In the post-"National Talk" era, we have passed the original research instead of the countercurrent

 Editor's note

The flow of high-level talents in the medical arena has become the norm, and in 2022, this flow will become more frequent
.

A few days ago, the news of the departure of Zhu Tong, vice president of AstraZeneca China, has caused heated discussions again

During the "Thirteenth Five-Year Plan" period, China's medical security work continued to make progress.

At present, the world's largest medical security network covering 95% of the country's population has been established

Since the establishment of the National Medical Security Administration in 2018, the reform of the medical insurance drug coverage policy has begun to accelerate, and the annual medical insurance access negotiation has become an important way to achieve market access for patented and exclusive drugs with higher prices or a greater impact on the medical insurance fund
.

On the "fast track" of market access based on the premise of "negotiating every opportunity", 17, 70 and 96 drugs have been included in the last three negotiations respectively, and prices have generally dropped by more than 50%

In addition to promoting the availability of high-value drugs and the stability of medical insurance funds, the medical insurance negotiation system has also had a fundamental impact on China's pharmaceutical industry.

The policy spillover effect has forced the transformation and upgrading of pharmaceutical production and distribution

Circulationstrategic purchase reshapes the promotion model 

At the beginning of the establishment of the National Medical Security Administration, the medical insurance, maternity insurance, medical assistance and other responsibilities originally under the multi-management of different departments have been integrated to realize the resource integration.

Expense settlement platform, organizes re-setting and adjustment of drug prices and charging standards

Enterprises whose products are included in the medical insurance catalog no longer need to use huge commercial promotion costs at the local level to push drugs into hospitals as in the past.

On the contrary, the National Medical Security Administration uses administrative means to ensure that drugs enter the medical system with public hospitals as the main body

Production andclinicalvalue orientation lead research and development 

The market access of medical insurance negotiation can allow enterprises to shift the resources originally used in commercial promotion to the research and development of innovative drugs with more clinical value, and promote and accelerate the integration of the industry
.

From the enterprise's point of view, during the negotiation agreement period, the enterprise reduces the uncertainty of profit expectations and helps organize production and stocking
.

In this sense, the state has regained the ability to dominate market prices by re-dividing the form of benefit distribution, and using the world's largest medical market as a bargaining chip in exchange for the opportunity for companies to compete to reduce prices to be included in medical insurance reimbursement

From a market perspective, strategic purchases of medical insurance squeeze out overpriced water, making the price discovery mechanism transparent
.

Medical insurance negotiation comprehensively uses decision-making tools such as pharmacoepidemiology, pharmacoeconomics, and health technology evaluation, starting from the clinical value of drugs and the unmet needs of patient groups, and taking the affordability of medical insurance funds and drug cost-effectiveness ratio as external and internal price constraints respectively

Today, the actual price paid by medical insurance has become the de facto market benchmark price, which to a large extent plays a role in guiding the formation of consensus from all walks of life
.
Medical insurance negotiation has become an endorsement of the effectiveness and economy of drugs with government background, and has a crucial influence on the market size estimation of listed and listed companies in the capital market
.
In 2019, the competitive negotiation model was introduced for the first time in the medical insurance negotiation.
Several HCV direct antiviral drugs from foreign companies were included in the national medical insurance category B catalog through bidding, and the average price dropped by more than 85%
.
As a local original research hepatitis C new drug, the product of Ascletis Pharmaceuticals was unfortunately out, which caused the stock price to plummet
.
Similarly, last year, tumor immunosuppressants represented by PD-(L)1 also lowered the market valuation of such targets from 100 billion to 10 billion due to medical insurance price negotiations
.
In fact, the medical insurance negotiation has played a role in correcting the overheated capital in the medical field
.

On the other hand, medical insurance negotiation has played a role as a wind vane for drug research and development and marketing
.
With the substantial implementation of national policies to encourage innovation and the support of policies such as the Science and Technology Innovation Board, medical insurance may benefit more patients in the long run due to the emergence of more competitive products
.
The competition pattern of a specific product directly determines the cost-effectiveness of the reference drug.
Only when more cost-advantaged products are available, the original research and first imitation companies will have the incentive to reduce prices
.
China's pharmaceutical industry started late, and faces restrictions on technology export from developed countries.
In a sense, a large number of existing Chinese companies engaged in innovative drug research and development need some kind of support from the state to develop commercial prospects.
products, and then compete with foreign varieties for the market in a fair and open environment
.
In the 2021 version of the medical insurance drug list, 7 drugs for rare diseases such as hemophilia and idiopathic pulmonary fibrosis have been added, many of which are from local pharmaceutical companies
.
The successful varieties of medical insurance also provide valuable merger and acquisition targets for the capital market, guide capital market funds and social forces to invest in areas that are urgently needed in clinical practice, and help enterprises to provide a relaxed innovation environment and competitive remuneration for life science talents
.

 Ambition  for domestic-funded enterprises to internationalize their layout 

China is a large developing country that has been in the primary stage of socialism for a long time.
As economic development enters a new normal, it will face enormous pressure from an aging population in the future
.
This means that China's medical insurance financing level is unlikely to be maintained for a long time in the past few years, and the positioning of "basic insurance" and "do your best and do what you can" of medical insurance cannot be changed.
Therefore, the benefits obtained from the domestic market are ultimately limited.
of
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Capable and ambitious companies have already been active in internationalization
.
A number of domestic or joint venture innovative pharmaceutical companies have taken the initiative to join hands with multinational pharmaceutical companies after obtaining coverage from China's medical insurance, and have reached cooperation and licensing agreements for development, production and commercialization in many countries
.
These examples show that the innovation level of Chinese enterprises has gradually matured under the incubation of policies and the domestic market in the past period
.
Taking advantage of the mature promotion experience in the local market, multinational companies have formed commercial teams and academic promotion layouts in many countries, especially in high premium countries such as Europe and the United States, helping Chinese companies to obtain greater returns in the vast global blue ocean
.

The advantages of Chinese products are: on the one hand, they can take advantage of China's vast and relatively stable market environment to maintain basic revenue; on the other hand, they can reduce the cost of enterprises after scale expansion, and use huge production capacity to sell to the vast majority of countries including countries along the "Belt and Road".
Projection products for low- and middle-income countries
.
It can not only correct the prices of exclusive varieties of some multinational companies to a level that the local people can afford, but also use overseas revenue to cross-subsidize the domestic market, further reducing the Chinese people's drug burden
.

There are views that the lower price of domestic medical insurance negotiation relative to the international reference price may hinder the overseas commercialization of the product
.
But this argument does not hold in most cases
.
The international reference price is currently not included in the formal health assessment process in most countries and regions except Japan, France, South Korea and Taiwan, and more price negotiations are completed through direct negotiation between medical payers and manufacturers
.
Comparability is a prerequisite for applying the international reference price.
The international reference price is still based on the five developed countries in the EU, because these countries and regions have similar medical insurance systems and relatively consistent medical goals
.
As mentioned by the Medical Insurance Bureau in "Soul Bargaining", the population gap between China and South Korea makes it impossible to directly compare the pricing of the two countries.
Few countries have such a huge patient group as China and relatively weak medical care in developed countries.
Affordability, China's medical insurance access price is unlikely to be directly used for overseas market access due to lack of comparability, so it is unlikely to be directly used for overseas market access negotiations
.