Medical Representatives Encountered Another "Role" Transformation Test

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On December 24 last year, the CCTV-13 News Channel broadcast the news "High Drug Prices under High Kickbacks", pointing to the problem of high drug kickbacks in the purchase and sale of medicines and medical services, which stirred up waves with one stone. Both Shanghai and Hunan have severely investigated and dealt with illegal doctors and pharmaceutical companies involved. The National Health and Family Planning Commission requires all provinces to draw inferences from one another in response to such situations and in-depth control of unhealthy practices in the purchase and sale of medicines and medical services.

It is reported that in the past ten days, medical institutions in many places have responded to the requirements of CCTV News and the Health and Family Planning Commission, strictly investigating unhealthy practices in the purchase and sale of drugs, and strictly prohibiting medical representatives from visiting the hospital. The industry believes that this is the most severe compliance torture encountered by the drug purchase and sale model since the comprehensive control of commercial bribery in the medical and health field in 2006, and medical representatives are facing a role transformation.

Another Crisis

In 2005, the national medical and health sector launched a campaign to rectify commercial bribery and regulate the drug market environment. According to statistics, from August 2005 to the end of July 2006, 790 commercial bribery cases in the field of medicine and health were investigated and dealt with nationwide, involving 57.01 million million yuan, 1160 people involved and 230 people criminally dealt.

"Back then, the anti-commercial bribery storm made medical representatives almost no 'living space', doctors shunned, and the various marketing activities they carried out were monitored and inspected everywhere. The sales of pharmaceutical companies plummeted, and medical representatives switched their businesses." Senior pharmaceutical marketing person Zhang Xiaolong said.

Once upon a time, pharmaceutical representatives were synonymous with the advanced marketing concepts of multinational pharmaceutical companies. Most of the first batch of pharmaceutical professional managers in the industry had the experience of pharmaceutical representatives. In the late 1980 s, multinational pharmaceutical companies such as Merck and Pfizer entered China. They brought new drugs that were relatively cutting-edge in the field of diagnosis and treatment, but many doctors would not use them or even heard of them. As a result, these multinational pharmaceutical companies have hired a large number of professionals engaged in clinical medicine and pharmacy to promote the academic promotion of drugs to clinical experts and doctors. These academic promoters are called medical representatives.

The main work of early medical representatives was to organize front-line doctors to participate in academic conferences and activities at various levels, and to educate doctors in medicine, basic pharmaceutical research, new drug development, clinical trials, treatment plans, etc., so that they can gradually master the mechanism of new drugs, Efficacy, use methods and adverse reactions, and form medication habits. This new drug marketing model, which cultivates doctors' "medication habits" in the form of "academic promotion", is called "consultative marketing".

Shi Lichen, founder of Beijing Dingchen Medical Management Consulting Center, believes that medical representatives have played a great role in improving the level of clinical medication at a certain stage, and there is no problem with their profession itself. the problem lies in the fact that some pharmaceutical companies do not divide their marketing and sales responsibilities, positioning medical representatives as sales personnel. The sales staff's work scope is to maintain the customer group relationship, collection, delivery, etc., which is necessary to have a relationship with money and form a business relationship with the hospital.

In 2014, GlaxoSmithKline (China) Investment Co., Ltd. was fined 3 billion yuan for bribery. This is by far the largest fine for corporate bribery in China.

"In the field of drug purchase and sale, the main reason why bribery and high kickbacks are repeatedly banned is the existence of medicine to support doctors." Gan Rongfu, a senior researcher at Guoyao Holdings, said. It is undeniable that, up to now, there are still hundreds of thousands of drug intermediary groups in the field of pharmaceutical purchase and sale, and some pharmaceutical enterprises still adopt the mode of controlled marketing agency to sell drugs, forming a hotbed of high rebate.

An industry insider who did not want to be named bluntly said that due to the inadequate reforms in the medical and health field, the reality of using medicine to support doctors exists. Whether it is a high rebate for doctors or a rebate for hospitals, it is a different form of medicine to support doctors. "For example, pharmacy trusteeship mode, GPO procurement mode, etc., all have a rebate link for medical care, which is just sunshine."

Compliance test

In fact, the industry has long discussed the role and code of conduct of medical representatives. Many years ago, the China Chemical Pharmaceutical Industry Association drafted the "Code of Conduct for Medical Representatives" (hereinafter referred to as the Code), which not only clearly stipulated the basic responsibilities of medical representatives, but also limited their qualifications. The guidelines stipulate that the basic functions of medical representatives are to "scientifically recommend drugs to doctors and medical institutions, correctly publicize the safety and effectiveness of drugs, and assist medical institutions in rational drug use; collect adverse reactions of recommended drugs, timely feedback to manufacturers, put forward effective measures and disposal methods, seriously understand clinical needs, and provide scientific pharmaceutical services". The guidelines also make it clear that the income of a medical representative must not be linked to the amount of prescriptions prescribed by a doctor.

"In fact, after several rounds of drug market regulation, excellent pharmaceutical companies have been moving towards compliance. Overall, drug purchase and sale behavior is becoming more and more standardized." Gan Rongfu said.

It is reported that after the CCTV news was broadcast, the National Health and Family Planning Commission sent multiple inspection teams to some provinces to supervise. The top three hospitals in Beijing, Tianjin, Nanjing, Shanghai and other major cities issued notices prohibiting medical representatives from visiting the hospital. Some foreign-funded enterprises began to cooperate with the hospital, requiring medical representatives to comply with the relevant provisions of the hospital. Some medical representatives were given a holiday and their performance was not assessed for the time being.

On December 30 last year, the 31st meeting of the Central Leading Group for Comprehensively Deepening Reform was held, and the "Several Opinions on Further Reforming and Improving Drug Production, Circulation and Use Policies" were reviewed and approved. The opinions emphasized that it is necessary to improve the procurement mechanism of drugs, consumables, and medical devices, implement the reform of the "two-invoice system" for drug purchase and sales, reduce circulation links, purify the circulation environment, and rectify outstanding problems. It is necessary to break the mechanism of relying on drugs to support medical care, cancel drug markups, straighten out the prices of medical services, and implement government investment responsibilities.

The industry believes that more stringent drug purchase and sales regulations will be launched this year, and the reform of the "two-invoice system" is imperative. Twenty-four provinces and cities across the country have responded positively to the "two-vote system", and Anhui and Hunan provinces have issued opinions on the implementation of the "two-vote system.

Gan Rongfu believes that pharmaceutical companies will face three major problems in the field of drug purchase and sale this year: first, the price of drugs purchased through bidding will still be reduced; second, the State Food and Drug Administration may strictly investigate low-priced drugs. If the quality of drugs in enterprises that win at low prices does not pass the standard, it is a dead end; third, how can enterprises solve the problem of purchase and sale compliance if they do not get rid of medicine.

Shi Lichen believes that China's medical representatives will one day return to the road of specialization, and the elements of pharmaceutical purchase and sale resources will be reallocated. At present, the purchase and sale of drugs in developed countries is composed of three links: market, sales and distribution. Pharmaceutical representatives belong to the market link, and their main task is to provide professional drug promotion for doctors. "In the future, with the continuous deepening of reforms in the pharmaceutical field, the market will become more and more standardized, and the profession of pharmaceutical representatives will get rid of embarrassment and become a respected group." Shi Lichen said. (Reporter Fang Jianchun)