"Real World Study" on the Impact of National Medical Insurance Negotiations on Drug Sales

Coinciding with the approaching annual national talks, it seems that "medical insurance brainless bargaining locks up the space for innovative drugs" has become a self-evident consensus, and the business model of innovative drugs is somewhat out of place, so that it is up to the Medical Insurance Bureau
to sell innovative drugs or even to do innovative drugs well.

Fortunately, since the first round of national talk about the implementation of the medical insurance catalogue adjustment for many years in 2016, it has produced a large enough sample size, and we have modeled on the "real-world study" on the impact of drug collection on sales that we have done before, and quantitatively, meticulously, comprehensively and deeply examine the impact
of national medical insurance negotiations on drug sales.

Quantitatively, meticulously, comprehensively and deeply examine the impact of national health insurance negotiations on drug sales

The first is still the data declaration
.
The scope of analysis is all the varieties successfully transferred in the first five national medical insurance negotiations from 2016 to 2020, and the sales of sample hospitals in the years before and after the negotiation are queried through the PDB database (the real sales of the experience need to be magnified by about 2-4 times), and the core focus is the change in the sales of each drug before and after the negotiation
.

The core focus is on the change in sales of each drug before and after the negotiations

A list of all varieties and changes in sales is listed in the annex
at the end of the article.

It must be explained in a few points: 1) Due to the limitation of the data caliber of the sample hospital, the total sales amount and the horizontal comparability between drugs with different indications will be affected, but the same variety is completely comparable vertically; 2) Sales are aggregated according to the universal name, that is, generic drugs and biosimilars will be considered together with the original research drugs; 3) Investigate the change in sales to the peak before the negotiation and the peak after the negotiation, and do not rule out the decline in sales after the negotiation due to factors such as collection and mining, competitive product extrusion market share, and unfavorable policies, but it should not affect the conclusion; 3) The average peak of sales before and after the negotiation of each group is to do the peak as an arithmetic average, because the peak years of different varieties are different, so there may be a slight difference from the peak of average sales in each year (that is, this is not an "Abel group", PS: I am so happy that I can still install this 13), but it does not affect the conclusion
.

1.
Overall trend

1.
Overall trend

Is Medicare paying for innovative drugs? Is it feasible to exchange price for volume? Does innovative drugs still have commercial value? I think the following chart should eloquently answer these confusions
that are often found in the market.

A total of 222 varieties were successfully transferred to the catalogue in the first five national talks, and the sum of the peak sales increased from 14.
9 billion before the transfer to 43.
3 billion, an increase of nearly 3 times, while before 2017, the increase outside of
medical insurance was relatively slow.
The timely inclusion of innovative drugs in the medical insurance catalogue indisputably provides an increase in sales, and the current total payment is only in the order of 100 billion at most, which is still very limited
compared to the nearly 2 trillion yuan of the entire pharmaceutical market.
This is also consistent with the analysis at the end of the previous article "What Industry Logic Is Subverted by Medical Insurance Control Fees
".

The sum of peak sales increased from 14.
9 billion before the transfer to 43.
3 billion, an increase of nearly 3 times

2.
If you remember the negotiation year, the 2018 and 2019 national talks caused great repercussions and controversy at that time, the core focus was that PD-1 and tenibs were significantly reduced in price, and the "medical insurance stifling innovation" theory that later became popular probably began
from this 。 It is true that PD-1 after the price reduction from a hundred billion blue sea white swan to tens of billions of ugly duckling, is bound to make the commercial value of innovative drugs significantly lower than some people imagine (should not also review their own imagination), but to say that the stifling should still be too extreme, after all, the success of medical insurance negotiations is obviously still bringing increments to these drugs, especially the benefits of large varieties of innovative drugs are more obvious
.

2.
The success of the health insurance negotiations in the negotiation year has clearly brought an increase to these drugs

3.
Another topic that has been criticized for the adjustment period of the medical insurance list of drug types is the inclusion of proprietary Chinese medicines
.
However, the fact is that proprietary Chinese medicines do not take advantage of the medical insurance bureau, and even after the negotiation of transfer, sales do not rise but fall (this is still in some varieties first rise and then fall, according to the calculation rules described in the beginning of the article is defined as the peak sales increase
).
The main reason is that the amount of new varieties of traditional Chinese medicine is not fast after being transferred, while the old varieties have encountered policy measures such as injections and auxiliary drugs after being transferred, resulting in a decline in
sales.

3.
Proprietary medicines of drug types do not take advantage of the Health Insurance Bureau

4.
The type of manufacturer we should all believe that the medical insurance bureau is talking about zz, and the control of fees and domestic substitution is undoubtedly the biggest zz he faces, and it can be understood that in the case of basic clinical value, the choice between high-priced imported drugs and low-cost domestic drugs is said to be that they should choose the
latter without hesitation.
However, the truth is just the opposite, from the perspective of the number of successful negotiations, the absolute volume of sales and the relative increase in volume, imported drugs are significantly better than domestic drugs
.
Then there is only one explanation, the health insurance bureau still will not jump out of the big framework of medical economics and clinical value assessment, the current imported drugs still objectively still have significant clinical value advantages, they will still pay for these drugs; A simpler and more direct corollary is that as long as it is a good medicine, it cannot be refused, or that "the dish is the original sin"
.

4.
From the perspective of the number of successful negotiations, the absolute volume of sales and the relative increase in the number of manufacturers, imported drugs are obviously better than domestic drugs, as long as they are good drugs, they cannot be refused

5.
In the maturity stage, we divide each variety into five stages of different maturity according to the sales before the negotiation: 1) the climbing stage, which has been listed for more than 3 years and the sales volume continues to grow rapidly (the annual growth rate is >20%); 2) Stable stage, the listing time is long and the sales volume has remained basically unchanged (the annual fluctuation range is <20%); 3) New previous stage, listed within 2 years (inclusive); 4) A small number of stages, more than 3 years on the market and sales are always at a small level (less than 20 million); 5) In the decline phase, the market time is long and sales have declined significantly (annual decline >20%)
.

5.
Maturity stage

It can be seen that in addition to the varieties that have declined (the probability is that the patent expires or even the collected varieties), the varieties at different stages will get sales increases from medical insurance: the varieties in the climbing stage and the new upper stage will benefit the most in the medical insurance negotiations, and a small number of varieties that are basically unsold before the negotiation may also take the opportunity to obtain some increments, even if the stable varieties will also get a stable improvement
.

, all kinds of varieties at different stages will get sales from medical insurance

6.
The climbing stage of representative varieties is the main export of medical insurance increments, although these drugs are old, but because the clinical value is very clear, even if they do not enter the medical insurance, they are climbing steadily, and even if the price is significantly reduced during negotiations, it can also obtain a large jump in the total amount through the doubling of sales
.
The most convincing is the kind of bevacizumab, which has been on the market for many years and even soon biosimilars have been approved, and according to the general idea, it must be like a cliff fall, but the fact is that it has become a super heavy variety
all the way.

6.
Representative variety

For the short-term inclusion of innovative drugs after the market, it is the most brilliant link in this round of pharmaceutical reform, and in fact, this has indeed provided a great boost
for the commercialization of innovative drugs in the Chinese market.
We can't always stare at the "conditional probability" of price reduction, and ignore the "full probability" of entering the medical insurance directory, if there is no happy trouble of negotiating price cuts, many innovative pharmaceutical companies will almost completely be able to establish commercialization capabilities
in just three or four years after approval.
For details, please refer to [Medical Garden Guan Domain] Not all drugs sold are called commercialization
.

Those varieties that are almost completely unsold without medical insurance, as long as the clinical value is clear, solving certain payment problems may bring about a very considerable increase
.
The most typical is the global drug king adalimumab, although the current sales are still far from the international level, but in any case there has been a significant increase; Another intuitive self-comparison is lapatinib, whose sales jumped rapidly after 17 years of successful negotiations to transfer into the catalog, but quickly declined
after being kicked out of the catalog after failing to renew in 19 years.

Even older varieties, which had slowed down before the negotiations, are entirely likely to see significant sales gains after entering the catalog, provided that they are still clinically valuable
.

The Health Insurance Bureau is probably the most unpopular authority in the medical industry, but how they are doing, I think it should be supported
by data.
We have clearly seen that they have carried out a differentiated "cage" through the combination of collection and competition pattern, and truly observed that they have carried out a significant increase in "bird change" based on clinical value through national medical insurance negotiations, coupled with the combed cost control logic, should at least to a certain extent be able to wash away the crime of destroying Chinese pharmaceutical innovation without discrimination? Based on these observations, the author once again reiterates that it is clearly opposed to the view that medical insurance subverts the logic of the medical industry, and believes that the Health Insurance Bureau as a whole basically follows the original intention of its establishment, and even if it is partially extreme, biased and wrong-killed, it has not deviated significantly from the medical economic framework
based on clinical value.

Through the combination of collection and competition pattern, the "Tengcage" has been differentiated, and the "bird change" has been significantly increased based on clinical value through the national medical insurance negotiations, which clearly opposes the view that medical insurance subverts the logic of the medical industry, and believes that the medical insurance bureau as a whole basically follows the original intention of the establishment, even if there are some excesses, deviations and wrongdoing, it does not deviate significantly from the medical economic framework based on clinical value

annex

annex

Included in the collection #