Control fees, compliance, reasonable! The full analysis of the policy impact of pharmaceutical companies.

Medical Network July 27th, July 23, two important documents issued at the same time, namely, the General Office of the State Council on the issuance of the second half of 2020 to deepen the reform of the medical and health system key tasks notice (hereinafter referred to as "notice") and the National Health and Health Commission website issued by the "National Health And Health Commission Office on the continued management of the clinical application of antimicrobial drugs", for the development of the pharmaceutical industry further pointed out the directionTogether with other relevant documents recently released, the second half of the pharmaceutical marketing field of the impact of the policy can be refined into control fees, compliance, reasonable three categoriesControl fee 1, the volume of procurement "notice" requires "orderly expansion of the scope of centralized procurement and use of drug varieties of state organizations", to "should be harvested" and further pushforwardIn addition, although the expansion of the 4 plus 7, 4 plus 7 renewals and the second batch of band procurement and part of the local band procurement as early as December last year has started, but due to the outbreak of different degrees of delay, its full implementation is mostly occurred in the second half of this year, and the day before yesterday Shanghai Sunshine Pharmaceutical Procurement Network issued a third batch of tape procurement mapping, it is expected that the third batch of tape procurement will also be carried out in the second half of this year, so the second half of this year will be the year of the overall volume of procurement, that is, the year of the overall cost of the management of the It is also the beginning of the disruption and restructuring of the pharmaceutical industryThe volume purchase price reduction is huge (Figure 1), the cost savings are obvious, the first two batches of state-organized drug collection of 57 selected drugs cost from 42.7 billion yuan to 8.3 billion yuan, saving 34.4 billion yuan, of which the price reduction effect of 18 billion yuan, the substitution effect of 16.4 billion yuan2, transfer out of health insurance with the 2019 version of the national medical insurance drug catalog in various places, the provinces have adjusted provincial additions and key monitoring drugs, and according to the 4:4:2 rhythm of all three years, before the end of June this year will be the national key monitoring varieties out, which will bring a huge impact on the industry, of which, annual sales of more than 2 billion yuan of varieties on as many as 15 (Figure 2)3, DRG "Notice" stressed that the promotion of disease diagnosis-related sub-group pay national pilot and pay per diseaseOn June 19, the National Health Care Administration issued the "National Health Care Administration Office on the issuance of medical care disease diagnosis-related sub-group (CHS-DRG) sub-group program (version 1.0)" notice, the group of 376 groups of core DRG (ADRG) further refined into 618 groups, marking the second half of the DRG pilot will further accelerate the pace of progress, in addition to the 30 national pilot cities released on June 5 last year, Zhejiang and other non-pilot areas have also carried out THE DRGs point method for the exploration of health insurance paymentAccording to U.Sexperience, the average length of hospital stay and the proportion of hospital expenses decreased after the implementation of DRG, and the corresponding proportion of retail prescription drug costs increased (Figure 3)4On July 9, the General Office of the State Council issued the Guidance on Promoting the Reform of the System of Supervision of The Medical Security Fund, which is followed by the Opinions of the State Council of the CPC Central Committee on Deepening the Reform of the Medical Security System on March 5, which is another heavy document aimed at cracking down on fraudulent insurance fraudIn 2019, for example, the State Health Insurance Administration organized 69 inspection teams and conducted flight inspections of 149 pharmaceutical institutions covering 30 provinces, and found a total of 2.226 billion yuan in suspected violationsCompliance 1, June 5, the National Health and Health Commission, the Ministry of Public Security and other nine ministries jointly issued "on the issuance of 2020 to correct the pharmaceutical purchase and sale of the field and medical services in the main points of work", calling for a severe crackdown on pharmaceutical enterprises and contract marketing organizations (CSO) enterprises collusion, fictitious fees to pay illegal marketing costs of illegal violations and fake academic conferences, scientific research collaboration, academic support, donations to promote the improper conduct of the pharmaceutical industry, thus setting off the second half of the anti-corruption industryand a huge shock to the industryIn fact, as early as last June, the Ministry of Finance led the 77 pharmaceutical companies to carry out a quality inspection of accounting information in the pharmaceutical industry2, credit, June 5, the State Medical Insurance Administration issued "on the establishment of pharmaceutical prices and recruitment credit evaluation system guidance (second draft for comments)," which proposed the establishment of pharmaceutical prices and recruitment of credit breach list, the development of pharmaceutical enterprise credit rating, graded disposal of breach of trust, aimed at curbing in recent years in the pharmaceutical field commercial bribery, market manipulation and other acts caused by the drug price inflated, rapid growth in medical expenses, medical insurance fund loss and other serious harm to the safety of the health care fund 3, the record system of pharmaceutical representatives June 5, "pharmaceutical representatives for the record management measures (trial)" (draft for comments) issued, this is after December 22, 2017 after another consultation, but also for the 2017 State Office No 13 and the State Office No 42 further implementation, and clearly stated that pharmaceutical representatives shall not undertake the task of drug sales, not to deal with the purchase and sale of bills and not to deal with the pharmaceutical representatives, such as the great impact on the pharmaceutical representatives In Japan, for example, the number of medical representatives peaked at 65,752 in 2013 and has declined year after year, to 59,900 in March last year, a decrease of more than 5,800 (Figure 4) In 2019, The largest number of pharmaceutical representatives in Japan, with 2,220 pharmaceutical representatives, is the largest number of domestic companies in Japan, with only five foreign companies (Pfizer, Mercado, Lilly, GSK, Bayer) (Figure 5) The three documents, released on the same day on June 5, basically run through the entire chain of pharmaceutical marketing, opening a multi-ministerial effort to clean up the bad wind in the pharmaceutical industry Rational drug use 1, base medicine priority "notice" requires the promotion of priority provision of national essential drugs In fact, as early as October 11, 2019, the General Office of the State Council issued "on further doing a good job in the supply and stability of the shortage of drugs" on the promotion of the priority use of basic drugs, improve the proportion of basic drug use, and gradually realize the government-run primary health care institutions, secondary public hospitals, tertiary public hospitals, the proportion of basic drugs equipped with varieties in principle is not less than 90%, 80%, 60% (986) to promote the formation of basic drugs-led "1 plus X." "("1" for the national list of essential drugs, "X" as non-essential drugs, by the local basis for determination) drug use model, the base drug market will be expanded, to 289 base drugs, for example, in 2016 the national public medical institutions sold a total of 61.4 billion yuan, including in urban Public hospitalsales amounted to 34.1 billion yuan (55%), followed by 11.7 billion yuan in county-level public hospitals, and, in terms of the nature of enterprises, the higher the proportion of local pharmaceutical enterprises, such as in township hospitals, local pharmaceutical enterprises accounted for 88% (Figure 6) 2 On July 23, the General Office of the National Health and Health Administration issued the Notice on Continuing to Do a Good Job in the Clinical Application Management of Antibacterial Drugs, in order to implement in depth the Opinions on Strengthening the Management of Medicines in Medical Institutions and promoting Rational Drug Use and the National Action Plan for Curbing Bacterial Resistance (2016-2020), continuously improve the level of rational use of antimicrobial drugs, and pointed out that to optimize the list of antimicrobial drugs supply, medical institutions should combine the "1 plus X" drug use model led by essential drugs The growth rate of the antibiotic industry will be further hampered by the optimization of the list of antimicrobial supply The market size of chemical antimicrobials in public medical institutions (including urban public hospitals, county-level public hospitals, urban community health service centers, township hospitals) has increased from 119.9 billion yuan in 2013 to 158.9 billion yuan in 2018, but the growth rate has decreased from 10% in 2014 to 1.7% in 2018 3, the needle limit agent on February 26 this year, the National Health and Care Commission and other six departments issued "on strengthening the management of medical institutions to promote rational drug use" stressed that can oral doosine, can do not infusion, as early as October 8, 2017, the State Office No 42 on the requirements of "strict drug injection review and approval." Strict control of oral preparations to injecting agents, oral preparations can meet clinical needs, do not approve the injection preparations for listing." China's large size of the injection injection market, has increased from 563 billion yuan in 2012 to 829.4 billion yuan in 2017, but the growth rate has slowed from 13.3% in 2014 to 5.1% in 2017, the release of this document, will further increase the decline in the injection market With the comprehensive roll-out and landing of fee control measures led by the volume of procurement, the increase of wind strength and the strengthening of rational drug use, pharmaceutical enterprises, especially pharmaceutical marketing will face greater challenges, only eat through the policy, grasp the new medical reform guidance, so as to adjust the enterprise strategy in a timely manner, and continuously improve the quality and scale of operation to be invincible, and even into the "large-scale backbone enterprises as the main body" camp