The life-saving medicine went to the hospital, but the patient couldn't get in。
Following the country's “twinway” policy on medicines, the life-saving drugs may be purchased at a fixed retail pharmacy and be covered by the health insurance reimbursement policy。
Since may this year, the national health and insurance board has issued successive communications on the management of the two-channel system in various provinces, including anhui, fujian, jiangxi, jiangsu, sichuan and qinghai。
The landing rate of the twin channels is increasing. In recent days, the national health service has issued a "promoting order": by the end of october 2021, the provinces will have established and made public the list of medicines to be managed in the province; by the end of november 2021, the provinces will have at least one eligible two-channel retail pharmacy in each municipality and will be able to provide the corresponding drug supply security services。
The health community has learned that the "two-way" policy, which will be fully operational throughout the country on 1 january 2022, will effectively alleviate the problem of access to innovative medicines, while also opening up new development opportunities for the dtp (specialized pharmacies) and the drug o2o。
What's the problem
The issue of how innovative drugs can break through the "last mile" of hospitalisation has been the focus of the industry。
Taulibo, a researcher at the centre for health policy and technical assessment of the medical department of beijing university, stated that in the national health-care system, medicines were subject to cataloguing management。
There are two main aspects, namely, negotiation of access to innovative medicines, whereby management and pharmaceutical manufacturers negotiate reimbursement for the pricing of innovative and exclusive products, without volume, and the procurement of non-exclusive medicines through competitive bidding, in which the main mode of landing for competitive purchases is bulk collection。
In the first model, as negotiated medicines are not available, which means that the prices of medicines will be higher and even the quantity of medicines will not have to be guaranteed, so there are many difficulties in landing。
If these negotiated-accessed drugs are to land, they need to face more gaming links. The first is the negotiation of the national agency, which must be accompanied by the local authorities, and then the hospital must be able to be admitted to hospital, after which the doctor can prescribe, and then a series of steps, such as taking medicines for the delivery of compensation。
In the view of tollibo, it is not entirely the hospital itself to talk about admission. Because hospitals have their own management needs. For example, new medications in hospitals require the convening of pharmaceutical committees to review them. Hospitals have hospital considerations. Hospitals have nearly 3,000 health-care catalogues and hospitals can only selectively incorporate medicines from the catalogue。
Figure 1
According to a set of data provided by wang minghui, senior manager of operations and analysis at the national drug control and retail medical services department, the number of health-care catalogues in the country's 2020 version is 2,800, with a ceiling of 1,500 general public hospitals, with a sharp difference of nearly twice, which also leads to the failure of nearly half of the innovative medicines to reach hospitals, despite being covered。
At the same time, research into more than 1,400 sample hospitals found that, by 2018, less than 20 per cent of the cancer innovation drugs negotiated by the state for entry into the national health insurance catalogue had been available for sale in 2019。
In the case of the three nationally produced pd-1 products, sindar, heung shwe and kung-seo, the highest percentage of ghenmin pd-1 products in hospitals is only about 10 per cent and the lowest is only 5 per cent。
Innovative medications are difficult to access, doctors are difficult to prescribe, patients are difficult to buy, and are known as the "triple dilemma" for selling in innovative pharmacies。
The two-channel policy, which is starting here。
In the view of management, the advantages of pharmacies should be exploited, and access to pharmacies is easier than access to new medicines, which is complex in relation to hospital procedures. In addition, there are a variety of control fees in hospitals, while there are fewer controls in pharmacies. According to tolippo, the authorities have therefore worked very hard to establish pharmacies as a way to negotiate the landing of medicines in the country, thus opening up a new opportunity for the distribution industry。
Wu ming, vice-president of the chinese society for health and economics, also believes that the two-way policy of negotiations on medicines addresses, inter alia, the problem of negotiating access to medicines, thereby increasing the accessibility of patients。
As a result, the two-channels are beneficial for retail enterprises, on the one hand by increasing the flow of patients, which is conducive to higher turnover, and, on the other hand, a necessary trend in the flow of prescription drugs。
Professional pharmacies will benefit most
The two-way policy is designed to address the issue of the accessibility of negotiated varieties, the "hospital difficulties" of national sentencing of innovative medicines。
According to liu woo-teng, a researcher for chinese securities, negotiating varieties have the same payment policies and prices for medicines both inside and outside the institution, and patients can choose retail pharmacies that are more widely distributed, more marketable and more flexible in their services to improve access to medicines. As a result, the two-channel policy is expected to bring benefits such as "surged patients" and a significant increase in the value of the channel, as well as accelerate the division of head and small and medium-sized pharmacies, by incorporating the "two-channel" retail pharmacies into the general health insurance fund. Through quantitative measurements, retail pharmacies are expected to take over $10 billion a year, and the "twinway" policy is expected to yield substantial benefits to retail pharmacies over a longer period of time。
Public information indicates that the sichuan province has so far taken over nearly 80 per cent of the sales of pharmacies by piloting a two-way policy nationwide. The head of the medical services department of the sichuan department of medical care and security (sichuan province) explained that sichuan province had begun exploring the "two-way policy" in 2017 and was currently implementing the "two-way system under one-way payment management"。
Through classification management, the number of high-priced, population-specific and well-defined drugs negotiated is included in single-line payments management, specific payment policies and services are implemented, and the list of single-line payments and dual-channel drugs has increased from 37 to 88 at present. Pharmacies account for as much as 78 per cent of the sale of "twinway" and hospitals for only 22 per cent。
Figure 2
The "two-way" policy, which is an out-of-the-box exercise by the health insurance board, is an important policy that drives prescription outflows and will profoundly influence changes in the market patterns of pharmaceutical terminals, with retail market shares rising even further. According to wang ming fai, there are three main obstacles to prescription outflows, namely, the source of prescription barriers, the accessibility of payments and the taking over of pharmacies。
The state is now strongly supporting e-prescriptions and prescription outflows, as well as local pro-poor protection projects, and the twin-channel policy is gradually breaking down the barrier to pharmacy delivery. Following the gradual dismantling of the three main obstacles, it is projected that by 2023 the overall volume of prescription outflows will have exceeded approximately 540 billion, and the total size of the under-line pharmacies will have reached 130 billion。
The competitive environment is changing, including traditional retail listed companies, as well as some innovative internet companies, all entering the professional pharmacies (dtp) track, and the competitive environment will become more intense。
The so-called model of professional pharmacies, i. E. Pharmacies are granted the right to distribute the products of pharmaceutical enterprises, and patients buy drugs directly from pharmacies and receive professional guidance and services after obtaining prescriptions in hospitals. According to cmbh data, the dtp market sales in 2020 amounted to 44. 5 billion yuan, an increase of 29 per cent over the previous year. As the main channel for the marketing of new medicines, the dtp channel has continued to grow at double-digit rates over the past two years, and markets have expanded rapidly to become market engines and industry hot spots。
Figure 3 |dip channel - sales volume (left) and sales volume (right) size and growth %
Zhao hae-chun, a researcher at the national gold securities corporation, believes that more drugs of "clinical value, patient continuity, small substitution" are expected in the future, bringing added value to pharmacies。
In the process of taking on high-value varieties, the dtp doors will benefit from this dividend because of their advantages in informationization and integrated management capabilities。
According to the data, by 2020 there were 143, 89, 40 dtp pharmacies in the leading pharmacies, which were expected to benefit most。
The optimism about the new market under the policy should be accompanied by rationality. According to tolibo, the "twinway" policy is not so easy to land in pharmacies. The pharmacy, which is eligible for dual access, has been authorized by the health-care department in a timely manner, but the pharmacy must negotiate with the manufacturer a discount on the cost in order to ensure the proper functioning of its medicines at the pharmacy. The negotiations for admission to the hospital were not priced, but the entry into the pharmacy had to be subject to a certain discount, otherwise the pharmacy had no incentive。
In addition, specialized pharmacies have to do some good work, including storage, distribution, etc., which needs to be linked to hospital prescriptions and must have very good rules. Tollibo reminds that every local health care provider has a strict norm in choosing a two-channel fixed pharmacy, so that only a few pharmacies have acquired this qualification so far。
And the double-channel pharmacies will face a lot of tests if they are to set up their own processes. “not all pharmacies are suitable for double-channel fixed-point pharmacies, because the number of negotiated drugs is not as large as it is now.”
In addition, there are difficulties with the outflow of prescriptions from hospitals。
“when we look at the two-channel policy in various places, there is still limited access to prescription drugs at the two-channel point pharmacies, and the health-care sector is very strict in its management, because it is feared that these drugs will cause problems of quality in the course of the pharmacies’ circulation, thereby exposing the patients to an adverse effect on their use. Tauribo says that the two-channel policy is still in a careful pilot phase。
These concerns or obstacles also place greater demands on the capacity-building of professional pharmacies. In response, wang ming fai believes that the current state-negotiated varieties are largely based on innovative medicines, predicting that in the future slow-disease, health-conservation varieties will enter retail channels and achieve a complete separation of medicines。
From the point of view of capacity needs, as the two-channel policy becomes fully operational, the manufacturers have made demands on various aspects of network layout, cold chain management, etc., while the doorshop has demands on its profitability and specialized services because of its own needs。
Thus, under the two-way policy, the specialization, informationalization and digitization of retail pharmacies need to be strengthened。
Innovative drugs are creating channels for change
In addition to benefiting from the professional pharmacies, one of the main beneficiaries of the policy is the non-innovation drug industry。
For innovative pharmacists, the right to negotiate medicines is better guaranteed, and the distribution channels will be expanded from the former single hospital channel to the hospital + pharmacies' "twinway" and changes in distribution channels have led to changes in innovative marketing models。
At a recent siepp conference in 2021, "twinway" became the subject of discussion。
The transition of innovative medicines from in-house to out-of-house markets was also a significant change at the conference。
The president of sino-kantung science and technology, wu sheng, argued that the out-of-court market would become a highly dynamic market, with a large number of multinational enterprises, such as rousseau and aslicon, with prescription drugs, which would then increase significantly the focus on the out-of-court market。
It is important, for example, that aslicon and nakayun enter into strategic cooperation agreements, which will provide the former with a professional system of intelligent services, and that aslicon will contribute to the future development of a holistic change in the information, digitization and intellectualization of services such as slowness management of pharmacies, patient management, etc., which will help pharmacies to serve their customers more professionally and further enhance their professionalism。
According to liu khing, vice-president and chief market officer of the china district of aslicon, in the new policy environment, the window period for the introduction of new medicines became short, with the former exclusive new product having a monopoly of more than five years, but it is not wrong to have five months now。
New products must therefore grow faster and their marketing patterns must be changed accordingly。
Over the past few years, there has been an increasing increase in online retailing of prescription drugs, which has surpassed non-prescription medicines and health products, and an increasing number of manufacturers have formed their own electric teams and started to set them up, which has also become a strategic channel for pharmaceutical companies to ignore。
According to liu, aslicon's prescription drugs are currently working with internet platforms, not simply pharmaceutical electricians, but integrated supply systems online。
In his view, if a company did not have its own internet hospital, internet doctors, including a line-up, prescription drugs were only on-line electricians and were in fact very difficult to grow, and innovative medicines could not be sold except for older medicines that were well known beyond patent periods。
Since prescription drugs cannot be promoted to patients, effective delivery of product messages is also a major challenge for pharmaceutical companies。
Liu khiem believes that if the prescription drug electrician platform can be installed, it is not just a marketing platform, but a platform for linking patients to slow disease management. From this perspective, prescription drug electricians are also part of business marketing. The ideal future must be for the offline pharmacy+line electrician and for the company to integrate its marketing in hospitals. If it doesn't work well, it won't last long。
Of course, domestic innovative medicines are not waiting to die, but are also moving quickly。
In december, the chief executive officer of alexian medicine, who was listed on the board last year, stated that the company had begun to develop strategies and plans of action following the "two-way " policy。
One is to actively pursue research policies to track the fallout of the policy of double-tracking in various locations; the other is to restructure the company's organizational structure, which was to be followed by a large proportion of medical admissions to health insurance, which in the future will shift to pharmacies or supply chain team management; the third is to reorient doctor's education by adding "how to cross-traffic with prescriptions outside the hospital" as well as to increase the education of shopkeepers; and the fourth is to consider combining with commercial security so that patients feel that pharmacies are in fact a very high-profile location。
With the development of the dtp, the cornerstone medicine industry will consider data marketing in addition to strengthening the outside market. The new trends in the two-channels, how to access and standardize some of the perceptions between doctors and patients, are areas where the marketing of data is important. “it’s time for the government to take a step forward,” he said。
In may 2021, zhang xiaoping, secretary-general of the dtp board of the chinese medical materials association, stated that the dtp dispensaries in the three major departments of medicine, chinese medicine and upper medicine were still leading the market pattern, but the rate of growth slowed; the number of regional dtp chains was generally small, but they were more eligible for both major medical insurance and two-channel fixes。
At the same time, the internet-based medical dtp pharmacies are showing strong momentum, with the market size of three powerful markets, including hearts, minds and neighbours, at over 1 billion yuan, with growth rates exceeding 100 per cent。
In december 2020, the first commercial product, the btk inhibitor, obutini, was listed。
However, it was too late to enter into health-care negotiations. As a result, the internet medical dtp dispensary became its target. The chairman of the board of directors and ceo choe cheong-sung said that oboutini had chosen to work with dr. Ton-tung and the siem rehab health unit in the hope of working together to create a complete "internet+referendation+drug" closed loop。
Among the innovative drugs listed in the first quarter of 2021 were pratini, vumitrine, tetsip and eupidrome。
If these innovations are successful, they may be the first to benefit from the "two-way" policy。
On 15 september, the guangdong department of health and social security, among others, issued a joint advisory opinion on the implementation of a mechanism to improve the management of medicines for the negotiation of national health insurance. The implementing opinion also states that targeted medical institutions and "twice" pharmacies are encouraged to provide "internet+" drug-circulation services, and to "offline" or "offline"。
The senior vice-president of the beijing circle technology group ltd., rodongto, stated that the guiding policy identified the "two-channel" internet+drug-circulation city, which was a very good guide to traditional pharmacies through internet tools or means。
Figure 4
Rodongto believes that, in the future, basically all retail pharmacies will consider developing pharmacies through offline models, which means that the internet o2o model will accelerate and the drug+o2o model will be integrated into our daily lives。
Under such policy-led and industry trends, the marketing transformation of innovative pharmacies is bound to have to be carried out。
