Original title: resumption of the strongest medical insurance Negotiation: 'Yaowang' reduced its price by 83%, only for the amount of drugs
'I always wear a bracelet every day. On November 11, the monitoring data show that the pressure red label is displayed all day. High pressure was maintained for 11 hours throughout the day. " Liu Hongliang, deputy director of Jilin social medical insurance administration, said that what he felt on the first day of participating in the medical insurance price negotiation was not the double 11 red envelopes.
Liu Hongliang made these memories at a press conference held by the State Medical Security Bureau in Beijing on November 28. The conference also officially announced the 2019 national medical insurance catalogue, with a total of 2709 drugs listed in the catalogue, of which the biggest highlight is the new 70 price negotiation varieties. These successful drugs are mostly new drugs with high clinical value in recent years, including 22 anticancer drugs, 7 rare drugs, 14 chronic diseases such as diabetes, hepatitis B, hepatitis C, rheumatoid arthritis, and 4 children.
At the media briefing on August 20 this year, Xiong Xianjun, director of the medical service management department of the National Medical Insurance Bureau, introduced that 128 varieties were included in the scope of medical insurance price negotiation this time. The results showed that 70 were finally negotiated, and the success rate was 54.7%, which intuitively proved that price negotiation was not easy.
There is a video of the negotiation scene circulating on the Internet, describing how AstraZeneca's dagliejing film was cut to 4.36 yuan step by step.
The market price of dagliejing (10mg) is 15.96 yuan per tablet. The negotiators of the enterprise quoted a low price of 5.62 yuan at the beginning, but this is obviously not enough. Under the persuasion of the experts of the negotiation team, after two consultations with the enterprise, when the latter finally reported 4.40 yuan, it was already lower than the lowest price in the world in the Korean market. Finally, because he said '4 is too bad', Leng was cut by the experts of the negotiation team by 4 cents and selected with 4.36 yuan.
It is this kind of bargaining that makes the average price drop of 70 varieties reached 60.7%.
After being included in the category B catalogue of medical insurance, the actual reimbursement of these drugs in various places is basically more than 60%. In other words, the part paid by patients only needs about 15% of the original price of drugs at most, and individual drugs are even as low as 5%.
According to the exclusive disclosure of CCTV, according to the preliminary calculation of the National Medical Insurance Bureau, according to the bidding and purchase prices of these 70 drugs in various places in 2018, the total sales of these drugs will reach 28.5 billion yuan in 2020, and after the negotiation, the total actually paid expenses will be reduced to 9.9 billion yuan.
Seemingly calm, several rounds of negotiations made tens of billions of big deals back and forth. In fact, the undercurrent surged -- the game between the parties reached the level of close combat, which is the difficulty of the medical insurance price negotiation.
'4 too much' is a negotiation skill
On November 13, the last day of price negotiation, the National Medical Insurance Bureau was still in full readiness to prevent any possible information leakage, and the security was even more strict than individual major events.
The day before that, an internal letter from Japan Weicai pharmaceutical circulated on the Internet. Weicai's team participating in the price negotiation regretted to inform the company's colleagues that Weicai's liver cancer specific drug 'Le Weima' failed to pass the negotiation. Wei Cai said that the company had made careful preparations for the negotiation and negotiated with the "maximum discount, the most honest and sincere price", but it still failed.
Subsequently, the aspect of health materials confirmed to the interface news that the company's product Le Weima (renvatinib) failed to enter the national medical insurance directory through negotiation in the recent medical insurance negotiations.
Liver cancer is a high incidence tumor second only to lung cancer in China. At present, 'Le Weima' is the only first-line drug for liver cancer in China. However, because the price is not as low as the bottom line set by the medical insurance bureau, it can only be regretted to be out.
Lin Song, an expert of the medical insurance negotiation team and head of Fujian pharmaceutical machinery joint procurement center, introduced the negotiation method in detail at the press conference of the National Medical Insurance Bureau on November 28: "the national medical insurance bureau first determines the expected price of medical insurance payment, and the enterprise will quote twice. If both quotations exceed the expected price by 15%, they will be out."
In the two attempts, the experts of the negotiation team will 'strive to guide the enterprise to offer a sincere price'. If the final quotation of the enterprise is within the line of "exceeding the base price by 15%" of the medical insurance bureau, the negotiation experts will negotiate again to 'ensure that the enterprise's bid is not higher than the previously determined expected price'.
From this scheme, it is not difficult to see that dagliejing tablets can be cut from 4.40 yuan to 4.36 yuan. The premise is that 4.40 yuan has been within the range of "exceeding 15% of the reserve price" of the medical insurance bureau, and 4.36 yuan is likely to be the real reserve price of dagliejing tablets by the medical insurance bureau. The so-called '4 too much doesn't sound good' may be just negotiation skills.
Even 1% of the profits are 'penny pinching', which is the hardest part of the price negotiation. According to the pharmaceutical enterprises involved in the negotiation, the whole process of the negotiation was recorded and recorded, and the closed management mode was implemented throughout the whole process. Lin Song said that this was to keep the base price of the negotiation absolutely confidential.
Therefore, in the three days from November 11, there was no way for the outside world to know any progress in the medical insurance price negotiation. Except for enterprises such as Jiehua biology, Weicai and so on, most of the negotiation information was false and true, and finally was falsified one by one.
Hu Shanlian, an expert of the drug economy calculation group and professor of Fudan University, introduced that the negotiation base price is the conclusion obtained by combining China's per capita GDP, consumption level and international market reference price, and fully evaluating the threshold of drug cost / effect. 150 varieties were reviewed within 21 days, the base price opinions were given, and several rounds of simulation were carried out to ensure the rationality of the base price.
For enterprises, the negotiation base price is an absolutely acceptable but uncomfortable price, which is the wisdom of the price negotiation of the medical insurance bureau.
Price for quantity, 'Yaowang' reduced its price by 83%
It is understandable for pharmaceutical enterprises to consider their own economic interests. However, after several exchanges, many enterprises found that the negotiation ability of the medical insurance bureau was indeed different. The industry has the saying that it is meaningless to negotiate without lowering it to less than 50%. In fact, 50% is far from reaching the standard.
Since its establishment in 2018, the National Medical Insurance Bureau has conducted two price negotiations. On September 15, 2018, 17 of 18 negotiation varieties were successful in the special negotiation on anticancer drugs, with an overall decrease of 56.7%. This time, the decline in negotiations was pulled down to 60.7%.
In the face of such a low price, some regret to leave the field, but also actively enter the field. Providing value for patients while realizing their own value has become the common idea of the finalists.
Novartis' bone marrow fibrosis drug lucotinib phosphate participated in the price negotiation in 2018 and became the only product that failed to be negotiated. At the press conference on November 28, Deng Yuexin, head of Novartis tumor (China) market access department, said: "after several rounds of in-depth communication with the headquarters, Novartis made substantive adjustments to the strategy of lucotinib in the Chinese market and gave a very sincere global lowest price in this year's negotiations."
Since 2012, the star product and immunotherapy drug xiumeile of Alberta has been the drug with the highest sales in the world for seven consecutive years. In 2018, the global sales reached US $19.936 billion, and the industry is known as the "drug king". This time, the king of medicine will also 'condescend', from 7600 yuan to 1290 yuan. If xiumeile had not started this year, it would have reduced its value to 3160 yuan in some provinces and cities, and the 'drug king' would have accepted a bargain of 83%.
Because of the high price, xiumeile has been used by less than 1% of Chinese patients. After entering medical insurance, patients may be able to use xiumeile for less than 5% of the original price.
Liu Hongliang also said that among the enterprises he negotiated, some made market strategy adjustments at the negotiation site, and even made fundamental strategic adjustments to reduce drug costs and benefit the society.
'price for quantity' is the general policy of medical insurance price negotiation, and the core purpose is to promote a sharp decline in drug prices. " Medical reform has been promoted for many years. The problem of "expensive medical treatment" has not been fundamentally alleviated before, and the focus of the contradiction has focused on drug prices. In terms of solving the problem of expensive medical treatment, among the three 'hospitals, pharmaceutical enterprises and circulation links', only pharmaceutical enterprises have not been deeply touched for many years, which is also the core of the problem.
In recent years, around drug prices, various national departments have promoted a series of policies, including the implementation of generic drug consistency evaluation, the promotion of centralized bidding procurement of drugs, the inclusion of large quantities of drugs into key monitoring, and the negotiation of medical insurance prices of innovative drugs. Industry insiders believe that only by pressing down the drug price, the gray and corruption problems around the drug price can be completely eradicated, and the medical and health system can truly restore the essence of public welfare.
In this sense, medical insurance price negotiation is an important part of people's livelihood. It not only provides market space for innovative pharmaceutical enterprises, but also provides more cheap and efficient choices for the treatment needs of the people, which is a win-win good thing.
Medical insurance business experience of pharmaceutical enterprises
In fact, the inclusion of pharmaceutical enterprises in the price negotiation system is not 'only about dedication without return', but the income is considerable.
The effect of medical insurance is very obvious. In May 2019, CICC made statistics on the sales of four star single products, including melova, Herceptin, Aventin and Novelli, according to the PDB drug comprehensive database data provided by China Pharmaceutical Industry Information Center. They were all included in the medical insurance price negotiation system in 2017.
According to the data, although the price reductions of the four drugs after entering the medical insurance were 29%, 65%, 62% and 43% respectively, due to the growth of sales volume, the actual sales amount of the four varieties in 2018 increased by 13%, 48%, 74% and 120% year-on-year respectively.
As long as the production capacity is sufficient and not selling at a loss, the increase in sales can fully cover the diluted profits. Therefore, the price negotiation is widely accepted by pharmaceutical enterprises. Pharmaceutical companies are more concerned about whether the production capacity can keep up after large-scale production.
In addition, the establishment of benign interaction with the medical insurance department is also conducive to the recognition of enterprises by relevant competent medical departments. Since 2015, the market access environment of China's pharmaceutical industry has undergone earth shaking changes, and the approval cycle of innovative drugs and medical insurance access cycle have been greatly shortened. The improvement of the access policy means that enterprises with innovative strength can rely on their own ability to realize the return on investment faster and more expected. " The amount 'may not only bring a drug variety, but a subsequent batch of drugs. Many smart pharmaceutical enterprises will not fail to calculate such an account.
Enterprises that give up medical insurance opportunities do not see this layer, but out of market strategy considerations. The hot topic of this negotiation: among the four PD-1 varieties that can treat a variety of cancers, only Xinda biology was selected, and the other three chose to give up. Among them, MSD's PD-1 product 'k drug' has three approved indications for the treatment of lung cancer and is the only variety in the market. Therefore, it is not surprising that MSD, which is in the 'seller's market', has not reduced its price to enter medical insurance.
Similarly, some varieties of medical insurance also have their own more commercial considerations, such as xiumeile. On November 8 this year, the State Food and Drug Administration approved the listing application of adalimumab of baiaotai company, and the domestic version of 'xiumeile' has been released. " If the drug king is still holding a shelf, it is not impossible to be 'hanged' by domestic enterprises in the future. It is appropriate to take a low profile and advanced medical insurance to seize the opportunity.
At the press conference on November 28, Xiong Xianjun made it clear that there is still a chance for drugs not included in the catalogue in the future, 'the National Medical Insurance Bureau will conduct further negotiations in comprehensive consideration of clinical needs, medical insurance affordability and the willingness of enterprises to reduce prices