What are the investment opportunities in the medical insurance negotiations in 2021?

Looking back on the past three years, medical insurance negotiations have achieved excellent results, including more than 200 new varieties, and through negotiations, the price of drugs has been greatly reduced, and the availability of drugs has been improved
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In the 2018 medical insurance negotiations, 17 anti-cancer drugs decreased by an average of 56.

01 The results of medical insurance negotiations in 2021 may be released at the end of October

01 The results of medical insurance negotiations in 2021 may be released at the end of October

According to the "2021 National Medical Insurance Drug List Adjustment Work Plan" issued by the National Medical Security Administration in June
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The adjustment of the National Drug List in 2021 is divided into five stages: preparation, declaration, expert review, negotiation, and announcement of results

Table: 2021 National Medical Insurance Drug List Adjustment Process

At present, the adjustment of the medical insurance drug catalogue is in a critical negotiation stage (September-October).
The specific contents of the negotiation stage include:

1) Revise and improve the template for the submission of materials for negotiation of drugs;

2) Solicit the intention of relevant companies for the drugs to be included in the negotiation
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According to the company's intention, organize it to submit negotiation materials as required;

3) Organize calculation experts to carry out evaluations through fund calculations, pharmacoeconomics and other methods, and provide evaluation opinions;

4) Strengthen communication
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Communicate face-to-face with the company on the evaluated drugs, and solve the problems encountered in the evaluation in a timely manner;

5) Negotiation experts conduct on-site negotiations with companies based on the evaluation opinions, determine a unified national medical insurance payment standard, and clarify management policies at the same time
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From the specific content of the negotiation stage, it is not difficult to find that the negotiation stage is the climax of the adjustment of the medical insurance drug catalog
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At this stage, the medical insurance bureau and pharmaceutical companies play a game with each other, while ensuring the interests of pharmaceutical companies, as much as possible to release the heavy burden of medication for patients

From the analysis of the decline in previous years, there is a high probability that the decline in the medical insurance negotiations this year will exceed 50%
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An unresolved question is-when will the results of this year's medical insurance negotiations be announced? This may be evident from Haisco's answer

02 Analysis of key products in medical insurance negotiations in 2021

02 Analysis of key products in medical insurance negotiations in 2021

According to the 2021 drug catalog adjustment rules, the time node for inclusion in the scope of the drug catalog review is from January 1, 2016 to June 30, 2021
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According to "2021 national health insurance drug list by adjusting the preliminary review of the form of declaration drugs list" 15 China-made class Ⅰ drugs worth focusing on innovation, involving companies, including Hengrui Medicine, Beta Pharma, Baiji China, Zhejiang medicine

Table: Key Drugs in Medicare Negotiations in 2021

In general, the willingness of companies to impact medical insurance often depends on the number of competitors and the status of the inclusion of competing products in medical insurance.
Therefore, the competitive landscape is closely related to the outcome of medical insurance negotiations
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From the perspective of the competitive landscape, the above drugs can be roughly divided into three categories, including those with a good competitive landscape and no competing products included in the medical insurance; the competitive landscape is better, but the competing products have been included in the medical insurance; and fierce competition, generic drugs, A variety of innovative drugs competing on the same stage

(1) Products with a good competitive landscape and no competing products included in the medical insurance: Akirensai injection, vedicitumumab

Logic: Due to a good competitive landscape, there is limited incentive to cut prices for such drugs
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However, if it can be included in medical insurance by virtue of a smaller decline, it is expected to further consolidate the moat of the product, and accelerate the race enclosure with the help of policies

Akirensai injection is a CAR-T cell therapy targeting CD19, currently priced at 1.
2 million yuan
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Although WuXi Genuo's Ruijilunsai injection was approved for listing in September, it missed the current round of medical insurance negotiations due to the missed time node at the end of June
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However, due to the high price of Akilunza injection, even if it is included in medical insurance, it will inevitably aggravate the pressure on the medical insurance fund, so the probability of including it in medical insurance is relatively limited
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Perhaps, commercial insurance is the key to getting through the last mile of CAR-T drugs.
For example, Ping An Health Insurance i Medicine Insurance (upgraded version) has included CAR-T treatment on the basis of the basic drug list
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Vidicuzumab is the first HER-2 ADC drug approved for gastric cancer indications in China
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Although another HER-2 ADC drug, T-DM1, was approved for marketing in January 2020 and tried to impact medical insurance, it was not included in the medical insurance catalogue
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In addition, the approved indications of T-DM1 (breast cancer) and the indications of vedicitumumab are not the same, so there is no competition between the two
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(2) The competitive landscape is better, but the competing products have been included in the medical insurance varieties: Ensatinib, Vometinib, Tacitarcept, Fluzoparib, Abutinib, Pamidinib, Hybomai cloth, Dona Fini and so on
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Logic: For the above varieties, competing products have taken the lead to be included in medical insurance
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In this context, latecomers are more willing to be included in medical insurance
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However, whether the inclusion of medical insurance can achieve price-for-quantity depends on the price reduction of the drug and the competitive landscape of the market.
For products with limited market share and smaller price reductions, the inclusion of medical insurance may become an important driving force for the increase in the volume of drugs
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PARP inhibitors have become one of the most promising targeted drugs for the treatment of breast cancer, ovarian cancer and prostate cancer
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With the approval of fluzoparib and pamiparib, the competition of PARP inhibitors in China has become fierce
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Considering that AstraZeneca’s Olapali and Zai Lab’s Nilapali will be included in the medical insurance catalogue in 2019 and 2020 respectively, it is expected that Hengrui Pharmaceuticals and BeiGene will do their best in this medical insurance negotiation and strive to Its PARP inhibitors are included in medical insurance
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(3) intense competition, generic drugs and innovative drugs competing against varieties: Nainuo Sha star, ring, etc.
propofol
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Logic: Innovative drugs, with better efficacy and safety, realize the upgrading of old products, that is, "new wine in new bottles"
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However, under the influence of volume purchases, the prices of some old varieties have dropped sharply, or the negotiated prices of innovative varieties have fallen, resulting in the final negotiation result being less than expected
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Nenoxacin is a non-fluoroquinolone antibacterial drug, with high antibacterial power against drug-resistant strains, and good safety and tolerance
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Studies have shown that against methicillin-resistant Staphylococcus aureus (MRSA), the antibacterial activity of nanofloxacin is 4-16 times that of fluoroquinolones, and has potential application value for skin and soft tissue infections caused by MRSA
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In June 2021, Zhejiang Medicine's Class I innovative drug nanoxacin malate sodium chloride injection was approved for listing, which is expected to bring new vitality to the company
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Although the efficacy of nanofloxacin has advantages, considering that both moxifloxacin and levofloxacin have been included in the collection, and the decline is very sharp, it may affect the final negotiated price of nanofloxacin
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In June 2021, levofloxacin injection was shortlisted for the fifth batch of volume purchases.
In the end, six companies won the bid.
After the price reduction, the price range was only 17.
5-33.
65 yuan, an average drop of up to 75%
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03 Summary

03 Summary

Negotiations on medical insurance in 2021 are coming soon
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As the annual medical exam, there are many highlights in this year's medical insurance negotiations, and all new drugs such as CAR-T and ADC are on the battlefield
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In addition to the new drugs listed in this article, some domestic innovative drugs approved for marketing in 2020 are also worthy of attention, such as Hengrui Medicine’s remazolam tosylate, Renfu Pharmaceutical’s remazolam besylate, and Xinlitai Teriparatide, etc.
, following the failure of negotiations in 2020, will fight again on the battlefield of medical insurance negotiations this year
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Finally, I sincerely hope that more innovative drugs will be included in medical insurance as soon as possible to protect the health of patients
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