Tripartite game: Pharmacy Trusteeship: the strongest opposition of production enterprises

Source: daily economic news 2014-04-15 a new wave of pharmacy trusteeship has caused polarization in the pharmaceutical industry Pharmaceutical companies, distribution companies and public hospitals have shown different performances, some in favor, some in opposition The policy discussion of pharmacy trusteeship is still an unsolved topic Recently, an authoritative person from the health and Family Planning Commission of Guangdong Province told reporters that the national health and Family Planning Commission has been organizing experts, scholars and enterprise representatives to discuss the pharmacy trusteeship model, but no relevant policies have been put forward so far "I've had a lot of internal discussions I was about to have an eye on it, but I didn't have any more." Behind the policy of pharmacy trusteeship is the interest game among the public hospitals, the trusteers and pharmaceutical enterprises The trusteers want to monopolize the purchasing right and bargaining right of the public hospitals The "zero difference rate" of the public hospitals Under the pressure of the policy of separation from medicine, or facing the reality of losing drug revenue; pharmaceutical enterprises are not willing to third-party trusteeship to join the formed drug circulation link Listed pharmaceutical companies have surrounded Kangmei pharmaceutical industry, which is the leader in this round of pharmacy trusteeship boom In January and February 2014, Kangmei Pharmaceutical Co., Ltd issued four consecutive announcements that it has signed pharmacy custody agreements with more than 80 public hospitals, including 9 public hospitals under the jurisdiction of Puning City, Guangdong Province, 45 public hospitals under the jurisdiction of Tonghua City, Jilin Province, 4 hospitals directly under Liaoning University of traditional Chinese medicine, 22 hospitals under Liaoning Medical Group of traditional Chinese medicine Traditional Chinese Medicine pharmacies in hospitals Baiyunshan annual report, a listed company under Guangzhou Pharmaceutical Group, shows that its pharmaceutical companies have signed modern pharmaceutical logistics service extension cooperation agreements with Guangdong Second People's Hospital, Meizhou Dapu people's Hospital and other hospitals According to the statistical analysis report on the operation of drug circulation industry in 2012 released by the Ministry of Commerce in May last year, there are 29 enterprises undertaking the custody of pharmacies in 2012 So why do pharmaceutical companies suddenly favor pharmacies in public hospitals? The reporter learned that there are two main business models of medical trusteeship: one is that the enterprises of trusteeship pharmacy distribute drugs exclusively to the hospital, pay the trusteeship fee or profit share to the hospital every year, the hospital pays the drug circulation fee to the trusteeship enterprise, and the enterprise can also get the price difference from entering the hospital's drugs; the other is that the trusteeship enterprise only earns the flow of exclusive drug distribution for the hospital General expenses, bear the cost of pharmacy personnel and drug management On the face of it, it is not a cost-effective business for an enterprise to bear the salary of pharmacy staff, fixed expenses of pharmacy, rent and rent of facilities, advance funds, pay custody fee to the hospital in a certain proportion, and face the risk of drug price reduction and original debt In fact, the decision right and bargaining right of the entrusted drug varieties are the prey that the pharmaceutical enterprises are competing for Analysts of Guosen Securities believe that pharmaceutical companies have the right to purchase all the drugs in the hospital and can directly negotiate prices with pharmaceutical companies, and the price difference belongs to the company The company is mainly responsible for the cost of pharmacy labor and long-term hardware and software transformation The fixed cost is not high With the growth of income scale, the profit margin will gradually increase Yu Mingde, President of China Pharmaceutical Enterprise Management Association, told reporters that assuming that 30 enterprises supply drugs to the hospital together, only one enterprise has the right after the drugstore is entrusted, and the remaining 29 enterprises have to come to this enterprise if they want to continue to supply, "this is an absolute monopoly for the drugstore." The reporter combed the annual reports of several listed companies and found that the relevant companies all said that they would make great achievements in the pharmacy custody business Baiyunshan annual report mentioned that the company will dynamically control the "pharmacy trusteeship" mode under the new situation to bring the third running horse enclosure of pharmaceutical business, and play the synergistic and complementary effect of pharmaceutical industry and business Lou Dingbo, chairman of Shanghai pharmaceutical, said at the performance presentation meeting of Shanghai Pharmaceutical Group that at present, the company's pharmacy custody business has made little contribution to the company's profits due to its short time, small scale and unequal input-output The company will actively participate in the custody work of the pharmacy, and the business will be profitable in the future when it reaches a certain scale For a long time, Cr Pharma has denied doing pharmacy trusteeship, and the cooperation between CR pharma and Guangdong People's hospital belongs to pharmacy trusteeship A relevant person of China Resources Guangdong Pharmaceutical Co., Ltd recently clarified to the participating enterprises at a seminar on "pharmacy trusteeship" that China Resources pharmaceutical did not do pharmacy trusteeship "The cooperation project between China Resources pharmaceutical and Guangdong People's hospital is to provide extended medical logistics services for the hospital We have invested 70 million yuan in the provincial people's hospital to modernize and upgrade the intelligent information of the hospital's drug logistics What we do is a public welfare project, not to make money " However, a representative raised a question on the spot that although CR Pharma did not pursue profits at present, its focus was on the absolute bargaining power and drug selection right behind the pharmacy of the provincial people's hospital Insiders of China Resources medicine responded that Guangdong People's hospital has about 1.8 billion yuan of purchasing amount every year, and the annual income of China Resources medicine accounts for about 1 / 5, or 360 million yuan In the past, pharmacists used to allocate, distribute, keep accounts, purchase and check drugs by hand, with low efficiency and high error rate If the share of Cr medicine in provincial medicine reaches a certain proportion, it can support the information platform of drug management "Now we have solved the problem of patients waiting in line to take medicine, and the hospital has realized intelligent drug management Among the original 28 suppliers of Guangdong People's Hospital, except for the withdrawal of Guangyao group due to individual reasons, the supply shares and prices of other suppliers have not changed " Said the person But many in the industry have expressed the opposite view A deputy general manager of a chain drugstore in Guangzhou said that in the near future, Cr Pharma began to put forward a rebate demand of 5 points to other enterprises; another industry personage who did not want to be named further said that previously, Cr Pharma issued invoices to enterprises with a discount of 9.5%, now with a discount of 9% "They call it information management in other words, but they have invested so much money, which is definitely in return." However, relevant people of China Resources medicine did not respond to the above statement The reporter noticed that the public hospital is also one of the promoters of this round of pharmacy trusteeship In the new round of medical reform, the zero margin reform of drugs pushed by the government is just the booster Yu Mingde told reporters that in the past, drug revenue was the main revenue of the hospital Now the government promotes the separation of medicine and zero difference rate of medicine In the name of "custody fee", the hospital not only avoids the separation of medicine, but also does not cut off the drug revenue Liao Xinbo, deputy director of the health and Family Planning Commission of Guangdong Province, provided such a set of data: the income of first-class drugs in township hospitals accounted for 70% of the total income According to the statistical yearbook of the national health and Family Planning Commission, from 2007 to 2009, the drug revenue of the government run medical institutions accounted for more than 41% of the total revenue In the work plan for price reform of county level public hospitals in Guangzhou, after several hospitals in Conghua achieved zero interest rate, the fund gap reached more than 70 million yuan, and the government financial subsidy was only 15 million yuan Under the pressure of such funds, some local governments or hospitals try to leave pharmacies as a burden to enterprises However, in the new round of trusteeship upsurge, some key details have not changed: the property right of the pharmacy still belongs to the hospital, and the trusteeship pharmaceutical enterprise is only responsible for the specific operation; the personnel relationship of the original staff of the pharmacy, the function of the pharmacy department and the identity of the staff of the pharmacy remain unchanged, and the salary and remuneration are in the charge of the trusteeship enterprise From the perspective of cooperation mode, public hospitals are the beneficiaries of "no compensation for profits" In the agreement with the pharmaceutical enterprises, there is such an article: the hospital must be guaranteed not less than the drug revenue before custody, and the profits shall be paid in a certain proportion Liao Xinbo pointed out to reporters that hospitals and doctors are likely to be dissatisfied and boycotted because they are not clear about the quality and safety of the replaced drugs after they are replaced by the trusteeship On the other hand, the agreement between the trusteeship and the hospital has linked the two together, and it is inevitable that a large prescription will be made in the interest seeking behavior Chen Hailong, an industry person who once participated in the trust mode negotiation of Nanjing pharmaceutical pharmacy, told reporters that he once participated in the "Nanjing mode" negotiation as the general manager of a pharmaceutical factory in 2007 Due to the high gross profit rate of the products, they entered the procurement smoothly, but the sales situation in the later stage was not good "Even in the model of pharmacy trusteeship, doctors still have the right to prescription." Among all the stakeholders, the production enterprises have the strongest opposition In their view, pharmacy trusteeship not only can't solve the problem of supporting doctors with drugs, but will aggravate the corruption of medicine According to Liao Xinbo, the mode of pharmacy trusteeship has neither cut off the phenomenon of "supporting doctors with drugs" nor changed the phenomenon of "medical kickbacks", but just added a "managing mother-in-law" on the original basis " First of all, the pharmacy trusteeship does not squeeze the unreasonable interest structure and price moisture in the circulation channel; second, the trusteeship side has the absolute say in the supply chain by virtue of the absolute advantage of exclusive purchase and sales, and the pharmaceutical production enterprises are in a passive position in order to sell the drugs; third, the trusteeship contract has determined that the hospital and the trusteeship side are the interest community With the trend of profit, it is still difficult to avoid the hospital's large prescription, and the trustee may even lower the drug sales price " Production enterprises bear the brunt of lowering the drug sales price Chen Hailong confessed to the reporter of "daily economic news" that the behavior of pharmacy trusteeship can not avoid the hospital to obtain drug profits through the disguised pharmacy trusteeship, "Nanjing mode" is to take high gross profit products as the management core and complete the sales task through product substitution "There are new value conflicts in the market The trusteers need to make profits and the hospitals under trusteeship need to create benefits These actions determine the business orientation of both sides The gross profit margin of large pharmaceutical enterprises is generally low, and mature products are either faced with making profits or will be replaced " To this end, Liao also agreed, "under all kinds of pressure, there may be a result: drug companies do not supply, hospitals do not have good goods The living space of pharmaceutical enterprises is seriously compressed, so it is possible that they will not supply to the trustee " Although the current policy is not clear, many people in the industry are not optimistic about the prospect of pharmacy trusteeship In March this year, some people in the pharmaceutical industry jointly proposed in Beijing to stop the trusteeship of pharmacies with administrative power to allocate resources and return the autonomy of medical institutions to purchase drugs