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It was a café next to the hospital, and it was noisy
.
In the store, some customers whispered about the price of
drugs and devices.
After the customer orders, the clerk will habitually ask, "Do you want to issue an invoice?" ”
Zhang Yu (pseudonym) arrived in the dust, and before he sat down, he apologized
for being half an hour late.
He ordered a takeaway cake, and half an hour later the takeaway was delivered, and he had to rush back to the hospital to deliver the cake to the doctor
.
Zhang Yu visited the doctor to sell generic drugs
.
This is something he never imagined after working as a pharmaceutical substitute in the original pharmaceutical company for several years
.
Since last year, Zhang Yu has been in charge of a large item with annual sales of more than 1 billion yuan - an original drug
with an expired patent.
After the third batch of centralized procurement in August 2020, this original drug lost its bid
.
In the winning bid list, replacing this original drug are two domestic generic drug competitors, of which the bid price is less than 1/4
of the original drug.
In the four years since the normalization of centralized procurement, the pharmaceutical industry has undergone
tremendous changes.
The policy was implemented, the group of medical representatives with up to 3 million people shrank by hundreds of thousands, and collective salary cuts, layoffs, and career changes, and people's hearts fluctuated
.
Compared with the medical representative who "won the bid and lost his job", Zhang Yu is a "survivor", at least he can stay in this industry
.
But to stay, you must face the changes
of the times.
In the "post-centralized procurement era", in the few remaining hospital market space, the space left for the original research drug has shrunk many times, and it is difficult to sell the original research drug in the hospital and complete the performance
.
New "rules of the game" have also been gradually established: if you want to sell your original drugs, you must wait for the hospital to complete the quota
for winning generic drugs.
Zhang Yu and his colleagues inherit the consistent professional characteristics of medical representatives: they are good at seizing gaps in market and policy and seeking room for growth
.
In order to sell the original drug, Zhang Yu and his colleagues had to embark on a road
of generic drug promotion.
The original drug that was "kicked out" of the hospital
The original drug that was "kicked out" of the hospitalWhen it comes to the work after collective procurement, Zhang Yu feels "more tired"
.
Last year, almost every quarter, the original drug that Zhang Yu was responsible for would be stopped by the hospital once, and this year it is more frequent
.
The reason for stopping the drug is very simple, this Shanghai tertiary hospital that Zhang Yu has visited countless times, if the agreed purchase volume of the winning product cannot be completed, the prescription of the original drug
will be prohibited.
Hospitals spread the quota evenly over each month, and doctors need to meet the corresponding quota
.
The prescription system of the pharmacy department monitors the use of drugs every minute and second, and if the collective procurement quota is barely completed at the end of the month, there is a risk that it will not be completed next month, then the use of the original drug
will be suspended at the beginning of the following month.
After the drug was stopped, the original drug in the prescription system was removed from the shelves, and even if the doctor wanted to prescribe it, he could not search for it
.
This is the worst situation
for Zhang Yu.
"If we sell 1,000 boxes a month, and stop taking the drug for half a month, we may only be able to sell 300 to 500 boxes
.
" After the collection, Zhang Yu was under pressure on performance
.
The house leak coincided with overnight rain
.
The epidemic in Shanghai in the first half of the year led to a large-scale suspension of the use
of original drugs in Shanghai hospitals.
In the hospital under Zhang Yu's responsibility, patients from other places cannot come to seek medical treatment, the number of outpatient clinics has dropped sharply, and it is difficult for the hospital to complete the quota of winning products, which will naturally restrict the use of
original research drugs.
"I have to stop taking the drug almost once a month," Zhang Yu said, "It's now December, and I've only completed 80% of my performance, and I can barely get the year-end bonus
.
" ”
After communicating with his Zhejiang counterparts, Zhang Yu's anxiety intensified
again.
Due to different regional policies, Zhejiang counterparts have a significantly better life
.
Previously, many hospitals in Zhejiang directly suspended the purchase of original research drugs "one size fits all", and later the management method became more flexible
.
Since Zhejiang Province allows hospitals to report their own volume, some hospitals will tend to report the volume lower and make it easier to complete
.
After exploring this "coping strategy", some hospitals resumed purchasing original drugs, and the performance of peers was easily completed
.
Compared with Zhejiang, Shanghai's "sunshine procurement mechanism" is more stringent, not allowing hospitals to report their own volume, and the annual agreed procurement is calculated according to the total amount
of drugs of this variety in 2019 (the year before the start of the third batch of centralized procurement).
After the policy was implemented, the original promotion plan of pharmaceutical companies was suffocated
.
In the face of the impact of centralized procurement, pharmaceutical companies that lost their products did their best to find ways to get more of the off-label market
.
They are trying to find hospitals with more "loose" barriers to entry, which are going more slowly, to break products in
.
An industry insider revealed to Eight Points that a number of pharmaceutical companies are entrusting consulting companies to investigate the centralized procurement of different hospitals in order to "find another good strategy"
.
One of
the strategies is to help promote the winning generic drug.
This is called "pushing"
.
It's hard to say who proposed the "push" at what point, but after the collection, Zhang's team began to do it
.
"The company doesn't have a dedicated training, and neither do our competitors
.
The company will only set sales targets
for the original drug.
In order to complete the indicator, this can only be done (surrogate).
”
Helpless move: help compete to sell medicine
Helpless move: help compete to sell medicineIn order not to stop the drug, Zhang Yu and his colleagues can only promote the winning generic drug to doctors to ensure that the hospital can complete the centralized procurement quota
in advance every month.
In practice, "pushing" is full of difficulties
.
In the way of selling generic drugs, the academic promotion that foreign-funded pharmaceutical companies have always been good at is
useless.
Experts generally only talk about academics, and at most briefly mention generic drugs
when describing the efficacy of a certain compound.
Playing the academic card does not work, Zhang Yu can only talk to the doctor about policy
.
"Tell them that this is a national requirement, passed the consistency evaluation of (generic drugs), and the efficacy can be guaranteed
.
" And the price is very cheap, the supply is relatively stable, and it will not be discontinued like the original drug
.
”
Doctors don't accept
it all.
Zhang Yu needs to "watch people cook", and when he encounters doctors who like to prescribe original drugs, he steps up the promotion of original drugs, and the same is true
for generic drugs.
At first, doctors felt very strange, how did the original drug generation promote generic drugs? "But the situation is here, if the winning drug has not completed the quota, the original drug will be stopped, and the doctor can understand
it.
" Zhang Yu needs to keep explaining
.
For innovators who start selling generic drugs, overcoming psychological thresholds is often the first step
.
Eight Points Jianwen learned that many "part-time pharmacists" will be disgusted by doctors and questioned professional ethics
.
In order to avoid suspicion, they will choose to sell generic drugs
in other hospitals.
If part-time work is discovered by foreign companies, some pharmaceutical agents will even be fired
.
"In fact, all pharmacies are about customer relationships
.
Those drug agents who have a very strong relationship with doctors, whether they are original pharmaceutical companies or generic drug companies, will come to the door, no matter what drugs they sell, doctors will recognize that they are called 'big contractors' or 'gunmen'
in the industry.
An industry insider described it this way
.
For the psychological threshold, Zhang Yu did not have much hesitation
.
The company defaults to this scheme, and the employees do it
.
Zhang Yu next faces a more difficult step: how to control the rhythm and push the medicine
with both hands.
He almost became a highly skilled "acrobat", throwing two balls of original drug and generic drug into the air, swinging the two balls to spin and jump while making sure they didn't fall off
.
Zhang Yu kept an eye on the completion of the hospital quota
.
He needs to get intelligence
.
Sometimes, he gets prescription data from the pharmacy department, and sometimes not once
a month.
If it goes well, Zhang Yu can bundle the two drugs to promote
together.
If he could get the data from the pharmacy department and calculate that the quota might not be completed in the current month, and there was a risk of stopping the original drug, he went to visit several directors and asked them to use more winning products
.
There are many precautions
for how doctors use generic drugs.
"It is best for patients whose condition is relatively stable, who need to reduce their medication themselves, and do not need strong drug effects," Zhang Yu suggested
to his doctor.
Promoting the drug requires the accumulation of new patients
.
Zhang Yu also told the doctor that if the patient changed from the original drug to the winning generic drug, he would continue and not change back, so as to stabilize the monthly dosage
of the generic drug.
"As long as we don't stop taking drugs, we can get more new patients
.
"
Since the quota for winning generic drugs cannot be changed, Zhang Yu can only "make the plate bigger"
.
For example, the total dosage of a certain drug is 100 boxes, and the maximum dosage in the off-label market is 40%, that is, 40 boxes
.
If Zhang Yu can persuade doctors to use more of this drug and increase the total dosage to 120 boxes, the ceiling of the original drug will also be expanded to 48 boxes
.
As for patients buying original drugs outside the hospital, this did not harm the interests of the company, but affected Zhang Yu's performance, so he did not recommend that doctors prescribe
outflow.
To some extent, Zhang Yu's "substitution" is special and is facilitated by three factors:
Shanghai strictly implements the centralized procurement policy, and hospitals cannot report the volume independently, resulting in greater pressure for hospitals to complete the agreed procurement volume; The hospital in charge of Zhang Yu is not strict in the assessment of doctors, and if the centralized procurement quota is not completed, the performance of doctors will not be affected; After winning the bid, the competing manufacturers directly cut off the sales team, giving Zhang Yu the opportunity
to promote on behalf of him.
Under the superposition of various factors, Zhang Yu is actually helping the hospital to manage doctors and assist the hospital to complete the amount of winning drugs agreed upon in centralized procurement
.
"Last year was a toss, a struggle
.
Promoted their own products, after a period of time, because the centralized procurement did not complete the discontinuation, after stopping the drug and then went to help the winning product push, after letting go and then stopping the drug, in fact, it is still more tired, but this year I
am a little more adapted.
”
Zhang Yu said
.
The new pharmacokinetic agent,
The new pharmacokinetic agent,Didn't make it to the end of the Golden Age
Didn't make it to the end of the Golden AgeIn the interview, Zhang Yu lamented the most that the present is not as good as the past, "In the past, as long as you promote your medicine well, there is no problem
of stopping the drug.
" ”
Zhang Yu studied pharmacy as a bachelor's
degree.
Previously, one of the mainstream ways out for graduates was to become a medical representative
.
The pharmacy major belongs to the class, and as a medical representative, you can go to a foreign-funded pharmaceutical company, which means that you pay more attention to compliance, more professional, and have more prospects
in career development.
A newcomer who has just entered the industry can receive a monthly salary of tens of thousands of yuan, which is equivalent to several times the salary
of a pharmacist in a hospital.
When Zhang Yu entered the industry, he once heard his leader talk about the previous "golden age"
.
These medical representatives, who entered the industry in the 90s, caught up with the outbreak of the industry, and the wind and dragons were mixed, which was almost an era
of "picking up money on the ground".
In the eyes of Zhang Yu's generation of young people, after several rounds of medical reform, the industry is in full decline, and they missed the last train
of rapid growth.
When he heard that the drugs he was responsible for were going to be collected, the first reaction of Zhang Yu and his colleagues was, "It's over, 70% and 80% (share) have been given to the winning bid, and they have nothing to do
.
" ”
This is largely true
.
For generic drug companies, a drug into the centralized procurement, sales are basically worry-free, many generic drug companies have cut the sales team of the winning drug, directly handed over to the agent or only pay the delivery fee
.
In the shadow of centralized procurement, the original pharmaceutical companies have been greatly squeezed in the market share of drugs
.
In addition to the winning generic drugs with a centralized procurement policy to ensure the dosage, Zhang's competitors also have non-winning generic drugs, which are called "sandwich layers"
.
After centralized procurement, most of these "sandwich layers" have significantly reduced their prices or been kicked out by hospitals
.
The hospital Zhang Yu is responsible for, and the "sandwich layer" has the same price as the original drug he is responsible for, which is 2.
4 times the price of the winning generic drug, which means that the other party's medical representatives will promote it
harder.
Under the fierce competition, the original research drug generation wants to expand the living space, in addition to vigorously developing the out-of-hospital pharmacy, community hospitals and other out-of-standard markets, but also derived various strategies
.
An old pharmacist also discovered the new phenomenon
of selling generic drugs on behalf of the original drug on behalf of the original drug on a part-time basis.
He recalled that such cases probably began to appear
after the sixth and seventh batches of collection.
After the collection and procurement of generic drug enterprises, the profits are diluted, and there is no money to support their own representatives, so they ask the representatives of the original research drugs to sell drugs
part-time.
"The first few batches of collective procurement pressure prices are too low, and there is no profit margin
.
But at the beginning of the sixth batch of centralized procurement, the price reduction is not so ruthless, and the profit margin of many products can reach 35%, which is very good
.
Part-time pharmaceutical agents to promote generic drugs, can get 10~15% of the profit, throw away the cost, and leave the profit in hand is almost 5~6%.
”
The old medicine man also mentioned that the profits that pharmaceutical agents can get are not as good as before
.
Before collective procurement, the drug rebate is basically 35% for doctors and 10~15%
for medicine.
However, after centralized procurement, the commission of part-time original research drugs has shrunk, but they do not need to work hard to promote generic drugs, they only need to report and ship, which is much
easier.
In addition, the medical representatives are almost "all of their own talents"
.
Some medical representatives privately represented a number of winning products, hoping to replicate the "small profits but quick turnover"
.
There are also medical representatives who directly buy out the remaining quota of the hospital's winning products, resell the drugs to the out-of-hospital market to earn the difference, and then continue to promote the unwon products
they represent.
Compared with other medicine substitutes, Zhang Yu's situation is not bad
.
The original drug he is responsible for has been on the market for many years, and has accumulated a large number of patients, which is also recognized by doctors, and has a considerable sales volume
even in the off-label market.
After more than a year of centralized procurement, Zhang Yu and his colleagues have gradually adapted to the new situation
.
But as an original research drug generation, it is foreseeable that it will be more difficult for Zhang Yu to get bonuses
such as growth awards.
Under the background of centralized procurement, where the future sales space and prospects of the original drug are are still a mystery
.
The decline in the share of original drugs in public hospitals is the general trend, and the sinking market is slow
to explore.
The amount of growth that is difficult to complete and the stagnant wages are constantly a reminder of the hardships of Zhangyu's industry
.
As a small screw in this industry, Zhang Yu also feels lost
.
In the torrent of the era of collective procurement, he naturally can't change anything, and he is transferred to be responsible for the original research drugs whose varieties have not yet entered the centralized procurement? At present, except for innovative drugs that have just been launched, almost all other drugs have been or will soon be included in centralized procurement
.
"Now we are making hard money," Zhang Yu lamented, "We haven't been able to catch up with the good times
.
" ”
