What signal is the government sending to let high-priced drugs go into health insurance immediately after the rebate door?

Recently, the biggest thing in the pharmaceutical industry is CCTV's "kickback door", that is, on December 24, CCTV recently broadcast a 16-minute special report "drug kickbacks are rampant" undercover program, in which it was pointed out that the commission of medical representatives was 10% of the drug price, while the rebate received by doctors was 30% to 40% of the drug price. Once the eight-month report of CCTV reporters' unannounced visits was broadcast, the National Health and Family Planning Commission quickly requested the administrative departments of the two health and family planning commissions to investigate the kickback incident and deal with the personnel involved.

However, when everyone was still worried or worried about the time of CCTV's kickback, on the last day of the 2016, the Shanghai municipal government, the center of the storm, announced that 24 high-priced anti-cancer drugs had been included in the medical insurance payment since 2017, and Shandong province also announced 18 anti-cancer drugs to be included in the medical insurance a week ago, This is undoubtedly another boost to the pharmaceutical industry suffering from "paroxysmal heart failure.

It has just been severely revealed that up to 50% of the drug costs are consumed in rebates, and then the two major provinces have successively included dozens of high-priced drugs in medical insurance. The time for these two events is so tight, especially The launch of the Shanghai catalog was obviously not affected by CCTV reports, and it is a full 24 high-priced anticancer drugs, which can be said to be unprecedented.

We have to wonder what signal the government wants to send to the pharmaceutical industry, is the pharmaceutical industry bullish or bearish in 2017? What are the criteria for selecting these dozens of cancer drugs that are covered by health insurance? Will these drugs be abused? How to ensure that there is sufficient health insurance costs to pay for them?

As the Shanghai Municipal Government announced, the purpose of including a batch of high-priced drugs this time is to respond to people's livelihood needs, reduce the burden on patients with major diseases and improve the efficiency of the use of medical insurance funds. This is not just a standard official document. It once again reminds that the goal of medical reform is to achieve basic medical security for everyone through reasonable allocation of resources and efficiency improvement. Although the abolition of medical care with medicines is the focus of medical reform at this stage, medical reform is by no means to combat Reform of the pharmaceutical industry. Conditional areas will gradually increase the level of medical insurance payment for drugs, which will be the main driving force of the pharmaceutical industry. Since the integration of the two guarantees this year, the financing level of the 0.8 billion covered by the new rural cooperative medical system has been continuously improved, bringing bright prospects to chronic disease drugs, first aid and women's and children's drugs. Dozens of high-priced tumor drugs that have benefited from this time are also first-line clinical drugs with long clinical use and definite curative effect, and have entered the medical insurance catalogue of no less than three provinces and cities. In the past, allowing patients to purchase at their own expense for a long time did not meet the purpose of the establishment of the health insurance fund.

A large number of high-priced drugs into the health insurance, will it be a feast for medical representatives but become a nightmare for the health insurance fund? Shanghai this time clearly "set the hospital, set the doctor, set the evidence" of the "three principles", the requirement is a certain level of hospital attending doctors above the case prescription, and health insurance will strictly monitor the growth of each doctor's prescription. In terms of drug prices, CCTV reported that the government was, of course, more cautious, requiring listed enterprises to reach a price reduction of at least 10%-30% with medical insurance, and the reduction was linked to the reimbursement ratio of medical insurance (the reimbursement ratio ranged from 40% to 60%), which was equivalent to the local version of the "national drug negotiation". Of course, in order to protect the national retail price of the variety, Shanghai acquiesced only to reduce the price of medical insurance payment. Both monitoring and price reduction, the security of the health insurance fund should be guaranteed. Pharmaceutical companies should be able to see an increase in sales, but it will not be explosive, and price cuts will also reduce gross profit, so pharmaceutical companies will not expand their sales teams or increase investment. Pharmaceutical representatives will not be the beneficiaries, but the importance of market access teams and pharmacoeconomic evaluations is re-emphasized.

Compared with Shanghai, which has a balance of nearly 300 billion million medical insurance funds, Shandong is included in the serious illness medical insurance this time, and the insurance coverage and proportion are slightly lower. In the future, all provinces and cities are expected to include high-priced drugs with definite efficacy according to their own financial resources, rather than simply depending on the price of the drug. On the contrary, some seemingly reasonable pricing but no curative effect of "magic medicine" is more to worry about.

Therefore, this is undoubtedly a good news for the majority of companies with strong knowledge and technology content. Imagine if there is a drug that has sufficient efficacy and people need it, then even if the price is high, the government will consider joining medical insurance. And joining the health insurance catalog is bound to bring about another increase in drug sales. If the patent rights of this drug are in hand, the commercial value and potential impact are even more incalculable. Bayer's aspirin mentioned in the article we pushed last week is the best example.

Looking back, if we look at the CCTV rebate door and the high-priced drugs into medical insurance together, we will find that under the condition of limited financial resources, the government is willing to increase the reimbursement of medical insurance but is worried about being abused, so there will be a move to crack down on drug rebates and expand medical insurance drug expenditure. In 2017, we can foresee that the supply-side reform of the pharmaceutical industry will intensify. The two-vote system, consistency and anti-commercial bribery will continue to clean up a number of pharmaceutical companies and practitioners. The medical insurance payment reform will protect the sustainability of the medical insurance fund as never before. When these two steps are almost completed, the government will have more efforts to support those genuine new drugs, and the spring without smog in the pharmaceutical industry will really come. It is also expected that enterprises with patents in hand will seize the opportunity to usher in their own spring in the future market.

News source:

　　http://www.y-lp.com/pages/Article.aspx?id=4927845801044117264

This news was re-edited and reorganized by the Huaxun team and added analytical comments.