Antidiabetic drugs are involved in the 'price reduction' storm!

On December 9, a "Notice on Reporting the Purchasing Data of the Fourth Batch of National Organizations for Centralized Procurement of Drugs" was released in the industry. The fourth batch of national drug procurement lists involved 44 varieties and 90 product regulations. According to the requirements of the documents, the report will be officially launched on December 12, the report will be completed on December 21, and the review of the guarantee will be completed on December 30. The fourth batch of national procurement in the industry is expected to be officially launched around the Spring Festival.

The scope of this collection covers diabetes, hypertension, respiratory diseases, psychotherapy, tumor medication, fungal infections, anesthesia pain, eye drops and other medication fields, mainly oral products, and 8 injection products were selected. It is worth noting that a variety of diabetes medications appeared in the fourth batch of centralized procurement, such as empagliflozin, canagliflozin, repaglinide, nateglinide, and gliclazide.

"Frequent Customers" with Quantity Purchase

Data show that diabetes is a kind of progressive disorder of sugar, fat, protein, water and electrolyte caused by absolute or relative insufficient insulin secretion, and the main marker of hyperglycemia is disease. It can be divided into type 1 diabetes and type 2. Diabetes, special types of diabetes and gestational diabetes.

The current diabetes treatment drugs mainly include oral hypoglycemic drugs and injection hypoglycemic drugs. The oral hypoglycemic drugs are divided into biguanides, sulfonylureas, glinides, and α-glycosidase inhibitors (AGI). , Thiazolidinediones (TZDs), dipeptidyl peptidase IV (DPP-4) inhibitors, sodium-glucose cotransporter 2 (SGLT-2) inhibitors, etc.; injection-type hypoglycemic drugs are divided into insulin and Analogs, Glucagon-like peptide 1 (GLP-1) receptor agonists, etc.

Tianfeng Securities pointed out that among oral hypoglycemic drugs, new hypoglycemic drugs such as DPP-4 inhibitors and SGLT-2 inhibitors are recommended by the guidelines, and can be used as a dual therapy at the front end of the disease process.

Enpagliflozin and canagliflozin are SGLT-2 inhibitors in this collection. Moreover, last year's medical insurance negotiations were allowed for these two drugs. The original manufacturers of Enpagliflozin and Canagliflozin are Boehringer Ingelheim and Janssen of Belgium. Four domestic SGLT-2 inhibitor generic drugs have been approved. Two generic drugs from Enpagliflozin have been approved by Hausen Pharmaceuticals and Kelun Pharmaceuticals, and two generic drugs from Canagliflozin have Hausen Pharmaceuticals and ChiaTianqing. Pharmaceutical approved. As of the end of 2018, the domestic market share of SGLT-2 inhibitors was only 0.2%, which is the same as the overseas market share of 10%, which has great room for improvement.

In addition to SGLT-2 inhibitor drugs, the gliclazide sustained-release tablets included in the collection are sulfonylureas insulin secretagogue drugs. In 2019, the sales of public medical institutions in China also exceeded 1 billion. ; There are also two non-sulfonylurea insulin secretagogues, repaglinide and nateglinide, which belong to the Glinide class of hypoglycemic drugs. Like sulfonylureas, they can promote the secretion of insulin to reduce blood sugar. effect.

The original manufacturers of gliclazide, nateglinide and repaglinide are Servier (Tianjin), Beijing Novartis, and Novo Nordisk; this time, the domestic generic drug companies involved include Beijing Fuyuan, Yichang Renfu, Zhuhai Tongyi, Jiangsu Hausen, etc.

In the first few batches of national collections, there were also “figures” of diabetes drugs, such as metformin, Glimepiride, and acarbose.

Fierce bidding for hypoglycemic drugs

For the hypoglycemic drugs selected by the centralized procurement, companies are fighting fiercely in bidding, and the price is reduced by a large margin. In the third batch of national procurement, taking metformin hydrochloride as an example, involving more than 40 pharmaceutical companies, the average price of a 0.5g single tablet is only 6 cents. After the price reduction, the monthly cost of metformin for patients does not exceed 7 yuan, about 4% of the original drug cost; in the second batch of national procurement, Bayer’s original acarbose single-chip reported 0.18 yuan, winning the BID at an ultra-low price, squeezing out East China Medicine; in addition, in the second batch of national procurement , Glimepiride tablets dropped by up to 96%, and the original research manufacturer Sanofi gave up the offer... The fourth batch of centralized procurement has included 5 diabetes treatment drugs. Compared with the previous drop of related products, the current round of price reduction is expected Not small.

It is worth mentioning that in the medical insurance negotiations in November 2019, another SGLT-2 inhibitor, AstraZeneca’s dapagliflozin 10mg, experienced a “soul bargain” by the Medical Insurance Bureau to 4.36/tablet, and the price dropped. As much as 73%. According to previous statistics, the domestic diabetes market is mainly monopolized by Novo Nordisk, Sanofi, Eli Lilly, and Merck, occupying nearly 80% of the market. With centralized procurement before and after medical insurance negotiations, the entire diabetes medication market will also intensify reshuffle and changes, and import substitution will accelerate.

Relevant data show that there are currently about 463 million diabetic patients in the world, and there are 116.4 million diabetic patients in China, ranking first in the world. The International Diabetes Federation estimates that among the 20-79-year-olds in my country, there are 114 million diabetic patients, with a prevalence rate of 10.9%, ranking first in the world. At the same time, the number of people with diabetes in my country is expected to reach 134 million in 2045, which is also the largest in the world.

Are diabetes drugs frequently selected by centralized procurement and bargaining? According to Sun Haishu, associate professor of Chinese Medicine at the Chinese Academy of Chinese Medical Sciences, as the most populous country in the world, the prevalence of diabetes in my country has risen sharply in recent years, and it has become one of the chronic non-communicable diseases with the heaviest disease burden in my country. From a medical point of view, the problem of large size, once properly resolved, is conducive to medical insurance management.

Shi Lichen, the founder of Beijing Dingchen Medical Management Consulting Center, also stated that there are a large population of diabetes patients in my country. The National Medical Insurance Bureau's drugs included in the national centralized procurement mainly consider drugs with large clinical use and high purchase prices. Diabetes drugs are very suitable, so The inclusion of such drugs in centralized procurement is more conducive to medical insurance control costs.

Insulin collection is also on the way

In July of this year, news from the Medical Insurance Bureau came out in the industry that biological products (including insulin) and proprietary Chinese medicines will also start mass purchases.

As the last line of defense in the treatment of diabetes, insulin is an essential medicine in the later stage of diabetes treatment. Mainly used for: Type 1 diabetes patients are absolutely lack of insulin due to the destruction of pancreatic islet cells, injection of exogenous insulin is the only effective treatment; type 2 diabetes patients often face the problem of oral medicine failure after taking oral medicine for a period of time, and also need Use insulin drugs to control blood sugar. The development trend of insulin is that the long-acting action time is longer and longer, and the short-acting action speed is getting faster and faster. However, insulin products are not included in the fourth batch of centralized procurement.

Although insulin has not yet been included in the national centralized procurement, it appeared in the Wuhan special centralized procurement in January this year. The total agreed purchase volume of 7 groups of insulin is 1.7 million, involving Novo Nordisk, Eli Lilly, Sanofi, Gan Li Pharmaceutical, and Tonghua Dongbao, United Laboratories and other enterprises. However, it is understood that due to the small market share of local centralized procurement and limited attractiveness, the decline of related enterprises is not very large.

Earlier, Huaxi Securities analyzed that insulin, as a special biological drug, is difficult to achieve consistency evaluation under current circumstances, and considering that the core difficulty of insulin lies in stable and large-scale production, it is difficult for insulin to become a nationalized belt in the short term. Quantity purchase varieties.

Shi Lichen told the editor of Sina Pharmaceutical that insulin products have not yet appeared, or because the National Medical Insurance Administration is still formulating relevant centralized procurement rules. There are many types of insulin products, which can be divided into three generations from low to high from the perspective of its development history and technical level; according to the time of efficacy, it can be divided into short-acting, medium-acting, and long-acting. The medical insurance bureau needs to consider how to divide the quality level, and the national procurement of insulin may be listed.

Regarding the inclusion of the national centralized procurement time, industry sources said that insulin will also enter the national centralized procurement by the end of next year at the latest. Shi Lichen also said that the centralized insulin procurement may also be carried out next year.

In the diabetes treatment drug market in my country, the market share of acarbose in oral hypoglycemic drugs ranks first, and the market share has remained at around 17%-20% in the past five years; data from public hospitals in key cities from 2013 to 2017 show that In the third-generation insulin, insulin glargine is the second only to acarbose to treat diabetes. Recently, the price of insulin glargine of Ganli Pharmaceutical has also been cut in some provinces, which seems to have also smelled the trend of national gathering.