"Auxiliary Drugs" To Cool Down: Three Quarter Sales Fell Sharply, Medical Insurance "Cage Cage For Birds" Upgrade Again

In the middle of 11, the three quarterly reports of all listed pharmaceutical companies have been completed. The growth of the head enterprises attracted the attention. The performance of the "auxiliary drug" enterprises is also a "invisible" focus of the medical capital market.

On the one hand, the market is "ice and fire two days": on the one hand, medical insurance funds continue to "replace the cage for birds" for innovative drugs. In November 13th, the new round of national health insurance directory negotiations reached the most vigorous time. Several PD-1 companies that were concerned were also in the talks. On the other hand, they were concerned about the performance of the "Medicaid" that was transferred out of the medical insurance catalog and monitored, continued under pressure under the influence of the policy, the market structure would be further adjusted and reshuffled, and the related enterprises would also face greater pressure of transformation.

"Entering the key monitoring directory has been moved out of the medical insurance directory. It is hard to find a long-term position in the market. In particular, some Chinese characteristics of "magic medicine", without the support of medical insurance, doctors will rarely use. In November 13th, Lin Na, a Chinese pharmaceutical industry analyst at UBS Securities, said in an interview with the twenty-first Century economic report that these enterprises are facing transformation. "Many of them are looking for products, looking for projects, finding teams, some of them are developing innovative medicines, others considering investing or purchasing biopharmaceutical projects or enterprises, and upgrading products or doing more generic projects." The transformation of R & D or sales is not completed in the short term, and it will undergo a painful and lengthy process.

Policy overlay effect

In December 2018, the national health and Health Committee issued the notice on the management of clinical application of supplementary drugs, and explicitly requested the provincial health and health administrative departments to formulate and submit an auxiliary drug list according to the annual usage amount, and the varieties should not be less than 20 in principle.

In June this year, the first batch of 20 countries focused on monitoring the list of rational drug use, and the provincial health and Health Committee announced on this basis the provincial key monitoring and rational drug use list and published. In addition, the clinical use of medical institutions as well as the main persons in charge should be assessed.

This batch of surveillance drugs includes ganglioside, brain glycoside carnosine, ralazidam, creatine phosphate sodium, calf serum deproteinized, alprostadil, Salvia miltiorrhiza Ligustrazine, mouse nerve growth factor, thymus five peptide and so on 20 drugs.

The second wave of policy pressure came from the new version of the national health insurance directory published in August 20th. Through the dynamic adjustment, there was a big change in drug structure. A total of 150 varieties were transferred. About half of them were drugs which were revoked by the state drug administration departments. The rest were mainly drugs with low clinical value, obvious abuse and better substitution.

The 20 drugs monitored were all among the transferred varieties. According to IQVIA estimates, there are nearly 20 varieties of the large scale sales of over 1 billion, and the varieties transferred by western medicine can save about 25 billion of the medical insurance fund, and the varieties transferred by Chinese medicine can save about 15 billion of the medical insurance fund, which can save at least 40 billion.

Taking the 20 key monitoring varieties as an example, the national health insurance directory is also being withdrawn from the local medical insurance directory. These supplementary drugs will re engage in market competition and may face the danger of double sales and prices.

According to the database of the State Administration of drug administration, the 20 varieties involved 578 drug approvals, among which the most approved brain protein hydrolysates (109 approvals), followed by thymic peptide five (100 approvals). Most of them are varieties with high clinical usage and high market share, and some varieties are exclusive varieties of enterprises. The transfer may have an impact on the production and operation of related enterprises.

These effects are directly reflected in the latest earnings data. According to the three quarterly bulletin published by listed companies, the "recruit" enterprises are affected to varying degrees.

Take ganglioside as an example, the three quarter revenue and net profit of Sai long pharmaceutical and Sai Sheng pharmaceutical company both dropped sharply. The three quarter revenue of salon pharmaceuticals was 42 million 660 thousand yuan, down 55.62% from the same period last year, and net profit was negative in the third quarter, down 110.33% from the same period last year. In the performance forecast, salon pharmaceuticals indicated that the price of drug bidding was reduced and some products were included in the key monitoring directory, and the sales revenue of products was less than expected.

Another serious effect is rat nerve growth factor. The performance of four enterprises has declined to varying degrees. Among them, the God of Shu Tai is the most serious. Its third quarter revenue was 179 million yuan, down 5.47% compared with the same period last year, but net profit fell 75.5%. Shu Tai Shen said in the earnings report that the sales volume and sales revenue of Su Su Sheng of its products were much lower than that of the same period last year due to the adjustment of pharmaceutical industry policy and the market environment. The adjustment of the 2019 edition of the list of medical insurance drugs in August 2019 has brought great challenges to Su's marketing work. In view of the above reasons, it is predicted that the cumulative net profit from the end of the first half to the next reporting period will decrease considerably compared with the same period last year.

The leading products of the four ring medicine "top list", which are mainly used as auxiliary drugs, have the most monitoring products, including gangliosides, brain glycosides, carnosine, ticlutin brain protein hydrolysates, Salvia miltiorrhiza Ligustrazine, brain protein hydrolysates, cinepazide maleate and so on. In its interim report, it said: the list of key surveillance drugs issued in July 2019 is expected to have a further impact on the prescription and procurement mode.

The long transformation

IQVIA China Hospital Drug Statistics report shows that since 2016, the sales of these 20 varieties have been decreasing year by year. For example, in 2018, sales of bone peptides for cerebral infarction diseases dropped by 25.3% compared with the previous year, and sales of RNA were 12.6% down.

Meanwhile, supervision over the use of these drugs has also been escalating in recent two years. Such as limiting the amount of use, regular discontinuation and regular interviews. IQVIA analysis, after the establishment of the health insurance bureau, the access management of catalogues is more refined, and pharmacoeconomics is gradually incorporated into the directory assessment. In the future, similar products will be processed in the same treatment domain, and most of the supplementary drugs are difficult to enter the reimbursement scope of medical insurance.

The national level of "auxiliary drugs" list is published, which means that medical insurance will be upgraded again, so the medical insurance funds saved will be more used in areas with high clinical value and innovative medicine, so as to promote the continuous optimization of medical insurance expenditure structure. In October 29th, according to the information released by the Jiangxi Health Protection Committee, taking Fengcheng City as an example to promote the "three medicine" linkage reform, a large number of auxiliary drugs and nutritional drugs were stopped, and the drug regulations were reduced from more than 2600 to 1800, making room for about 80000000 yuan, adjusting the price of medical services synchronously, making room for drug purchase and making room for adjusting the price of medical services.

Through monitoring the auxiliary drugs, the medical insurance department can directly affect the prescriptions of the doctors, and limit the prescriptions of these varieties to a great extent. This will further squeeze the survival space of the relevant pharmaceutical companies, and the transformation is imminent.

"Some of the adjunctive products are approved to be listed later, relatively speaking, the safety and effectiveness are better than before. If such products are relatively small and sell properly, there will still be part of the market space." Lin Na analysis, there are many drugs used for cerebrovascular drugs in the drug centers that are being removed and monitored. "Now the doctors who are accustomed to using these drugs, especially those at the grass-roots level, can hardly change their medication habits in the short term, so some products will have some space for medication, but it is only temporary."

For the real transformation path, "some enterprises should use current cash flow to do research and development, or to merge Biopharmaceutical Enterprises, and combine capital with R & D. Some of the generics have advantages in sales channels, similar channels, and can introduce some new drugs. In the category, it is not realistic to stare at the tumor and start from scratch. Lin Na thinks, "we can also pay attention to such varieties as rheumatoid arthritis. These drugs need some teams that will really do the market, and the foreign companies in the front have not done so. First, drugs are too expensive, and patients' ability to pay is poor. Two, no enterprise seriously trains doctors in Department of Endocrinology. It is a very large and long-term market if we reduce the price by health insurance negotiations and biological analogues. "