Difficulties in the black-chain drug companies that are trapped in the circulation of medical products

Business Club December 30th The black interest chain in the field of pharmaceutical circulation has also made the survival of pharmaceutical companies worrying. According to data provided by the Zhejiang Pharmaceutical Industry Association, in recent years, more than a thousand pharmaceutical companies in Zhejiang have closed down one third.

Although the state has introduced a large number of control policies and adopted many measures, the reality is that it still does not fundamentally solve the problem of corruption in the medical and commercial fields. Why is the hospital frequently exposed the "rebate list" incident? Has the medical rebate really changed from "hidden rules" to "significant rules"? What is its root cause? How to eradicate? In the poor living environment of the medical circulation market, how can pharmaceutical companies not fall into the quagmire?

How to eradicate medical corruption

Faced with the phenomenon of medical corruption, people of insight in the medical industry are trying to change, and pharmacy hosting model is considered a useful attempt.

In 2006, Nanjing Pharmaceutical Co., Ltd. debuted pharmacy custody business and became the focus of the industry. In October 2009, Taizhou City Hospital of Zhejiang Province began implementing "pharmacy custody" to separate the ownership of pharmacies from the right to operate, and separation of personnel rights and management rights. Hospitals and pharmaceutical companies were divided according to the profits of drug sales. The director of the hospital, Li Qiugen, said that "pharmacy trusteeship" has caused the hospital to increase its revenue by more than 5 million yuan.

“To improve the pharmacy environment, more than 40 employees in the pharmacy need about 2.6 million yuan a year in salary and benefits,” said Zhu Chundong, chairman of Zhejiang Baorui Pharmaceutical Co., Ltd., who signed a three-year contract with the hospital and invested a lot in the early stage. He has been at a loss for the first few months, but he is convinced that he can make a profit in the future.

“The pharmacy trusteeship is a new thing. The government departments are still waiting and seeing. No policies have been introduced, and there has not yet been any promotion in the province.” Deputy Director of the Zhejiang Provincial Administration of Traditional Chinese Medicine Cao said the “pharmacy trusteeship” of Taizhou Chinese Medicine Hospital. , opened a public hospital in Zhejiang Province, but it can only be considered a hospital's own behavior.

However, experts in the industry believe that "pharmacy trusteeship" will not "be able to grow" after the implementation of medical reform. Chen Jisheng, chairman of Beijing Pharmaceutical Co., Ltd., believes that the “pharmacy custody” model cannot fully adapt to the medical system reform. The main reason is that at the time of this mode of operation exploration, there is no national health reform program, and the direction of reform and related policies are still not very clear. "It can only be said to be an attempt and an exploration. Therefore, I do not think it is a failure or failure. I can only say that this model is not yet adapted to China's national conditions."

Based on the purpose of cutting off the chain of corruption interests, "low-cost hospitals" have also emerged. In Hangzhou, the Wansley Hospital where private funds were invested was one of the attempters. However, the “low-cost route” was encountering difficulties.

The prospects of small and medium-sized pharmaceutical companies are worrying

The black interest chain in the field of pharmaceutical circulation has also made the survival of pharmaceutical companies worrying. According to data provided by the Zhejiang Pharmaceutical Industry Association, in recent years, more than a thousand pharmaceutical companies in Zhejiang have closed down one third.

“Zhejiang pharmaceutical companies are mostly small and medium-sized enterprises with annual sales of 30 million yuan or less.” Zhao Bowen, president of the Zhejiang Pharmaceutical Industry Association, told reporters that these enterprises are difficult to survive under the prevailing environment of corruption in the pharmaceutical circulation industry. There are prospects.

Under normal circumstances, the pharmaceutical industry's product sales basically rely on hospital channels, and pharmacy sales account for only about 10%. Medical corruption greatly reduces the profits of pharmaceutical companies.

"By deducting the expenses in the sales process, our single product profit may be only about 10%, and the comprehensive profit is only about 6%." The person in charge of a pharmaceutical company said that corruption in the medical circulation field allows drug companies to obtain only a meager profit. .

Connehbe Group, located in Lanxi, Zhejiang, has increased the proportion of commercial sales in recent years and invested heavily in building its own sales terminal. At present, Connbay Grand Pharmacy has direct operations and has joined nearly 70 stores.

In addition, Conba also consciously adjusted the product structure.

"Conba's products are mostly over-the-counter drugs, and consumers can buy them on their own, which is less affected by the sales model dominated by sales promotion. Based on these two points, Conneh determined that consumers should choose their own products, The basic concept of establishing a drug brand in the form of consumer products and focusing on the development of OTC (over-the-counter drug) brand.” Hu Jiqiang, chairman of Conba Group, said that prescription drugs flow through the company-commercial-hospital channel, and the final manufacturer’s revenue is very low. Taking brand drugs with a sales volume of more than 1 billion yuan as an example, a profit margin of 25% can be guaranteed.

However, not all drug companies can do brand drugs, advertising marketing costs and channel construction costs, have made many small-scale pharmaceutical companies daunted.

"Pharmaceutical companies want to get rid of the impact of pharmaceutical corruption, there are several ways, self-built commercial sales channels to do branding, or invest funds to engage in new drug R & D. But these initiatives require a lot of money, the general business is difficult to have such strength." The person in charge of the pharmaceutical company said that in Zhejiang, Connbain has succeeded in transforming as a brand, and Hisun Group has relied on strong financial strength to develop new drugs and has also made remarkable achievements.

At present, R&D of innovative drugs and biopharmaceuticals is promoting the development of Hisun Group to a higher level of development. Recently, adenosine methionine has recently been approved for marketing, while TNF-R antibody fusion protein is currently undergoing Phase II clinical trials. Production approvals are obtained within 1-2 years; Ambano, Herceptin, etc. are undergoing Phase III clinical trials and may be available within 2-3 years. Tacrolimus APIs are available in Europe from the end of July to the beginning of October this year. Tacrolimus is an immunosuppressant and the major domestic manufacturer is Huadong Medicine. After the company's products are made into formulations, they are handed over to TEVA for sale in Europe. The target for the next three years is to occupy 30% of the European market.

"The profit of listed new drugs is high, but the early research and development cycle is too long. The research and development process of a product may last as long as 5 years or even 10 years. The overall investment is tens of millions of dollars. This is not something that other small businesses can afford."

Where is medicine reform going?

China’s new Health Care reform is moving forward. In 2010, the reform of public hospitals will become a constraint for further advancement. In a regular top-three hospital, more than 40% of its revenue comes from the sales of medicines. The income of doctors is also closely related to the medicines on the prescriptions. It is really not easy to sort out such entangled relationships.

Zhao Bowen said that medicines are special commodities, and it is difficult for ordinary consumers to have a clear capacity for self-discrimination. Doctors have a strong dominant power; what medicines to choose, how effective the medicines are, and what side effects, etc., require the guidance of professional doctors.

Fang Ming, head of regional sales for a pharmaceutical company, said that because of this one-way decision, commercial bribery of drug sales has been spreading, especially in large hospitals.

It is worth mentioning that in China, there are too many generic drugs and the homogenous competition is too intense. There are as many as 4,000 domestic pharmaceutical companies, and some multinational companies have joined them. The competition is fierce, and some have to use “grey” means to stimulate sales.

“Commercial bribery misappropriates about 772 million yuan of state assets each year, accounting for about 16% of the annual tax revenue of the pharmaceutical industry in China.” This official survey data is constantly being quoted by people from all walks of life. Under the current medical system, the right to use drugs is mainly controlled by doctors. In the hands, this has also led to high levels of drug corruption.

The mechanism of “taking medicine to support medical care” has been criticized all the time, and it has made the public hospital mechanism reforms increasingly louder and louder. As the focus of this year's promotion of medical reform at the national level, reform of public hospitals is also a key part of medical reform programs.

As a test field to crack down on "the use of medicine to cultivate medicine," Beijing Traditional Chinese Medicine Hospital has taken the lead in implementing the doctor's performance appraisal system. Jin Mei, deputy director of the hospital, said that the main content of the hospital's assessment of doctors is whether the Chinese medicine diagnosis and treatment technology has been fully applied, whether the number of patients treated with non-drug TCM techniques and the prescription of the decoction pieces or hospital preparations have reached a certain proportion. "The implementation of a performance appraisal system not only reduces the cost of medical treatment for some patients, but also ensures that the doctor's income is protected."

Jin Mei stated that if we want to curb corruption, we must change the system. First of all, we should increase investment in health care and change the model of "taking drugs to support medical care." In addition to institutional problems, Gu Yicheng, deputy chief procurator of the Gulou District Procuratorate in Nanjing, also suggested that various forms should be adopted to increase the education of medical ethics. "At the same time, the intensity of judicial crackdown should also be strengthened. Only in this way can we fundamentally solve the problem of medical corruption."

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Foreign experience in combating medical corruption

Medical corruption is not unique to China. Corruption still exists in the United States, Japan, Germany, and other developed countries, and the circulation of medical services in these countries is worth our reference.

In early 2010, the U.S. Department of Justice issued a statement announcing that the UK-based pharmaceutical giant AstraZeneca has reached an agreement with the U.S. federal and state authorities to pay 520 million U.S. dollars to settle their allegations of illegal marketing of the antipsychotic Serochem Of this, $302 million will be paid to the federal government, and $218 million will be obtained by state governments.

The reason why the U.S. government has issued huge fines is related to the new U.S. medical reform that is being implemented. "Reducing industry fraud is an important part of Obama's healthcare reform. It is an important means for the Obama administration to implement health care reform by reducing drug abuse and thus reducing medical expenses. ."

On March 23, 2010, President Obama officially signed a health care reform bill. Reducing industry fraud is an important part of Obama’s health care reform. Reducing medical expenses by reducing drug mis-marketing is an important means for the Obama administration to implement medical reforms. Drug companies suspected of illegal marketing have become targets of the U.S. government’s attack. This investigation of AstraZeneca is a core part of the US government's crackdown on corruption in the healthcare industry. In the first half of the year, Pfizer, the world’s largest pharmaceutical company, was fined $2.3 billion for exaggerating its efficacy and bribing doctors.

Some pharmaceutical industry organizations have also introduced self-discipline programs, advocating companies to abandon their gifts to doctors or entertain doctors for entertainment. The American Medical Association, the American Association of Medical Colleges, and the American College of Physicians Association recommend that doctors refuse to receive gifts from drug companies. For example, regulations in places such as Vermont, Maine, and the District of Columbia require doctors to disclose gifts worth more than $25, while offenders penalize $10,000.

In Germany, the problem of medical corruption was very serious in the middle and late 1980s, and it was very common for doctors to collect drug rebates and receive various kinds of sponsorship from manufacturers. The German lawyers filed a lawsuit against the entire medical community and demanded that the court pursue all kinds of illegal activities in the medical community. This caused a great shock in the German medical community at that time. Many doctors' property was investigated and some doctors who were found to be corrupt were revoked for practicing medicine. Later, the German Physicians Association came forward and communicated with the Bar Association. According to the problems that existed at that time, a more stringent approach to physician management was introduced and this matter gradually subsided. Since then, there has been a clear convergence of medical corruption.

The experience of combating medical corruption in the United States and Germany shows that where there is commercial activity, there may be commercial bribery. If there is no minimum precautionary measure, facing a handy interest, even an honest man may not be able to hold it. Therefore, when it comes to preventing corruption, ethics cannot be an effective guarantee for monitoring people's compliance with the rules.

Corruption also needs to improve the personal property supervision mechanism. It is more meaningful to clear up loopholes than to investigate and punish severely. It should be said that once a certain industry has become corrupt, it will inevitably indicate that the industry's management system has a problem. Compared with the stringent punishment and severe laws, the introduction of practical preventive measures in line with the opinions of the industry will help solve the problem.

Foreign medical corruption cannot of course be used as an excuse to obtain psychological comfort. Their experience in cracking down on medical corruption is undoubtedly a reminder that although it is impossible to cure medical corruption without success, the effective preventive measures will undoubtedly ease medical corruption.

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