Super "Buyer Side" Attacking: Upgrading The New Round Of National Health Insurance Negotiation

The last heavy policy of China's pharmaceutical industry this year has finally been implemented.

Since December 14, the super "buyer" State Medical Security Bureau has started the negotiation on the adjustment of medical insurance catalogue this year. This round of negotiation is the formal implementation of the "2020 national medical insurance drug catalog adjustment work plan" announced on August 17, and is also the fourth round of national medical insurance negotiation since 2017, which will last for several days.

More than 95% of the buyers in China's overall medical insurance market are national health insurance, which is the largest payer. In recent years, the medical insurance negotiation launched by the medical insurance bureau has become the key to obtain market access for major innovative drugs, and become the most important channel for their sales volume.

This year's medical insurance negotiation has taken a more clear step in "changing cages for birds" and encouraging innovation.

August 17, 2020 is the most important time node in the announced plan, which greatly lengthens the time limit for drug inclusion, which means that more newly approved and qualified drugs can be declared, negotiated and competitive.

This means that the national health insurance negotiation will be institutionalized, normalized and transparent. "In particular, the adoption of the enterprise independent declaration system is the biggest bright spot, so as to avoid good drugs from being" strangled "in the evaluation cradle Jin Chunlin, director of Shanghai Health and health development research center, said in an interview with the 21st century economic report that "the conditions and directions of seven cases of medical insurance are specified, which are also consistent with the previous policies: to encourage the innovation of biomedicine, to pursue the optimization of catalog varieties (to change cages for birds), to improve the curative effect, and to pursue value medicine."

These policies are changing the internal structure and future trend of China's medical industry by superimposing the impact of epidemic situation, from bulk purchase to medical insurance negotiation.

Upgrading of "changing cage for bird"

On the evening of August 17, the official website of the state medical insurance bureau announced the work plan for the adjustment of the national medical insurance drug list in 2020 and the application guide for the adjustment of the national medical insurance drug list in 2020. The drug list adjustment is divided into five stages: preparation, declaration, expert review, negotiation and bidding, and announcement of results, which will last from July to the end of the year.

In terms of varieties, according to the "list of drugs that have passed the formal examination in 2020 national medical insurance drug catalog adjustment" issued by the medical insurance bureau in September this year, a total of 751 varieties have passed the formal examination, including 728 out of the catalog and 23 in the catalog.

Since 2017, the total number of negotiated drugs has increased year by year. In terms of the decline rate, the overall decline rates in the previous years were 44%, 57% and 60%, respectively, which has increased year by year. The situation this year remains to be determined.

"Biological drugs are not involved in this negotiation, but the general direction is very clear, and such drugs will also be included in the negotiation in the future. Variety diversification is one of the trends in the future, including Chinese patent medicines. As long as the drugs covered by medical insurance are gradually included, the price will definitely continue to decline. " Zhao Bing, chief analyst of the pharmaceutical industry of Huajing securities, said in an interview with the 21st century economic report that from 2017 to now, medical insurance funds have been "changing cages for birds" and "what are they changing for? Change the good medicine with therapeutic effect, which is beneficial to patients and the efficiency of medical insurance funds. "

In 2017, 36 kinds of negotiation drugs were included in the category B scope of the national basic medical insurance, industrial injury insurance and maternity insurance drug catalogue (2017 Edition), including 31 Western medicines and 5 Chinese patent medicines. Among the Western medicines, 15 are tumor therapeutic drugs, covering lung cancer, gastric cancer, breast cancer, colorectal cancer, lymphoma, myeloma and other cancer types, including trastuzumab, rituximab, bortezomib, lenalidomide, etc. Compared with the average retail price in 2016, the average decline of negotiation drugs reached 44%, the highest reached 70%. The payment standard of most imported drugs after negotiation was lower than the prices of surrounding international markets.

In 2018, 17 kinds of drugs were successfully negotiated and included in the list, with an overall decline of 57% and a decrease of 60% for foreign-funded varieties.

In 2019, a total of 150 drugs will be involved in the negotiation of national health insurance, including 119 new drugs for negotiation and 31 drugs for renewal. The price of 119 new drugs was reduced by 60.7% on average. The average decrease rate of three kinds of hepatitis C treatment drugs was more than 85%, and the average decrease rate of treatment drugs for tumor and diabetes was about 65%. 27 of the 31 renewed drugs were negotiated, with an average price drop of 26.4%. After this round of adjustment, 2709 drugs are included in the national basic medical insurance, work injury insurance and maternity insurance drug catalogue in 2019. Compared with the 2017 edition, 218 drugs were transferred in and 154 drugs were transferred out, a net increase of 64.

The negotiation in 2019 created the largest scale since the establishment of China's medical insurance system, and the significant reduction of drug costs is one of the biggest characteristics. The "soul bargaining" of Medical Insurance Bureau officials also let the public see the confidence of "strategic buyers" of medical insurance fund.

The negotiation led to a sharp drop in drug fees by trading in volume, which led to the "civilian price" of several world-famous "noble drugs", and the world's lowest prices were basically given for imported drugs. It is conservatively estimated that the personal burden of patients will be reduced to less than 20% of the original and individual drugs will be reduced to less than 5% through negotiation of price reduction and medical insurance reimbursement.

Another characteristic is to highlight the guidance of encouraging innovation. Eight of the 12 major domestic innovative drugs were negotiated, which released a clear signal to support innovation.

PD-1 is the "Internet red" variety in the negotiation. In 2019, the focus of industry discussion is "whether PD-1 should be included in the medical insurance". After Xinda bio xindilimab won the exclusive bid, with Baiji Shenzhou and Hengrui pharmaceutical PD-1 drugs approved for listing, this year, 6 enterprises participated in the competition, becoming the "big fight" variety in medical insurance negotiation.

"This year's negotiations on PD-1 drugs are bound to be intense." According to Zhao Bing, "the first factor to be considered in the negotiation is the affordability of medical insurance funds, involving product prices, per capita treatment costs and the number of patients. From the perspective of medical insurance expenditure, it is equal to the unit price of the product multiplied by the number of patients. The number of patients is relatively objective, and the product price becomes the most direct factor to consider in medical insurance. If pharmaceutical companies want to be included in the big indications and the number of patients is large, then the product price must be greatly reduced. "

For foreign-funded drugs K and O, the driving force of price reduction is far less than that of domestic drugs. First, they have more indications. Second, they must take into account other global markets.

The key to access

At the same time, how to balance the relationship between budget and value, how to ensure fairness and accessibility has become a test of all parties.

Industrial securities analysis said that health care negotiations have become an important catalyst for innovative drug volume. Pharmacoeconomic evaluation will become an important factor in the evaluation of innovative drugs. The rapid development of R & D to seize the first mover advantage and reasonable pricing strategy will become an important factor in the market competition of innovative drugs.

At present, the annual medical insurance negotiation has gradually normalized, and the two-year validity of the agreement makes the corresponding varieties face rolling price reduction before they are included in the regular list.

Looking back on the results of medical insurance negotiation in the past three years, on the one hand, the number of negotiation varieties showed an increasing trend, and at the same time, the participation of domestic varieties continued to increase, which reflected the continuous prosperity of the domestic innovative drug market; on the other hand, with the aggravation of market competition, the price reduction continued to rise, and the willingness and speed of innovative varieties to enter the medical insurance negotiation were also increasing.

Since the emergence of medical insurance negotiation mode, the stable price system of foreign pharmaceutical enterprises has gone forever. As the "main force" of participating in medical insurance negotiation, the average price reduction of foreign-funded varieties often exceeds the overall average.

Multinational pharmaceutical companies with innovative drugs have also tasted the benefits of "large-scale" through health insurance negotiations in the previous two years. Although the decline is large, the increase of sales volume after the medical insurance is included in most cases offsets the impact of price decline.

In the negotiations in 2019, on the one hand, the national health insurance bureau "soul bargaining", on the other hand, foreign pharmaceutical enterprises frequently show the global "lowest price" to win the bid. The "king of medicine" xiumeile has been in the doldrums for many years in China, and it was not until its biologically similar drugs were put on the market that it finally entered the medical insurance system. The direct antiviral drug of hepatitis C (DAA), which "adopts the form of competitive negotiation in an innovative way", involves 4 enterprises, involving a total of 6 drugs to participate in the negotiation. Finally, Gilead and moshadong entered the medical insurance system, and the drug price dropped by more than 85% on average, and the cost of each course of treatment decreased by more than 50000 yuan To 10000 yuan.

In 2019, Sanofi has three drugs entered the medical insurance list through medical insurance negotiation. "Sanofi is very supportive of healthcare negotiations. Because each review time of the medical insurance catalog was very long before, in recent years, we have also seen a dynamic balance. Shortening the time between each round of review is a very good thing for the government, enterprises and patients. " He enting, general manager of Sanofi global business unit in China and President of Sanofi China, said in an interview with 21st century economic reporter that "in the medical insurance negotiation, we also see that the government will weigh the value behind the pharmaceutical R & D, because it is not only the price negotiation, but also the recognition of the value of drugs."

Medical insurance negotiations also allow multinational pharmaceutical companies to constantly adjust their domestic strategies. Wu Kun, general manager of Pfizer biopharmaceutical group in China, said in an interview with 21st century economic reporter, "in the years of continuous updating of medical insurance policies, pharmaceutical enterprises have also enhanced the overall enthusiasm for research and development of major cancer-based diseases, and accelerated the introduction and listing of new drugs." It is reported that Pfizer will not only promote Aibo Xin in the field of breast cancer and duozerun in the field of lung cancer into the national medical insurance this year, but also promote the renewal process of the innovative drugs in the fields of renal cancer and lung cancer, such as irida and secorey. "In terms of health care, Pfizer China's actions and decisions have also been fully supported by the headquarters."

"There are three key factors in medical insurance negotiation, which include market access, hospital access and patient access." Zhao Bing believes that these three points are the most critical factors for innovative drugs. At the same time, medical insurance negotiation is an important driving force to influence the development trend of the industry. "Because of the large scale of medical insurance, enterprises need to control production costs and invest in research and development. In the past, it was generally believed that pharmaceutical enterprises should do three things: research and development, production and sales. In the early years, sales were too prominent, but in recent years, sales were weakened, and production and R & D were regarded as the top priority. After medical insurance negotiation and procurement with volume, the sales direction may be to find some new channels for products, such as external channels, embracing the Internet, etc