application for registration of ralizumab, and it has been submitted to the State Food and Drug Administration for approval on November 13 The conclusion of variety technical review is "production approval" According to the review and approval process, after the technical review, tirelizumab will enter the next stage of document preparation and the center's review and issuance, which means that the drug has entered the final administrative approval stage, and is about to be approved for marketing In fact, in order to understand the access of national health insurance negotiation, we must first understand the background and impact of the negotiation In the past decade, guiding rational drug use has always been the constant theme on the road of health care reform At present, more importantly, with the deepening of aging in China in the future, the pressure of health care expenditure will continue to increase Therefore, in order to meet people's higher demand for healthy life, it is imperative to release medical insurance funds to replace birds and improve the efficiency of use It is not polite to say that in October last year, 17 kinds of anti-cancer drugs were successfully negotiated into medical insurance, with an average decrease of about 57% This is only a preview of this negotiation With the establishment of the national health insurance bureau last year, everyone in the pharmaceutical industry can't deny that at present, the state has become more and more tough in the formulation of health insurance policies, and the official has the ability to reduce the price of the enterprise's products to the lowest level For the enterprise, the price drop means the reduction of profits Although there are official purchasing areas to sell the bottom and realize price for quantity, but in the future It remains to be seen whether the profit can be expected to achieve a win-win situation between the government and the enterprise The important point to observe is whether the sales cost saved by the enterprise after the volume purchase can be directly proportional to the depressed price The other point is whether the volume purchase has a positive effect on the medical insurance negotiation access after winning the bid In addition, it is more important that the number of bid winning enterprises with volume procurement is limited Once the pilot project is expanded to the whole country, it is not conducive to the market competition of drugs Once the number of competitors in the market is reduced, it is also not conducive to the negotiation of payers in the future volume procurement Therefore, as a powerful tool for payers to promote price reform, the current mode of volume purchase only purchases 50-70% market share of the same kind of drugs, leaving other shares Moreover, the drug price determined in the volume purchase bidding will be the main reference for the payment price of medical insurance in the future On the surface, the original price of drugs not included in the volume purchase can still be maintained, but once the payment price of medical insurance is determined, the rest of the market will still receive the payment according to the volume purchase price Therefore, it can be concluded that no matter whether there is a bid winning or not, the support point for maintaining high prices of enterprise products in the future no longer exists, because only by confirming this conclusion can we further discuss it Since drugs can no longer maintain high prices, the guarantee of quantity becomes crucial, which is also an important reason why the access of this healthcare negotiation has attracted much attention Now it can be said that the prelude of this health care negotiation is the bidding for expanding procurement with volume in late September this year, and the preparation for this round of health care negotiation started in August After the state health insurance bureau announced 128 varieties to be negotiated on August 20, it immediately convened a communication meeting on August 31 to ask for the willingness of enterprises to negotiate At the end of September, the state health insurance bureau began to receive the materials sent by the enterprises interested in negotiation, including the market price, drug donation price, sales volume data, basic drug data, indications, analysis of the impact on the budget of the health insurance fund, and the most important - the enterprise intention to pay price As for the negotiation of medical insurance, we can still regard it as another form of purchasing with volume After all, the purpose of price reduction into medical insurance is to expand sales From the perspective of historical experience, entering medical insurance through price negotiation will have an important impact on product sales For example, in 2016, gefitinib and ektinib negotiated price reductions, and entered the new version of the medical insurance catalog in February 2017, both of which saw rapid growth in sales Erlotinib did not choose to cut its price to enter the health insurance, and its sales fell.