Many kinds of effective and cheap drugs in our country disappear and lose money and make money. Pharmaceutical factories reduce production.
Including Beijing, in many hospitals and pharmacies across the country, pansentin, which is used to prevent thromboembolic diseases, has disappeared.
When this basic drug, which has been in supply for decades, disappears, the crisis of dipyridamole has transformed into a crisis of patients who need this cheap and efficient drug, and some patients have been traveling all over the country to seek medicine but cannot get it.
There are also a large number of cheap drugs such as protamine, Yinqiaochong and Weinao Rutong, which are familiar to the common people and are hard to find in pharmacies.
A sample survey of clinical medication in more than 40 tertiary hospitals in 12 cities across the country showed that there are more than 500 kinds of basic drugs supplemented by the state and local governments, and the shortage is as high as 342.
Why do cheap drugs disappear?
"Someone has monopolized the Pan Dingsheng raw material market. We can't get the raw materials." A pharmaceutical factory in Tianjin that produces Pan Shengding revealed.
According to a survey conducted by a reporter from the Beijing News, in addition to the rising market prices of raw materials, the influence of the original medical insurance bidding and policy price limit system, the respective interests of hospitals, doctors, pharmaceutical middlemen, pharmaceutical factories, and other links are also factors in the formation of Pan Shengding's crisis.
Ten years a drug is hard to find
In the weather of 34 ℃, 80-year-old Hu Qing walked nearly 4 kilometers along the route in his memory, vaguely remembering that there was a big golden elephant pharmacy not far to the east of the bus stop, but he did not find it after two stops. Hu Qing leaned against the stone steps by the side of the road, panting heavily, and the sweat on his forehead rose layer after layer. At the age of 80, he could not bear the journey of two stops in this hot day.
Looking for medicine and finding medicine for 15-year-old granddaughter Xiao Ran has become something Hu Qing is obsessed. For more than two months, after eating every day, Hu Qing took the bus. As soon as he saw a drugstore on the side of the road, he got off and went into the store for inquiries.
Dipyridamole (dipyridamole tablets) has been with her granddaughter Xiao Ran for 10 years. From 5 to 15 years old, Xiao ran's daily dose of dipyridamole also changed from 1 tablet to 4 tablets. A bottle of 16.7 yuan of dipyridamole is a cheap drug to prevent cardiovascular dilatation and antithrombosis. For Xiao Ran, who suffered from Kawasaki disease since he was a child, Pan Shengding has become a daily necessity, and the empty medicine bottles at home can be piled up into a hill.
In July, Hu Qing went to Beijing Children's Hospital to prescribe medicine as usual, only to find that the hospital had no Pan Shengding. Then he went to the First Hospital of Peking University, where he had bought Pan Shengding, but there was still no result. According to the dosage of 4 tablets a day, a bottle of 100 tablets of dipyridamole is only enough for Xiao Ran to take for 25 days. There were only three bottles of Pan Shengding's little Ran family left, and they immediately panicked.
In two months, Xiao Ran's family went to the people's sunshine, golden elephant and other pharmacies near their home, and the information they got was out of stock. Repeatedly went to Fuwai Hospital, Friendship Hospital, Beijing Children's Hospital, Peking University First Hospital and other hospitals to register, and the doctor told them that there was no such medicine. Hu Qing wrote down the telephone numbers of pharmacies in major hospitals in his notebook. From time to time, he turned them out to make inquiries. In a begging tone, the reply he got was still "no medicine" and "the manufacturer is out of stock." In more than half of Beijing, Xiao Ran's family did not get a bottle of Pan Shengding, whether they were looking for familiar doctors or asking relatives and friends.
"A pharmaceutical factory in Hebei also produces Pan Shengding, but the doctor told us that Tianjin is of good quality, so we looked for Tianjin." Hu Qing took with him the Pan Shengding medicine bottle produced by Tianjin Lisheng Pharmaceutical Co., Ltd. and went in to inquire when he saw the pharmacy. What he didn't know was that in two months, the number of Pan Shengding produced by Hebei Pharmaceutical Factory was gradually decreasing in the Beijing market.
The hard-to-find cheap drug is not just a pansentin. According to media reports, compound sulfamethoxazole injection, corticotropin for injection (ACTH), Weinarutong tablets, protamine, tabazol... These demand, good curative effect, low price of drugs, somehow disappeared in the pharmaceutical market.
Looking at the medicine bottle gradually emptying day by day, Hu Qing was very impatient and even dreamed of looking for medicine for his granddaughter at night. In his old age, Hu Qing couldn't understand why he could disappear out of thin air on the market after taking medicine for 10 years.
Cheap drugs "lose money and earn money"
When Pan Shengding was not found in hospitals and pharmacies in Beijing, the last glimmer of hope of Xiao Ran's family was pinned on Tianjin Lisheng Pharmaceutical Co., Ltd. Hu Qing dialed the telephone of Tianjin Lisheng Pharmaceutical Co., Ltd., but the old pharmaceutical factory, which has been producing Pan Shengding for decades, still did not give him a peace of mind that the dust had settled.
After several rounds, the first business department of Lisheng Pharmacy found some Pan Shengding drugs in stock in the past for the Xiao Ran family to meet their urgent needs. This means that once you finish eating the Pan Shengding in stock, the twists and turns of finding medicine will return to the family again.
The staff of Tianjin Lisheng Pharmaceutical Supply Department said that the price of 16.7 yuan 100 tablets was too cheap. Under the momentum of rising raw material prices, pharmaceutical companies had to consider costs and profits and control production.
A pharmaceutical factory in Hebei, which also produces dipyridamole, also said that due to the price increase of raw materials, although the company is still producing dipyridamole, the output is not large.
The price of raw materials is high, the production cost is increased, and behind the low ex-factory price, pharmaceutical companies reduce production, and the supply of drugs in the market is in short supply, resulting in out of stock. Such logic seems to be not uncommon in the pharmaceutical market.
According to media reports, in 2014, Shenwei Pharmaceutical, the Chinese medicine company with the largest market value on the Hong Kong Stock Exchange at that time, abandoned Shuanghuanglian Injection, which had brought it an annual output value of 80 million yuan. The highest retail price of each 20ml Shuanghuanglian injection is 1.8 yuan, but the cost calculated by the pharmaceutical company is twice as high as this price. At the same time, the sales manager of North China Pharmaceutical also found that the penicillin injection issued by its own manufacturer to Sichuan in one month had lost more than 100 million yuan. Haizheng Pfizer Pharmaceutical Co., Ltd. is still producing the tumor chemotherapy drug actinomycin D, but it has to admit that the production of this life-saving cheap drug is "losing money and making money".
Pan Shengding disappeared from the market, really just because of the single reason for the rise in raw material prices?
The cheap drugs of the past are hard to come back, but Pan Shengding, who has only disappeared in the past two months, cannot simply be attributed to the dilemma of rising prices of raw materials and increasing production costs.
With the approval of the State Council, the National Development and Reform Commission, the National Health and Family Planning Commission, the Ministry of Human Resources and Social Security and other departments jointly issued the ''Notice on Printing and Distributing Opinions on Promoting Drug Price Reform'', which will cancel most of the drug government pricing from June 1, 2015, Improve the drug procurement mechanism, and play the role of medical insurance to control fees. The actual transaction price of drugs is mainly formed by market competition.
The new deal came out, the heat did not disappear. If the price of raw materials rises, pharmaceutical companies can ensure profitable operation by raising the ex-factory price of drugs according to the market situation, and the dilemma of out-of-stock will be solved?
With Pan Shengding hidden in the pharmaceutical market rivers and lakes, there are all sides inextricably intertwined.
Tianjin Pan Shengding won the bid
Xiao Ran ate Pan Shengding produced by Tianjin Lisheng Pharmaceutical Co., Ltd. for 10 years, and the trust cultivated in 10 years stems from "Pan Shengding used by Beijing's big hospitals".
The Pan Shengding produced by Tianjin Lisheng Pharmaceutical Co., Ltd. can be sold in Beijing public hospitals and has experienced competition with various pharmaceutical companies in bidding. According to China's current centralized bidding method for drugs, all drugs used by public medical institutions must be purchased through competitive bidding. Drug bidders in accordance with certain procedures for bidding, bidding, so as to obtain the specifications of the drug winning bid.
Drug prices are examined and announced by the local provincial drug centralized procurement management office. This approved and announced price is also called the winning bid. The winning bid is the highest price for hospitals to purchase drugs, so the bidding price is the decisive factor in the price of drugs. Wang Zhen of the Institute of Economics of the Chinese Academy of Social Sciences pointed out that when a pharmaceutical raw material and production process have been widely used, lowering prices has become a major factor affecting whether a pharmaceutical company wins the bid.
This means that in order to win the bid in the competition, pharmaceutical companies need to control the price of drugs. Even if the raw materials rise and the production cost increases, in order to win the bid, the bid price of the drug will not be too high, so the selling price adjusted on the basis of the bid price will not be too high.
Online pharmacy search shows that dipyridamole tablets produced by Shiyao Group Ouyi Pharmaceutical Co., Ltd. have a specification of 25mg * 100s, sugar-coated and retail price of 18 yuan. After winning the bid, dipyridamole tablets produced by Tianjin Lisheng Pharmaceutical Co., Ltd. with the same label of 25mg * 100s and sugar-coated specifications retail price of 16.7 yuan.
Then why do pharmaceutical companies take the road of bidding?
Zhang Qiang, a Shaanxi pharmaceutical representative with more than ten years of experience in the industry, said that once the drug wins the bid, it means that the sales volume is guaranteed and the pharmaceutical market is opened. Compared with advertising and entering pharmacies, obtaining market share through bidding has become the best choice for many pharmaceutical companies.
"Bidding at low prices, even below cost, is no secret in the pharmaceutical industry." Wang Zhen introduced that pharmaceutical companies will not produce too many cheap drugs and make losses in order to make profits. After low-cost bidding to occupy market share, you can go other channels to sell other drugs.
Once the bid is won, the bid price has been fixed. In a certain period of time, even if the raw material prices and production costs of cheap drugs increase, pharmaceutical companies will not be able to adjust the price again. "In order to ensure profitability, the only way to reduce production or stop production." Zhang Qiang explained.
Cheap drugs are often referred to as "generic drugs" in the mouth of pharmaceutical agents to distinguish them from high-priced drugs. When the general medicine and high-priced drugs with, won the bid to obtain the market. Because of the low profit of cheap drugs, bidders will reduce the quantity of cheap drugs and vigorously push up the price of drugs in order to obtain benefits.
According to industry medical representatives, after winning the bid, its net profit is about 20% of the bid price. Naturally, he will mainly push for high-priced drugs. Cheap drugs only play a matching role and have never been the focus of their profits.
Cheap drugs that are hard to raise prices
In addition to occupying the market for bidding, the reason why Pan Shengding is difficult to raise the price is that it is a basic medical insurance drug, which can be paid by the basic medical insurance fund.
According to the national medical insurance catalogue, dipyridamole tablets, namely dipyridamole, are numbered 930 in the national medical insurance and are Class A drugs. It is reported that the Class A drugs in the basic medical insurance drugs are basically unified in the country and can guarantee the basic needs of clinical treatment. The cost of such drugs is covered by the basic medical insurance fund and is paid according to the basic medical insurance payment standard.
"Drugs that enter medical insurance involve basic medical insurance, and the price of drugs will not be expensive." Zhang Qiang believes that many pharmaceutical companies take the initiative to apply for drug entry, which not only ensures the market, but also falls into price constraints.
The "Notice on Issuing Opinions on Promoting Drug Price Reform" shows that since June 1 this year, the actual transaction prices of most drugs are mainly formed by market competition. The notice stipulates that for drugs paid by the medical insurance fund, the reasonable formation mechanism of drug prices shall be explored through the formulation of medical insurance payment standards.
"For the drug Pansentin, which also involves the convergence of medical insurance payments, it is not easy for pharmaceutical companies to rely on the market to adjust prices." Zhang Qiang, who has been engaged in the pharmaceutical industry for more than ten years, is not very optimistic about the launch of the New Deal.
"It is psychologically difficult for consumers to accept a drug that was originally cheap after a substantial price increase according to the market situation. At this time, instead of raising the price, the drugmaker might as well package a new drug with a higher price to go on the market." Zhang Qiang said that the subtle psychological changes of patients and their families will be included in the consideration of drug dealers. On the one hand, they honestly raise prices but lose their reputation, and on the other hand, they make a change in fame and money. The latter is the choice of most pharmacists.
The contest on the prescription pad
"In the treatment of cardiovascular diseases, dipyridamole is indeed an old drug with low price. More importantly, it has few side effects and is beneficial to old and young patients." October 9, Zhengzhou, Henan, a hospital doctor Wang Ping said.
However, is such a classic medicine, but in the doctor's prescription gradually disappeared.
The substitution of dipyridamole has made cilostazol tablets, clopidogrel and other drugs on the doctor's prescription notes. Li Zeping, chief physician of cardiovascular medicine in a public hospital in Shanghai, said frankly that his department has basically not opened pansengding to patients. "Although dipyridamole vice is small, few doctors still use it for adult patients."
The low profit of low-cost drugs can not promote the enthusiasm of doctors.
According to Zhang Qiang, the price of hospital drugs has increased by 15% on the basis of the bid price of drugs. At a fixed ratio of 15%, the higher the price of the drug itself, the higher the profit left to hospitals and doctors.
Cheap drugs that can't make a profit for hospitals are out of stock and face the dilemma of falling out of favor. "Even if some children's hospitals use pansentin, they will not take the initiative to increase the supply of such drugs once the warehouse is in short supply." Zhang Qiang said frankly that the hospital did not want drugs that did not make money.
The price is slightly higher, the drug effect is obvious, gradually become the new favorite of doctors. Choosing such a drug not only means an increase in commission, but also allows patients to see curative effects in a short period of time, which is jokingly called "not living up to the Tathagata".
"Doctors have their own medication habits, and few young doctors are familiar with the old drug Pansentin. They don't take the initiative to choose this inexpensive drug." A doctor from a key tertiary hospital in Chengdu, Sichuan, corroborated this claim.
Raw material market situation
"Pan Shengding's raw material market is monopolized by underwriting. We cannot get raw materials." The staff in charge of raw material procurement in the supply department of Tianjin Lisheng Pharmaceutical Factory revealed helplessness. The pharmaceutical company, which has been producing Pansentin for decades, is eager to spit out the bitterness of being in the downstream sourcing market.
What happened to Pansentin's raw material market?
On September 29, the reporter contacted an online retail manufacturer selling dipyridamole raw materials, and the quantity of its raw materials was still controlled by the upstream raw material market. For a 25kg cardboard barrel of raw materials, the reporter suggested that 10 barrels were needed. The sales staff were embarrassed and said that the raw materials were not easy to enter and it would take half a month to arrive.
From less than 500 yuan per kilogram two months ago to the price of 680 now, the price of Pansentin raw materials has gone up. "When goods are tight, prices go up." API sales staff for this phenomenon has become commonplace.
The staff of Tianjin Lisheng Pharmaceutical Supply Department said that the monopoly of the raw material market is very common, and he only knows that more than 20 kinds of raw materials are monopolized by some dominant distributors.
Wang Qingguo, who has been a representative of pharmaceutical companies in Henan for decades, said that once a monopoly is formed, the curtain of market price increases will be opened.
Market price increases can be, why raw materials difficult to buy?
Wang Qingguo smiled and put forward a concept commonly used in business wars: hunger marketing. Wang Qingguo said that only when enterprises create a "shortage" can they control the dominance of the market more firmly in their own hands.
Wang Qingguo believes that the main reason why cheap drugs are difficult to revive has changed from high cost, low profit and small output of manufacturers a few years ago to artificial manipulation of the raw material market.
Mr. Ren, an employee in Datong, Shanxi who specializes in drug production, also revealed to a reporter from the Beijing News that the monopoly of the raw material market must exist, but the situation of the monopoly still depends on the attributes of the drug itself. The more scarce the raw materials, the more complex the process of drugs, the easier it is to form a monopoly.
"The upstream of the raw material market is chaotic, and the downstream drug price reform cannot solve the main problem." Regarding the newly issued "Notice on Printing and Distributing Opinions on Promoting Drug Price Reform", with decades of familiarity with the pharmaceutical industry, Wang Qingguo remained on the sidelines of its effects.
In recent years, the national regulation and control policies for the pharmaceutical market have been issued frequently.
This year, the "Guiding Opinions of the General Office of the State Council on Improving the Centralized Procurement of Drugs in Public Hospitals" (Guoranfa  No. 7) and the "Notice of the National Health and Family Planning Commission on Implementing and Improving the Guiding Opinions on the Centralized Procurement of Drugs in Public Hospitals" (Guo Wei Yao Zheng Fa  No. 70) two policies (hereinafter referred to as Circular 7 and Circular 70) have attracted the attention of many people in the industry.
Han Huexue, director of the drug supply management department of the drug administration department of the state health and Family Planning Commission, said in an interview with Xinhua news agency that no 7 and no 70 are new mechanisms for classified drug procurement, and ensuring drug supply is one of the basic requirements.
Han Huixue said that in direct online procurement, enterprises can quote a price higher than the previous bid price and the highest price limit of the National Development and Reform Commission, and form a drug price through negotiations with hospitals.
Wang Zhen believes that the adjustment of centralized drug procurement in public hospitals should fall on the regulation of the role of the market. Wang Zhen stressed that in order to solve the dilemma of the disappearance of cheap drugs, it is necessary to adjust the communication and cooperation between hospitals and the Health Planning Commission in the procurement process. If only low-priced manufacturers are selected when the bid is priced, regardless of the profit-seeking nature of the drug itself, there will still be a situation where the cheap drug wins the bid, but the market is out of stock.
Khufu Looking for Medicine
Beijinger Lao Hu went to Beijing Children's Hospital as usual to prescribe medicine for his granddaughter's Kawasaki disease (Pan Shengding).
Doctor: "Pan Shengding is gone."
2 Late July
Lao Hu went to Peking University First Hospital, where he had bought Pan Shengding, with great hope. Doctor: "No medicine." (At this time, there were only 3 bottles of Pan Shengding left in the family, which was only enough for less than three months. Khufu panicked.)
3 August to September
Khufu ran all the pharmacies near his home.
Golden Elephant Pharmacy: "No stock."
People's Sunshine Pharmacy: "No, I haven't received any notice. I don't know why."
4 Mid-August to early September
Khufu kept calling pharmacies in many hospitals for inquiries.
Fuwai Hospital Pharmacy: "It's gone for a long time."
Friendship Hospital Pharmacy: "It seems that the factory was out of stock a month ago."
Pharmacy of Beijing Children's Hospital: "There is no medicine. I don't know when it will be available."
Pharmacy of Peking University First Hospital: "It is out of stock. It seems that the manufacturer has not produced it."
Khufu finally found several bottles of Pan Shengding in the first business department of Tianjin Lisheng (Pharmaceutical), a manufacturer, and was slightly relieved.
6 Early October
Khufu called Tianjin Pharmaceutical Factory again and was told that "there is no medicine." Khufu was in a hurry. After eating several bottles of Pan Shengding at home, what can my granddaughter do?