Shaking the medical circle: online medical insurance is being released rapidly, who is the turn of "pouring wealth and wealth"?

Health News Consultation

2024-07-02 09:04

As the last policy barrier to online drug purchases, the ice of medical insurance payment is melting.

In the past month, on the basis of Shanghai's pilot "takeaway to buy drugs, medical insurance payment", Beijing, Tianjin, and Guangdong have successively issued documents to promote the online purchase of over-the-counter drugs in medical insurance accounts. On June 18, Shenzhen announced that it would open an online payment service for medical insurance prescriptions to reimburse the available medical co-ordinated amount. Up to now, the four first-tier cities of Beijing, Shanghai, Guangzhou and Shenzhen have all realized medical insurance payment for online drug purchases.

For a long time, medical insurance payment has been a gold medal for offline pharmacies to resist the impact of online medicine. Before 2023, the vast majority of online drug purchases in China, whether B2C or O2O, will not be eligible for medical insurance reimbursement. Now, whether it is a personal account or a pooled fund, or whether it is an over-the-counter drug or a prescription drug, the door to the policy has been opened, and online drug purchase has essentially obtained full medical insurance treatment.

"We predicted that the time point for the liberalization of unified payment should be around 2026, but we didn't expect the policy to come so quickly and so quickly." Shao Qing, CEO of Pharmaceutical Empowerment and a senior pharmaceutical person, told "Health News Consulting" that as soon as the news of the Shenzhen pilot came out, the retail pharmacy industry mourned, "Everyone knows that hard times are coming." ”

At the other end of the scale, the O2O platforms such as Meituan, JD.com, Ele.me, and Dingdang Fast Medicine have undoubtedly gained the heaviest weight. A number of people interviewed by "Health News Consulting" said that it is conservatively estimated that the market size of pharmaceutical retail O2O will have 4-5 times the growth space, and the total amount is close to or even exceeds the offline part, and there is a high probability that there will be a giant platform.

In the 500 billion yuan pharmaceutical retail market, will there be another story of online subversion of offline?

The policy node has been greatly advanced, far exceeding expectations

If you want to trace the root cause from the policy level, the two blockbuster documents in 2019 and 2020 have revealed the propensity of the medical insurance department to support online drug purchases.

In August 2019, the National Health Insurance Administration issued the "Guiding Opinions on Improving the Price and Medical Insurance Payment Policy of "Internet +" Medical Services, proposing that eligible "Internet +" medical services can be supported by medical insurance payment policies in accordance with the principle of online and offline fairness.

If the 2019 document is still in the context of "Internet +" medical services, then in October 2020, the National Health Insurance Administration issued the "Guiding Opinions on Actively Promoting the Payment of "Internet +" Medical Service Medical Insurance", which has clearly pointed out that the consultation fees and drug fees incurred by the insured in the "Internet +" medical service designated medical institutions in the overall planning area and the prescription can be paid in accordance with the provisions of the overall regional medical insurance.

This year, the policy of the medical insurance department was the first to be responded to in Shenzhen - Dingdang Health's self-operated pharmacy Dingdang Fast Medicine took the lead in launching the "Medical Insurance to Home" service in Shenzhen, allowing citizens to purchase drugs in their medical insurance accounts on the APP of Dingdang Fast Medicine. To this end, Dingdang Express Medicine also specially designed an opening screen advertisement, highlighting the concept of "the first mobile phone drug purchase medical insurance payment", and emphasized in the press release that "the project was completed under the guidance of the Shenzhen Municipal Medical Insurance Bureau".

In 2021, Hangzhou and Shenyang also launched pilot projects for online drug purchase and medical insurance payment, initiated by Alibaba and Meituan, respectively. In the Hangzhou version, citizens need to complete the online drug purchase operation in the Taobao APP, and a total of 12 pharmacies have joined the pilot, postal express, and next-day delivery. In contrast, Shenyang's pilot included more pharmacies, reaching 62, and the delivery was more timely.

The pilot during this period basically followed the principle of "enterprise promotion, medical insurance cooperation", the scale was not large, the publicity was not much, and the scope of payment was also firmly limited to the level of individual accounts and over-the-counter drugs. This is because the use of medical insurance funds has a complex approval process, coupled with the unpredictable risk of online drug purchase, the medical insurance department does not have much motivation, and it is already "dedicated" to be able to open up individual accounts to participate in the pilot.

The Shanghai pilot in October 2023 is another important node for medical insurance to intervene in online drug purchases. Since this period, the medical insurance sector has begun to become the main force of reform, intensively promoting the implementation of a number of local pilots.

In this year, Jiangxi, Shanxi, Chongqing and other places have successively issued documents to clear policy obstacles for online drug purchase and medical insurance payment. The core of this is that local medical insurance authorities allow electronic prescriptions issued by Internet hospitals to be transferred to the corresponding retail pharmacies through the prescription platform. With the certification and regulation of e-prescriptions, online payments are a matter of course.

It is worth noting that in Shanxi's plan, the health insurance department has actually allowed the pooled fund to participate in online payments, although they have set many conditions for this. For example, only the electronic prescriptions issued by Internet hospitals relying on the designated medical institutions in the co-ordination area can be applied to the online payment of medical insurance, and the distribution scope of the purchased drugs cannot exceed the scope of the co-ordination area.

During this period, first-tier cities such as Shanghai, Beijing, Guangzhou, and Shenzhen attracted the most attention. Taking Shanghai as an example, as of April this year, the number of pharmacies covered by the pilot is close to 1,000, covering most of the over-the-counter drugs, with an average daily order volume of more than 5,000. The recent pilot of Shenzhen's liberalization of coordinated payment has laid the groundwork for medical insurance access to online prescription drug sales.

"The transaction cost of pharmaceutical e-commerce is the lowest and the cheapest is the cheapest, which can not only benefit the people, but also help the medical insurance fund to achieve the goal of cost control." An industry insider who has been engaged in pharmaceutical policy research for a long time said that in combination with the recent measures taken by the National Health Insurance Bureau to eliminate the inter-provincial price difference of "four same" drugs and compare the prices of designated retail pharmacies with online O2O as the anchor, the medical insurance department has a clear attitude and firm position on managing offline high drug prices and strictly controlling drug expenses.

"If nothing else, other qualified regions will soon follow Shenzhen's approach, so that online medical insurance payment covers prescription drugs, which is already the general trend." said the above-mentioned person.

A number of people interviewed by Health News Consulting agreed with this view. According to relevant sources, the next focus of the Shanghai Medical Insurance Bureau is to plan the circulation path of electronic prescriptions and prepare for the overall fund payment of prescription drugs. Once this link is opened, Meituan, Ele.me, and JD.com, which have already been connected to the takeaway drug purchase system, may become cooperative platforms for prescription drug retail and distribution.

The customer flow of offline pharmacies is bleak, and online platforms have taken off

When he saw the news of the pilot in Shenzhen in the WeChat group, Liu Yi (pseudonym), the store manager of a chain pharmacy on the eastern coast, was a little confused, and then he lit a cigarette and wrote four words in the circle of friends: give up illusions.

This is probably the true sentiment of most pharmaceutical retail practitioners. Previously, the pilots in Shanghai, Beijing and Guangzhou were limited to the field of over-the-counter drugs. This field is originally the core battlefield of online sales, and the penetration rate of pharmaceutical e-commerce is very high, so the variables that can be leveraged by policies are not large. Prescription drugs are different, as the category with the highest sales in retail pharmacies, thanks to the restrictions on medical insurance payments, the sales scene has been firmly locked offline.

Now, with the Shenzhen pilot rolling out across the country, this firewall will no longer exist.

"After the liberalization of online co-ordinated payment, outpatient co-ordinated designated pharmacies may benefit from sales, but because it is online payment, the customer flow will decline significantly. This will bring two problems, one is that the medical insurance drugs themselves are not profitable, and the other is that pharmacies cannot do 'value-added' services if people are not in the store. Li Congxuan, a pharmaceutical marketing expert and founding chairman of the Pharmaceutical Market Research 100 Association, told "Health News Consulting".

A veteran who has been in the pharmaceutical industry for more than 20 years said bluntly that this is the most difficult moment since he started his career.

Perhaps, we need to place this event in a longer period to truly understand the meaning of this sentence.

In the past five years, retail pharmacies that used to lie down to make money have been exhausted by two things: one is the centralized procurement of drugs, which squeezes out the profits of pharmacies; The second is pharmaceutical e-commerce, which diverts the flow of pharmacies. According to the financial reports released at the beginning of this year, several leading chains have encountered performance inflection points, such as Yixintang, Shuyu Civilian, Jianzhijia, etc., have experienced a decline in profits to varying degrees, and the transformation of the industry is imminent.

At the same time, the National Health Insurance Administration began to control offline drug prices, and some places even required that online and offline drugs must be at the same price, and retail pharmacies suffered from the enemy. In this context, medical insurance payment has opened the door to online drug purchases, and drug transactions have further shifted to online platforms.

"It's equivalent to two armies facing each other, the weaker side just planned to rest and recuperate, and the opponent began to charge again, and the strength was several times that of before, how do you say this battle will be fought." said the above-mentioned person.

From the standpoint of the O2O platform, the full opening of medical insurance payment is the moment they are most looking forward to.

One of the two chain pharmacies connected to the Shenzhen pilot is Dingdang fast medicine with O2O attributes. In addition, whether it is Meituan, Ele.me, JD.com, or Ali Health, they have actively participated in the pilot projects in other cities. JD.com, for example, was the latest to enter the Shanghai pilot, but it took the lead in its cooperation with Beijing medical insurance in May this year, launching related services earlier than Meituan.

"If online medical insurance payment is fully liberalized, the pattern of the drug retail market will be completely subverted." Li Junguo, vice president of Zhongkang Technology, told "Health News Consulting" that according to their calculations, the current proportion of O2O in the total retail sales of drugs is about 10%, and if it is fully liberalized, it is entirely possible that the share of online retail will reach 50%. Moreover, in the face of huge commercial interests, these platform-based enterprises are likely to replace the retail pharmacies on the platform by opening more front-end warehouses + a few stores, thus forming a kind of monopoly.

Shao Qing also has a similar judgment, according to his estimates, this year's drug O2O market size is between 500-60 billion yuan, according to the rhythm of existing policies, the upper limit of this number will reach 240 billion yuan, "As far as I know, Meituan has been supporting some small and medium-sized chains with a high proportion of O2O business." ”

The difference is that Shao Qing believes that traditional pharmacies are not completely without opportunities. The category of drugs, especially prescription drugs, has strong service attributes and requires refined management of patients, which is not available to e-commerce platforms. As long as the chain pharmacy is willing to work hard to manage the private domain traffic, there will still be a chance to compete with the platform in the future, "The key is to really pay attention to this matter, not just stay in the mouth." ”

Text / Mao Xiaoqiong

Editor / Pompeii

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