In response to this, on November 30, the state medical insurance bureau pointed out that through guiding local governments to carry out the exploration of centralized purchase of Chinese patent medicines, pilot projects have been carried out in Qinghai Province, Jinhua in Zhejiang Province, Puyang in Henan Province, etc., aiming at some varieties of Chinese patent medicines with large demand and high amount of money, and have achieved remarkable results in reducing prices.
At the same time, the state medical insurance bureau also made it clear that the next step would continue to guide the local governments to carry out centralized drug procurement, improve the procurement methods and reasonably determine the scope of centralized purchase according to the clinical drug demand.
For Lin fanrus proposal, the State Medical Insurance Bureau actually gave a negative reply.
The State Medical Insurance Bureau replied that at present, a certain proportion of Chinese patent medicines are included in the national essential drugs and medical insurance catalogue, and medical institutions can select appropriate drugs for clinical application in combination with their own diagnosis and treatment needs and it is not appropriate to impose mandatory restrictions on the allocation and use policies of Chinese patent medicines in medical institutions.
In combination with the scheme of hanging on the net without quantity and price limit adopted for Shenkang, Xiyanping, Tanreqing, Xueshuantong and other traditional Chinese medicine injections in Qinghai pilot project, the industry analysis shows that the procurement scheme of Chinese patent medicine with quantity will be different from that of chemical medicine, not only the product price will be greatly reduced, but also the market may not be expanded.
This also means that the Chinese patent medicine market, which can not prove its safety and effectiveness, will shrink sharply until it disappears.
A large number of traditional Chinese medicine have been kicked out?
In early November this year, a resolution of the hospital pharmacy management and pharmacotherapy Committee was circulated in the industry.
Coincidentally, before this, Xiangya No.2 Hospital, Huaxi Hospital, etc. had sent papers to refuse the admission of traditional Chinese medicine, traditional Chinese medicine injections and auxiliary drugs.
The standing list of drugs is a list of hospital drug procurement and clinical medication. Generally, the number of drugs in grade III A hospitals ranges from 1400 to 2000.
These traditional Chinese medicine varieties were kicked out of the catalog, which basically means losing the market of corresponding hospitals.
Why a large number of traditional Chinese medicine will be kicked out of the big hospital?
In July last year, the medical administration bureau of the Health Commission issued the notice of the first batch of national key monitoring and rational drug use list (chemical and biological products), which formally proposed that doctors of other categories other than traditional Chinese medicine should, after systematic study of TCM professional knowledge for at least one year and pass the examination, according to the basic principle of syndrome differentiation and treatment of traditional Chinese medicine, prescribe Chinese patent medicine.
On August 20, 2019, the State Medical Security Bureau and the Ministry of human resources and social security issued a notice on printing and distributing the drug list of national basic medical insurance, work injury insurance and maternity insurance. In the item of strict payment management, it is pointed out that the fund can only pay for the prescription of Chinese patent medicine and decoction pieces issued by doctors with corresponding qualifications.
On September 14, 2020, Jiangsu Provincial Health Commission issued a document: non traditional Chinese medicine doctors or rural doctors practicing in primary medical and health institutions can prescribe common Chinese patent medicines (including long-term prescriptions) for common diseases and frequently occurring diseases, or continue to use long-term prescriptions of Chinese patent medicines issued by Chinese medicine practitioners.
This means that at least the ban on prescribing Chinese patent medicines by western medicine in medical institutions at or below the county level has been basically lifted.
The reason why many departments have launched policies to limit the qualification of Western medicine prescribing traditional Chinese medicine is to standardize the disorder of Western medicine prescribing Chinese medicine and promote safe and rational drug use; on the other hand, in order to reduce unnecessary medical insurance expenditure.
In recent years, with the change of policy environment, the rationality of clinical drug use has been paid more and more attention. This has also led to a thorough change in the mentality of hospital medication, coupled with the pressure of performance appraisal, the cost-effective drugs are becoming more and more popular.
The irrational use of traditional Chinese medicine is serious and its use is limited
In fact, in June last year, Beijing, as the countrys second largest pharmaceutical market, opened its doors to the traditional Chinese medicine market.
Beijing Municipal Administration of traditional Chinese Medicine issued by Beijing Municipal Administration of traditional Chinese medicine three linkage action plan to improve service, improve quality and control costs clearly points out that it is necessary to strictly control the large prescription and excessive use of Chinese herbal pieces, and puts forward the index of single prescription, three limits for Chinese patent medicines.
Strictly control the large prescription and excessive use of Chinese herbal pieces. In principle, the average number of flavors in a single dose of Chinese herbal pieces should not exceed 16, and the average cost of each prescription should not exceed 10% year-on-year. The index of single prescription three limits for rational use of Chinese patent medicines means that no more than two kinds of Chinese patent medicines are prescribed in the same prescription, only one kind of Chinese patent medicines in the same subclass can be prescribed, and the maximum number of Chinese patent medicines prescribed for more than three diseases is not more than five.
In the 2019 edition of the medical insurance catalogue, it can be found that the use of traditional Chinese medicine injection has been greatly restricted. There are 33 kinds of traditional Chinese medicine injections limited to the use of secondary and above medical institutions.
According to the latest national ADR monitoring annual report, injection accounted for 54.6% of the ADR / event reports in 2017; if the ADR / event reports of TCM were distributed according to the route of administration, intravenous administration accounted for 54.0%, other injection administration accounted for 0.6%; serious adverse reactions / events reported by intravenous injection accounted for 84.1%, and other injections accounted for 1.0% u3002
Some medical institutions below the second level do not have rescue equipment, so we must be cautious and cautious when using traditional Chinese medicine injections.
Traditional Chinese medicine injections and other controversial products may be kicked out if they can not prove their safety, effectiveness and economy.
At the same time, the catalogue also limits the traditional Chinese medicine decoction pieces, and the following Chinese medicine decoction pieces will not be reimbursed:
Large probability of no quantity in centralized purchase of Chinese patent medicine
According to the latest Reply of the state medical insurance bureau to Lin fanrus proposal, although the industry still has doubts, the collection of Chinese patent medicines is a certainty.
On December 31, requirements for registration and classification and application data of traditional Chinese medicine will be implemented soon. As a supporting document of Drug Administration Law and Chinese medicine law, the State Food and drug administration has carried out a more detailed classification of Chinese patent medicines and put forward technical requirements. On the basis of standardizing drugs and biopharmaceuticals, the classification of the same name, the same prescription and exclusive varieties is determined. In fact, the track is set for the purchase with quantity.
However, from the pilot projects in Qinghai, Jinhua in Zhejiang and Puyang in Henan, there is a big difference between the centralized collection of Chinese patent medicines and the chemical medicine association.
The first is not limited to products with generic drugs, and a large number of exclusive products will also be included. Among the pilot projects in Qinghai, Xiyanping injection, Shenkang injection, Tanreqing injection, Shengxuebao granules and compound sea snake capsule are all exclusive varieties. Among them, Xiyanping injection is a large variety with annual sales of more than 3 billion yuan.
Secondly, it is not necessarily with quantity. The procurement with quantity opened at the end of July in Qinghai Province has shown this feature. Although the selected patent medicines did not publish the specific price, Qinghai clearly proposed no quantity price limit, and the final price was determined by negotiation between medical institutions and enterprises.
The reply of the state medical insurance bureau to Lin fanru also mentioned that the medical insurance department would not make rigid requirements for the use of Chinese patent medicines in medical institutions. This means that the price must be reduced, but the quantity is not guaranteed, and the choice of whether to use it is handed over to the hospital. How much to collect and how much to use depends on the self diagnosis and treatment needs of the hospital.
In recent years, the mode of relying on medicine to support medical care has been broken, the reform of medical insurance payment mode has been accelerated, and the baton of clinical medication has changed. Some Chinese patent medicines are lack of evidence-based medicine support in safety and effectiveness, and adverse reactions and contraindications are not clear. The hospital will be the first to kick them out.
The pilot project in Qinghai was carried out after the state medical insurance bureau announced the purchase of Chinese patent medicines with quantity, and the state medical insurance bureau also made it clear that it had conducted guidance, and the local pilot projects connected with Qinghai mode and even the national procurement of Chinese patent medicines were of guiding significance. The 100 billion market of Chinese patent medicines has entered the speed of life and death.
Chinese medicine market facing reshuffle
The Chinese medicine market has experienced a rapid growth stage. In 2017, the total output value of Chinese medicine industry reached 844.2 billion yuan, accounting for about one third of the total industrial output value of the whole pharmaceutical industry. In 2020, the scale of TCM health industry is expected to exceed 3 trillion yuan.
In 2015, the gross profit margin of tiansheli liver disease treatment, anti-tumor, cardiovascular and cerebrovascular drugs were all above 72%. In addition, according to the financial report of Jichuan pharmaceutical, its heat clearing and detoxification products, mainly Pudilan anti-inflammatory oral liquid and Xiaoer geqiao Qingre granules, reached a high point of 87.38% in 2016.
Among the comparable companies in the same industry listed by the above companies, the industrial gross profit margin of Yibai pharmaceutical, HongRi pharmaceutical and Buchang pharmaceutical are all above 80%; the industrial gross profit margin of China Resources 39, Yunnan Baiyao, Yiling pharmaceutical and Donge Ejiao are all above 60%. Among them, the peak gross profit margin of Buchang pharmaceuticals cardio cerebrovascular products, including Naoxintong, Wenxin Capsule and Danhong injection, also exceeded 85%.
In contrast, the proportion of R & D investment in the total revenue of Chinese medicine enterprises is often less than 5%, but the proportion of sales expenses is often as high as more than 30%, or even more than 50%. This pattern will inevitably lead to the risk of commercial bribery.
On the other side of the coin, 70% of Chinese patent medicine prescriptions are prescribed by western medicine, which objectively increases the risk of using Chinese patent medicine. But the product clinical research is not sufficient, not standardized and other problems are also very prominent, such as: more than 80% of the adverse reactions are not clear, also make the effectiveness of Chinese patent medicine widely questioned.
Since 2018, the impact of policy orientation on the traditional Chinese medicine industry has appeared, and this trend will be more obvious in 2020. In 2019, the gross profit rate of the main products of Chinese patent medicines will show a downward trend. Statistics show that, in the first half of 2020, more than 70% of Chinese patent medicine enterprises have a negative growth in revenue, and the net profit of some enterprises has even decreased by more than 1000%. The decline continued into the third quarter. Key monitoring, hospital kicking out and restricting the prescription of traditional Chinese medicine in western medicine are all important reasons. It is expected that with the promotion of centralized mining, the situation of related enterprises may further deteriorate. 21 new health comprehensive self: Health Bureau (author: Shen Haijing), Yuge, official website of national medical insurance bureau, interface news_ NB12679
Since 2018, the impact of policy orientation on the traditional Chinese medicine industry has appeared, and this trend will be more obvious in 2020. In 2019, the gross profit rate of the main products of Chinese patent medicines will show a downward trend.
Statistics show that, in the first half of 2020, more than 70% of Chinese patent medicine enterprises have a negative growth in revenue, and the net profit of some enterprises has even decreased by more than 1000%. The decline continued into the third quarter. Key monitoring, hospital kicking out and restricting the prescription of traditional Chinese medicine in western medicine are all important reasons.
It is expected that with the promotion of centralized mining, the situation of related enterprises may further deteriorate.
New health comprehensive self: Health Bureau (author: Shen Haijing), Yuge, official website of national medical insurance bureau, interface news