An innovative exploration of the pharmaceutical business chain under the pressure of the "one-vote system"


shangjie· 2019-12-03 04:22:14

The stigma of drug price middlemen has a long history.

"Drug delivery-national distributor-provincial agency-pharmaceutical bidding-district / county agency-pharmaceutical company-hospital-patient" is a traditional drug distribution model. After a medicine leaves the factory, it needs to go through multiple links and several commercial companies to change hands before it can finally reach the hands of hospitals and patients.

Every circulation will incur personnel salaries, pharmaceutical agency fees, bidding fees, advertising fees, public relations fees, agency profits and other expenses. After layering up, the actual sales price of the drug will be very different from the ex-factory price. far. In addition, under this circulation mode, there are even companies that operate by ticketing and money laundering.

In 2011, CCTV's "Weekly Quality Report" reported that the price of some intermediate drugs increased by more than 6500%. Reducing the circulation has undoubtedly become the key point to crack the high drug prices. In recent years, the government has introduced a number of policies, such as 4 + 7 centralized mining, to address the problem of high drug prices.

In 2019, reducing drug prices remains one of the policy priorities.

In October 2019, Shandong Province issued the "Implementation Plan for the Implementation of the" Two-Vote System "for Drug Procurement in Public Medical Institutions in Shandong Province (Trial)", stating that it is necessary to select part of the dosage in the pilot cities of Grade III and other general hospitals Pilot "one-vote system" for large-scale and simple market supply channels is encouraged, and regions with conditions are encouraged to take the form of joint purchase and centralized payment in units of cities and counties to explore and implement the "one-vote system" for drug procurement.

On November 15, 2019, the State Council issued the "Notice on Further Promoting the Experience of Deepening the Reform of the Medical and Health System in Fujian Province and Sanming City", which states that in 2020, the national organization will be expanded in accordance with the unified national deployment. The scope of centralized procurement and use of pharmaceutical products. The provinces under the comprehensive medical reform pilot program should take the lead in promoting the settlement of payment by the medical insurance agency directly with pharmaceutical production or distribution companies, and other provinces should also actively explore. This means that the "one-vote system" will be gradually promoted in all provinces.

The "one-vote system" for drugs means that the number of drug circulations must not exceed one. Hospitals and pharmaceutical companies directly settle the payment. Pharmaceutical companies and commercial companies directly settle distribution costs, which can significantly reduce the cost of drug distribution and purify the distribution. Environment, promote industry transparency, and facilitate the supervision and traceability of medicines.

Prior to this, many provinces have issued related policies to encourage or start pilot drug "one-vote system", such as Guangdong, Zhejiang, Hubei, Shanxi, Shaanxi, Beijing And Tianjin. As a vanguard, Fujian Province as early as 2016 clearly required hospitals to directly settle with pharmaceutical manufacturers when purchasing basic infusions and strictly implement the "one-vote system".

At present, all the cities that have been piloted are targeting some medicines, and have implemented a "one-vote system" in some hospitals. This time, the policy of Shandong Province is also to select some medicines with large quantities and simple market supply channels. The "one-vote system" has not yet been implemented in all provinces for all medicines and regions, but many people in the industry believe that the full implementation of the "one-vote system" for medicines may not be far off.

Under the "one-vote system", how commercial companies seek new profit growth points, and how pharmaceutical companies should build brands and build marketing networks have become the focus of discussions in the industry.

Artificial Network interviewed the famous doctor Zhonghe CEO Jiang Qiang, Yaofei Network CEO Xiao Lingfei, and medical cloud founder Dian Canghe and other relevant persons in the medical industry, and got the following opinions:

1 Commercial companies have a large number of contacts and resources, and they can create new profit growth points through the establishment of retail terminals, acquisition of pharmaceutical companies and API companies;

2. In a short period of time, the "one-vote system" It is difficult to cover primary medical areas, pharmacies, and small medical institutions. Commercial companies can continue to make efforts in these three markets;

3. Pharmaceutical companies without innovative capabilities and commercial companies without terminal channels will be out. Industry concentration will be further improved;

4. Pharmaceutical companies will need to establish their own business teams and marketing networks, and labor costs will increase;

5. Is it possible for medical insurance to pay for goods in advance? One of the keys to the successful implementation of the "one-vote system";

6. Big data, artificial intelligence and information technology can promote the smooth implementation of the "one-vote system" for drugs.

The "one-vote system" is an advanced version of the "two-vote system"

From the full implementation of the two-vote system for drugs to the "one-vote system" pilot, it only took more than two years time.

At the end of 2016, the State Council's Medical Reform Office and other ministries and agencies jointly issued the "Implementation Opinions on Promoting the" Two-Vote System "in the Purchasing of Drugs in Public Medical Institutions." Only after confirming that the ticket, goods and account are consistent can they be put into storage and used.

On January 9, 2017, the National Health and Family Planning Commission issued the "Implementation Opinions on Promoting the" Two-vote System "in the Procurement of Drugs in Public Medical Institutions (Trial)", announcing the national "two-vote system" Start.

"Two-vote system" refers to a one-time invoice issued by a pharmaceutical manufacturer to a distribution company, and a one-time invoice issued by a distribution company to a medical institution, which can reduce the circulation of drugs, regulate the circulation order, improve circulation efficiency, and reduce drug fraud High prices, crack down on illegal attachment, commercial bribery, tax evasion and other acts. After the implementation of the "two-vote system", the biggest impact was on large and small commercial companies.

Commercial companies: transforming into CSOs, laying out the primary medical market

The method for commercial companies with terminal channels to respond to the "two-vote system" is to transform into a CSO (Contract Sales Organization). Through the status of CSO, get rid of national general and provincial identities, directly connect with pharmaceutical companies in some areas, seize terminal resources, and maintain local business channels with pharmaceutical companies, without involving tickets and goods. You only need to sign consultations with pharmaceutical companies. contract.

In addition, some large commercial companies have also responded to the "two-vote system" through strategies such as the layout of the primary market, mergers and acquisitions, and drug retail. For example, China Resources Pharmaceutical has completed a number of prefecture-level and city-level project mergers and acquisitions, and has successfully entered Jiangxi, Qinghai, and Xinjiang markets through mergers and acquisitions. According to the Group's annual report, in the first half of 2017, China Resources Pharmaceutical's distribution business grew 16% year-on-year, M & A business contributed 2%, and hospital direct sales increased 20% year-on-year.

Pharmaceutical companies: self-built business teams and sales networks

If it is a pharmaceutical company with standardized operation, own brand, and self-built team development terminal, whether it is "two-vote system" or The "one-vote system" does not have much impact on such pharmaceutical companies. For pharmaceutical companies that have neither a terminal nor a brand, they need to build their own business team and build a sales network to handle shipments, invoices, and refunds.

The effect of the "two-vote system" on reducing drug prices is not obvious.

In the specific implementation process, many people in the industry found that the "two-vote system" did not significantly reduce the price. The role of drug prices.

In the past, with the help of billing companies, reducing the billing cost and avoiding the risk of cash withdrawal were the two main purposes of the bottom price billing of pharmaceutical companies.

Before the reform, the billing cost of the billing company was much lower than that of the production company. Therefore, the company chose the base price for billing and asked the dealer to find the billing company for billing, which could save costs. In addition, the cost of sales on behalf of gold must be found by way of cash withdrawal. Most companies are unwilling to bear this risk and can only be solved by the dealers themselves. Therefore, the ticket-taking company has assumed the role of cash withdrawal.

After the business reform and increase, the billing cost of the billing company is no longer superior to that of the company, and the company no longer finds the billing company. Instead, it directly opens up on its own, and the cost increase is inevitable. ; On the other hand, the withdrawal demand still exists. For the sake of risk, most companies will still hand it over to the dealer. The dealer will also have to find a ticket company or set up a company to be responsible for the withdrawal. The withdrawal cost and risk will increase and increase. These two parts of the cost are ultimately reflected in the price of medicine.

In addition, the "Economy" magazine reported that after the "two-vote system", some small commercial companies "skinned" into pharmaceutical companies to rebate and earn distribution fees. The phenomenon.

Comparatively, the introduction of the "one-vote system" is obviously more able to protect the price of drugs and purify the environment for drug distribution.

Terminal channels and innovation capabilities will become the foundation of commercial companies and pharmaceutical companies.

In the traditional circulation model, commercial companies assume the two functions of advancement and distribution. After the "one-vote system", the transformation of commercial companies into CSOs is no longer feasible. Because of the cross-border commercial companies, Medicare directly settles with enterprises, and commercial companies no longer play the role of capital advancement, only delivery functions.

In layman's terms, under the "one-vote system", commercial companies have become the role of courier, leaving only the distribution function, and the profit margin has been compressed. Dang Canghe, the founder of the pharmaceutical cloud, said: "Under the 'one-vote system', social logistics companies may take advantage of the pharmaceutical distribution business. For pharmaceutical companies, there are more options for drug distribution." This is a commercial company. In other words, it is a little more competitive pressure.

Commercial companies: actively transform and expand their businesses, and look for new profit growth points

Yaofei Network CEO Xiao Lingfei said: "The purpose of the 'one-vote system' reform is to further optimize Medical insurance payment and rational use of medicines. This will promote the further concentration of the industry, put forward higher requirements on the cost control of commercial companies, and commercial companies without service capabilities and distribution networks will be out. Finally, there must be several large commercials on the field. Companies. "

Some industry insiders also believe that demise is not the only ending for small business companies. They can choose to rely on pharmaceutical companies to become regional management, or they can transform to serve hospitals and other institutions, depart from existing operating models, and become consulting institutions. They can also use the valuable resources accumulated previously to connect with social logistics companies and help them develop. Market to achieve a win-win situation.

An interviewee told ArtNet that after the "one-vote system", pharmaceutical companies tend to choose commercial companies with lower distribution prices. The competitive point of commercial companies will focus on distribution costs and profits will be Thin. In this regard, Xiao Lingfei believes that distribution fees will not be the only source of profit for commercial companies.

Xiao Lingfei said: "A company with a large volume, high warehouse turnover, complete management system, and strong distribution capability will indeed occupy a competitive advantage, but commercial companies can also use industry contacts and resources to integrate through mergers and acquisitions , Extending the industrial chain, acquiring pharmaceutical companies, etc. to create new points of profit growth. "

For example, Shanghai Pharmaceuticals acquired the distribution company Kangdele and the pharmaceutical company Lepu Pharmaceutical; Sinopharm is actively expanding the device Field, strengthen the construction of its own device channels; Kyushutsu focuses on the primary medical market, and launched FBBC ("F" means upstream drug manufacturing enterprises, the first "B" means Kyushutong, and the second "B "Ie terminal pharmacies and clinics," C "means consumers. These measures can to some extent deal with the negative impact of the "one-vote system".

In addition, Jiang Qiang, CEO of Mingyi Zhonghe believes that China's primary medical market is fragmented, with a large number and a small demand for a single institution and a single product. Therefore, it is difficult to fully implement the "one-vote system" in the primary medical market, clinics, and small medical institutions in a short period of time. Commercial companies still have an irreplaceable role in these three markets, and can continue to make efforts in these three markets.

Pharmaceutical companies: self-built teams and marketing networks, without the ability to innovate will be out of the market.

The implementation of the "one-vote system" for pharmaceuticals is obviously less severe than the impact of commercial companies. After the "one-vote system", in the face of a large number of medical institutions, pharmaceutical companies must establish a business team and a marketing network if they want to connect with hospital terminals and exchange information.

In addition, a person in charge of an innovative drug research and development company said that products are the core competitiveness of pharmaceutical companies. Regardless of the "two-vote system" or "one-vote system", the market demand for innovative drugs will not cut back. Xiao Lingfei also said: "Now, many pharmaceutical companies sell duplicate products. Under the" one-vote system ", in the past, it has become more difficult for commercial companies to pass tickets and transfer payments. There will be a large number of pharmaceutical companies without innovative capabilities and product advantages. Out. "Therefore, the majority of pharmaceutical companies need to focus on product quality and innovation capabilities.

"One-vote system" is still a long way to go nationwide.

Dian Canghe said that if he wants to implement "one-vote system" nationwide, no It will be as smooth as the "two-vote system" and some key issues need to be addressed.

Medical advances. Previously, commercial companies had assumed the role of advancement to ensure that pharmaceutical companies received payment in a timely manner. After the implementation of the "one-vote system", the ability of pharmaceutical companies to pay back funds in a timely manner has become the focus of industry attention.

People in the industry believe that the difficulty of repaying pharmaceutical companies may draw lessons from the "one-vote system" of consumables.

For example, in November 2017, Zhejiang Pharmaceutical Machinery Purchasing Center started running a new platform for purchasing medical consumables in Zhejiang Province. The platform realizes the "three-in-one" of information flow, business flow, and capital flow. It encourages changing the direction of sending purchase orders, and medical institutions send orders directly to production enterprises, reducing the circulation. On the launch of the platform, the Second Affiliated Hospital of Wenzhou Medical University issued 10 purchase orders for medical consumables, of which 6 orders were delivered on the same day. After 8 days, the supplier Wenzhou Yingte Pharmaceutical Co., Ltd. successfully received the payment, and the speed of payment was significantly accelerated.

Some interviewees believe that with the popularity of follow-up medical insurance advancement, the difficulty of reimbursement by pharmaceutical companies can be properly resolved. However, Jiang Qiang is not optimistic about the "one-vote system" in the hospital market. "Because of the differences in economic levels in different regions, the" one-vote system "settlement requires medical insurance to be able to pay all the goods in time to the hospital or directly settle the drug delivery company. If only a part of the advance is paid, it will be difficult to completely solve the difficulty of reimbursement for pharmaceutical companies. "

In this regard, Dian Canghe said:" On the premise of prepayment for medical insurance, the repayment of medicines has been greatly improved. Guarantee, if the payment period can be agreed like 4 + 7 collection, the repayment period will be greatly shortened, which will greatly reduce the pressure on repayment and funding of pharmaceutical companies. However, it is worth noting that pharmaceutical production, operating companies and medical insurance directly Does the settlement of the payment mean that the drug company and the doctor keep the drug transaction? ——This is fundamentally different from the current medical insurance purchase of the services of designated medical institutions. Does the medical insurance need to set up a company that specializes in the payment of the drug? And does this company To obtain a drug business license? Does this comply with relevant legal and policy requirements? All need to be reviewed. "

Primary medical market drug supply issues. Jiang Qiang said: "China's primary medical market is vast, and under the 'one-vote system', whether it can guarantee the supply of drugs in the primary market is still a question worth pondering.

Stakeholders object. There are interviews The author mentioned: "The" one-vote system "" will undoubtedly move some people's cheese. "For example, Guangdong Province took the lead in referring to the" two-vote system "in the reform of the pharmaceutical distribution system proposed in 2007, but was The pharmaceutical companies signed a letter of opposition and put it on hold. Until the end of 2017, the related implementation plan of the "two-vote system" was introduced.

Facing the above problems, Jiang Qiang believes: "Big data, artificial intelligence, and information technology are one of the solutions, but how effective is this solution? Is there a better solution? Still needed Explore in practice. "

Xiao Lingfei said:" The 'one-vote system' has a positive significance for reducing drug prices and purifying the circulation environment, but it is too late to talk about the full implementation of the 'one-vote system'. Early, from pilot to full implementation, it will take a long time to explore and polish. "

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