The impact of new policies such as centralized procurement on the pharmaceutical market is unprecedented, and what is the specific impact?
This article analyzes this with 7 figures. Of course, the impact is far from being covered by the 7 maps.
01
scale
In 2020, due to the full implementation of national procurement and the obstruction of diagnosis and treatment of medical institutions due to the outbreak of the new crown epidemic, the scale of terminal drug sales in the country declined for the first time, with 2020 (1,643.7 billion yuan) and 2021 (1,774.7 billion yuan) both less than the pre-epidemic peak of 1,795.5 billion yuan in 2019, and only 1.9 billion yuan in 2022 (1,793.6 billion yuan) has tied 2019 and hit a record high in 2023. It exceeded 1.8 trillion yuan (1,886.5 billion yuan) for the first time, a year-on-year increase of 5.2%, because the epidemic will "end" in 2023 and negative factors such as centralized procurement have been digested.
02
variety
1. Vacate the cage for birds
According to the data of the National Institute of Medical Insurance Research, in 2023, the national procurement will evaporate the generic drug market by 162.5 billion yuan compared with 2019 (from 348.7 billion yuan in 2019 to 186.2 billion yuan in 2023), and the new drug market will increase by 89.5 billion yuan compared with 2019 (from 49.4 billion yuan in 2019 to 138.9 billion yuan in 2023).
Of course, this only refers to the impact of national procurement based on over-evaluated chemical drugs, and only refers to the hospital market, excluding biological drugs other than traditional Chinese medicine and insulin, and the overall out-of-hospital market.
2. Large varieties of generic drugs: "depletion"
After nine batches and ten rounds of centralized procurement, there are very few large varieties of generic drugs that have been evaluated with full competition. Among the selected varieties in the national procurement, in terms of the number of varieties with sales of > 1 billion yuan in public medical institutions in the country in the year before the centralized procurement, the ninth batch is the least (only 6) in the previous national procurement, only about 1/5 of the peak fifth batch (29), and the previous batches have large varieties of > 5 billion yuan, and the largest variety in the ninth batch is less than 4 billion yuan (3.8 billion yuan in rabeprazole oral regular-release dosage form).
Of course, the above-mentioned large varieties only refer to the over-rated chemical generics with sufficient competition, excluding the exclusive, insufficiently competitive (over-rated < 5+0 pattern) and non-reference preparations (such as sodium chloride injection, etc.), and do not include large varieties of traditional Chinese medicine and biological drugs.
3. Large varieties of new drugs: protrusions
Centralized procurement has forced traditional pharmaceutical companies to transform and innovate, poor financing has forced Biotech to accelerate commercialization, and in the context of the whole chain of supporting innovative drugs, such as the acceleration of review and approval and national talks, and the gradual resolution of the "last mile into the hospital", large varieties of innovative drugs have been emerging.
In 2023, the sales of the largest innovative drug (excluding varieties with undisclosed sales) have exceeded 9 billion yuan, that is, the first innovative drug approved by the US FDA in China, BeiGene's BRUKINSA (zanubrutinib) sold 9.3 billion yuan, of which most of the sales were contributed by the international market.
sales of 50~9 billion yuan, such as Enbipu (butylphthalide, stone medicine) 6 billion yuan;
With sales of 30~5 billion yuan, such as Fukewei (anlotinib, Chia Tai Tianqing) 4 billion yuan, tislelizumab (tislelizumab, BeiGene) 3.8 billion yuan, Carvykti (cilta-cel, legendary) 3.6 billion yuan, magnesium isoliglycyrrhizate (Chia Tai Tianqing) and Amele (ametinib, Haosen) have sales of 3 billion yuan;
With sales of 20~3 billion yuan, such as Tyvyt (sintilimab, Innovent) 2.84 billion yuan, Anko (bevacizumab, Qilu) 2.8 billion yuan, Hanquyou (trastuzumab, Henlius) 2.6 billion yuan, Zejule (niraparib, Zai Ding) 2.1 billion yuan, Eitan (apatinib, Hengrui) and rossamostat capsules (Fabojin) all sold 2 billion yuan.
The figure below shows 20 new drugs with sales of > 1 billion yuan in 2023, including 8 large molecules (blue column) and 12 small molecules (red column), 9 traditional pharmaceutical companies and 11 biotech.
02
channel
1. Prescription outflow
As can be seen from the figure below, after the opening of centralized procurement in 2018, the outflow of prescriptions began to accelerate, and the proportion of drugs in hospitals decreased by 6.1 percentage points (from 67.4% in 2018 to 61.3% in 2023), and the proportion in pharmacies increased by 6.4 percentage points (from 22.9% in 2018 to 29.3% in 2023).
2. Hospitals: The share of foreign companies has declined
According to Zhongkang CMH data, taking the proportion of sales in ≥ secondary hospitals as an example, the concept of adjuvant drugs that began in 2015 and other factors led to a decline in the market share of local companies and an increase in the share of foreign companies.
After the start of centralized procurement in 2018, the market share of local pharmaceutical companies increased by 2.8 percentage points (from 69.9% in 2018 to 72.7% in 2023), while that of foreign companies decreased by 2.8 percentage points (from 30.1% in 2018 to 27.3% in 2023). Both local and foreign companies are affected by centralized purchasing, but foreign companies are even more affected, which promotes the substitution of generic drugs and the emergence of the patent cliff of original drugs.
3. Pharmacies: the share of foreign companies has increased
According to Zhongkang CMH data, after the implementation of centralized procurement, the share of local pharmaceutical companies in terms of the proportion of drug sales in pharmacies decreased by 4.3 percentage points (from 80.3% in 2018 to 76% in July 2022), and the share of foreign companies increased by 4.3 percentage points (from 19.7% in 2018 to 24% in July 2022).
Part of the reason is that the centralized procurement is mainly carried out in the hospital, and the impact on out-of-hospital pharmacies is still small, and the price linkage between inside and outside the hospital is not extensive in the early stage, especially before the fifth batch of national procurement is included in a large number of injections, the first four batches of national procurement are mainly oral drugs suitable for out-of-hospital sales. Therefore, by virtue of its long-term accumulation of brand effect, perfect sales team and policies, patient stickiness, and especially the common appeal of pharmacies and manufacturers to maximize the interests of pharmacies, the original drug can still maintain a certain sales volume in pharmacies, and the proportion of its sales volume in the generic name can even double, while generic drugs are mostly non-exclusive, even before centralized procurement, there is no long-term plan to create their own brands.
Of course, after the release of the "four sames" policy, price linkage has been widely carried out, not only outside the hospital and within the hospital, but also online and offline. The "advantage" of original drugs in pharmacies has been greatly challenged.
The above article comes from Cyber Blue, written by Dr. Zhang Tiantian