How about the 17 anti-cancer drugs talked about in 2018?

The 2022 health care highlight is coming.

On June 13, the National Medical Security Administration released the “2022 National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug Catalog Adjustment Work Plan” and Relevant documents are publicly solicited for comments, which means that the 2022 medical insurance negotiation work has kicked off.

In the past, the adjustment cycle of the National Medical Insurance Catalog could be as long as eight years, and later it was adjusted to every two years. In September 2020, the medical insurance The Bureau issued the “Interim Measures for the Administration of Medication for Basic Medical Insurance”, which stipulates that the medical security administrative department of the State Council establishes and improves the dynamic adjustment mechanism, which will be adjusted once a year in principle.

This is a major benefit for innovative drugs. The normalized adjustment of the National Medical Insurance Catalogue will help bring more good drugs, new drugs, The urgently needed drugs are included in medical insurance in a timely manner, helps innovative pharmaceutical companies to rapidly increase their volume, achieve revenue and profit growth, and then feed back innovative R&D.

Since 2016, the national medical insurance negotiation has been carried out in six batches, from the pilot of 5 varieties in 2016 to the anti-antibiotics in 2018. In the special negotiation of cancer drugs, as many as 138 participants will participate in the negotiation by 2020, the national negotiation mechanism is gradually improved, and more and more indications and drug varieties are covered.

So, what is the situation of the high volume of drugs after entering the medical insurance?

We selected the 2018 Guotan Drugs as the research object. In 2018, the Medical Insurance Bureau organized special negotiations on anticancer drugs, and 17 anticancer drugs were successfully included in the medical insurance.

These 17 anticancer drugs include 12 solid tumor drugs and 5 hematological tumor drugs, all of which are clinically necessary, curative, and urgently needed by the insured. , involving non-small cell lung cancer, kidney cancer, colorectal cancer, melanoma, lymphoma and other cancer types, of which the only domestic drugs are Chia Tai Tianqing’s Anlotinib and Hengrui’s Pegaspargase.

It is reported that the implementation period of these 17 countries talking about drugs is two years, from the end of 2018 to the end of 2020. After the agreement expired, 3 of the drugs were listed as generic drugs and were included in Category B management, and the other 14 exclusive drugs were successfully negotiated for renewal and further reduced their prices, with an average decrease of 14.95%, and individual decreases of more than 60%.

Now, three years have passed, how about these 17 anti-cancer drugs? What conclusions can be drawn from the changes in their market shares, so as to provide reference for decision-makers and enterprises?

New drugs with a small market base are more advantageous

Cancer drugs have implemented the negotiation cycle since the end of 2018. After one year of 2019, most anti-cancer drugs have achieved sales growth of more than 10 times.Azacitidine and The growth rate of afatinib has reached more than 20 times, and the growth rate of anlotinib and ceritinib is close to 20 times. cancer drugs.

Table 1: Sales Growth Analysis of Anticancer Drugs Special Negotiated Drugs in 2018

*Drugs marked in yellow are listed in 2018, and drugs marked in pink are listed in 2017

*pegaspargase and octreotide ( Microspheres) each has two product specifications included in the national discussion, and the average price drop is taken here. , after entering the medical insurance through price reduction, the sales growth is relatively slow. According to the PDB comprehensive database, cetuximab, crizotinib, sunitinib In 2017, the sample hospital sales of Nitrogen, pegaspargase and octreotide (microspheres) all reached the level of more than 10 million yuan, which has a certain market foundation. The sales growth rate of these drugs in 2019 did not exceed five times. The highest growth rate was crizotinib, which increased by 439% year-on-year, while the growth rates of pegaspargase and octreotide were 7% and 12%, respectively.

Therefore, national medical insurance negotiation is more suitable for new drugs with a small market base.On the one hand, new drugs often represent better efficacy/safety and are easily accepted by doctors and patients; on the other hand, new drugs usually correspond to unmet clinical needs and have huge room for expansion. Therefore, new drugs enter medical insurance through price reduction, which is the easiest to achieve rapid sales growth.

There is no significant positive correlation between growth and decline

In addition to innovation and market base, are there other important factors that affect sales growth?

The most exciting thing in the previous national talks is the decline rate. In 2021, Bojian’s rare disease drug Nosinagen Sodium Injection will be reduced from 550,000 yuan to 33,000 yuan. , dropped by 94%, and it has become a talking point in the industry.

Looking at the previous national talks, except for the 44% drop in 2017, the other national talks all dropped by 50%-60%, slightly higher than the previous national purchases with volume The average decline is 50%+, and the largest decline in the state talks in 2021 is 61.7%.

According to the classic market supply theory, it is easy to think that the lower the price, the more consumers will be willing to pay for it. So, is this really the case?

The fastest year-on-year growth rate in 2019 was afatinib, which was 2334%, and the drug dropped by 39%, only slightly higher than this time. The lowest drop in the national talks was 37.5%. The drugs with the highest declines, cetuximab (71%), osimertinib (71%) and crizotinib (71%), The year-on-year growth rates in 2019 were 131%, 685%, and 439%, respectively. These growth rates are not low, but compared with the growth rates of several thousand percent for other drugs in the same batch, there is still a certain gap.

Table 2: Analysis of sales growth of anticancer drugs in special negotiations in 2018

span>The rate of decline is high, and sales growth is not necessarily fast. Companies will naturally consider cutting prices less or not. What about the sales of the products with the least decline?

two grades of asparaginase were used, with an average drop of 37.5%, which was 20 lower than the average drop of 56.7% in this round of national talks percentage points, the lowest decline. However, the sales growth rate of Pegaspargase in 2019 was only 7% year-on-year, the lowest growth rate. Another drug, octreotide (microspheres), with a lower decline, also has a growth rate at the tail end of the crane, with a year-on-year growth rate of 12% in 2019.

However, a low drop is not necessarily a low growth rate. The price of anlotinib dropped by 45%, 10 percentage points lower than the average drop, but its sales grew rapidly, with a year-on-year increase of nearly 20 times in 2019.

In general, the higher the rate of decline, the higher the sales growth rate of drugs, while the lower the rate of decline, the higher the sales growth rate is. lower, but there are exceptions.

In fact, it is also easy to understand. Unlike other consumer goods such as clothes, medicines have limited usage scenarios, and rational people only use them when they need them. will buy medicines, so the price elasticity curve of medicines is relatively flat. This leads to the fact that when the drug drop is too large, the sales volume cannot effectively make up the price gap, and the final performance is that the sales increase is not obvious.

Clinical value is the most critical

< span>Compared with the rapid sales growth in 2019,In 2020, the growth rate of these 17 countries’ drugs will be relatively slow, and the median range will remain at around 40%-50%. Among them, two new drugs launched in 2018, azacitidine and ixazomib, have the fastest growth rate of 70%, followed by afatinib, which was launched in 2017, with a rate of 60%. %.

However, also new drugs, ceritinib and vemurafenib experienced slightly negative growth in 2020, -3% and -1%, respectively. Ceritinib is Novartis’ second-generation ALK-targeted oral small-molecule drug, a single drug for patients with ALK-positive locally advanced or metastatic non-small cell lung cancer (NSCLC).

Table 3: 2018 Anti-cancer Drug Special Negotiation Drug Sales Growth Analysis Over the Years Ritinib sales fell for a number of reasons. First, the proportion of ALK mutations is low, which is called “diamond mutation”, and the market ceiling of ceritinib targeting ALK mutations is low; Substituting ALK inhibitors, the clinical efficacy of ceritinib is obviously inferior to that of alectinib, and ceritinib is at a disadvantage in clinical use. During the same period, the market growth rate of alectinib is far ahead of ceritinib.

In contrast, Ixazomib’s three-year growth rates from 2019 to 2021 are: 1520%, 70% and 33% respectively, and it has maintained a better-than-average growth since it was included in the national talks.

Ixazomib is the first oral proteasome inhibitor. Compared with similar drugs bortezomib and carfilzomib, Ixazomib The all-oral treatment plan has greatly improved the convenience of medication and treatment compliance for patients. Clinical research data also proved that ixazomib combined with lenalidomide and dexamethasone (IRd) can significantly shorten the onset time and prolong the survival of patients by up to 10 months. In terms of safety, ixazomib (Ixazomib) did not significantly increase adverse events compared with the control group.

Therefore, although we are more likely to be attracted by prices and declines in centralized procurement and national negotiations, drugs want patients to pay the bill and achieve Sales growth ultimately depends on the clinical value of the drug. Although cancer treatment usually brings great financial pressure to patients, in the face of efficacy and safety, patients are more inclined to choose the best within the affordable range, rather than the cheapest.

Summary

2021 medical insurance negotiation A total of 85 varieties were included. Compared with the 119 varieties in 2019, the number of 138 varieties in 2020 was significantly reduced. This is because with the normalization of national talks, the previous national talks have exhausted the historically accumulated new drug negotiations. . Therefore, the 2021 medical insurance negotiations began to expand the scope of new drugs to new drugs that have been marketed in the previous five years, and the same is true this year. However, according to the previous analysis, medical insurance negotiation is more suitable for new drugs with a small market base, which are relatively easy to achieve sales growth through price cuts. But no matter whether it is centralized procurement or national talks, it just paved a clear road for enterprises to enter the market. On this road, whether pharmaceutical companies rush all the way, or walk alone, is ultimately determined by the clinical value of the drug.