On August 26, the 12th session of the 13th National People's Congress (NPC) approved the newly revised drug administration law with 164 votes in favor and 3 abstentions. Prescription drugs are not included in the list of drugs that cannot be sold online under the new drug administration law, which is seen as a signal to break the ban on selling prescription drugs online.
Four days later, the national health insurance bureau issued "about" Internet + "medical service price and payment policy guidelines" (hereinafter referred to as "guidelines"), the first to "Internet +" medical service price included in the current medical service price policy system of unified management, to conform to the conditions of "Internet +" medical services, according to the principle of fairness of online payment policy.
Although the two policies are not related to each other, they are actually closely related to the linkage of "three doctors", namely the linkage of medical insurance system reform, health system reform and drug circulation system reform. With the opening of the policy gap in the online sale of prescription drugs, it is bound to accelerate the outflow of prescription and force public hospitals to reform the system of "supporting doctors with medicine".
After the Internet diagnosis and treatment is included in the medical insurance payment for the first time, the diagnosis and treatment of chronic and common diseases will be accelerated online, and patients in public hospitals will be separated, so as to reduce the pressure of diagnosis and treatment in hospitals. At the same time, the popularization of Internet diagnosis and treatment will be accelerated, which will constitute favorable factors for ping an good doctor and other enterprises.
Behind the new rules: years of controversy, online prescription drug policy twists and turns
Reviewing the introduction of the new drug administration act, online sales of prescription drugs have experienced many policy wobbles. In May 2014, the former state food and drug administration issued the draft regulations for the supervision and administration of Internet food and drug distribution, which proposed for the first time to liberalize the sales of prescription drugs in e-commerce channels.
Due to regulatory problems, in May 2016, the former state food and drug administration (cfda) decided to end the trial of online drug retail on the third-party Internet platform.
In 2018, however, things took another turn. In April of that year, The General Office of the State Council issued opinions on promoting the development of "Internet + medical health", which stipulated that medical institutions and drug dealers could entrust qualified third-party institutions to distribute prescriptions for common diseases and chronic diseases issued online after being reviewed by pharmacists.
Since then, the drug e-commerce platform can only carry out "online ordering and collection" and "online ordering and delivery" of prescription drugs in the form of online display, appointment and distribution in offline stores, so as to comply with online and offline regulations.
The advantage of this approach is to strengthen the regulation of online prescription drugs, but it is difficult to really form a market size. For the pharmaceutical e-commerce platform, if it wants to expand its market share, it can only continue to acquire more offline pharmacies so as to expand the distribution scope of e-commerce.
"At present, the biggest difficulty of proprietary drugs lies in unclear policies and regulations, unclear related regulations, and the lack of effective guidance in the operation of enterprises." Health officials from jd.com said that the biggest cost in the current drug distribution comes from the cost of the drug itself and the expense incurred by professional pharmaceutical care personnel.
But the online prescription drug controversy is not over. In April this year, the pharmaceutical administration law of the People's Republic of China (revised draft) "(hereinafter referred to as the revised draft) to the thirteenth session of the tenth National People's Congress standing committee meeting review, the revised draft explicitly put forward the" drug marketing authorisation holder, pharmaceutical trading enterprises shall be through direct sales network sales third-party platform prescription ", was not to revise the draft vote at the meeting.
Until August 26, the 12th session of the 13th NPC Standing Committee voted to pass the newly revised drug administration law. According to the new drug administration law, vaccines, blood products, narcotic drugs, psychoactive drugs and other drugs under special state control are not allowed to be sold online. Prescription drugs are not included.
, director of the National People's Congress standing committee li administrative law Yuan Jie said that the current approach is to make clear a regulation network can not direct sales of prescription drugs to the public, but in all aspects of the comprehensive opinion, adhere to the principle of online the same standard, integrated regulation and laws are selling online drug regulation, the principle of the comparison of the required network sell drugs to abide by the relevant provisions of the pharmaceutical trading, and authorize the pharmaceutical supervisory and administrative department under the state council jointly with the competent department of health under the state council and other departments to make way, at the same time, several kinds of special management drug can't in online sales, with space for the practice exploration.
Nuggets potential: prescription outflow leverages the 100 billion market, e-commerce platform to seize the opportunity to eat
Currently, the medical e-commerce platforms are mainly ali health, jd health and ping an good doctor, and these enterprises have a certain scale of revenue. Alibaba health's 2019 financial report (from March 2018 to March 2019) showed that the company's e-commerce business amounted to 5.045 billion yuan, accounting for 99% of the company's revenue. According to the data disclosed by jd health, the company has realized a revenue of over 10 billion yuan, most of which comes from the drug e-commerce business. In the first half of this year, ping an good doctor achieved a revenue of 2.273 billion yuan, of which healthy mall contributed 1.454 billion yuan.
Zhu hengpeng, director of the public policy research center of the Chinese Academy of Social Sciences, believes that the online sale of prescription drugs has controllable risks and can be open, but it needs a transitional period for the regulatory authorities, health departments and hospitals. With the upgrading of public demand, income and continuous competition among enterprises, the market will eventually become healthy.
"Don't start off so demanding. It's unrealistic." Zhu Hengpeng, said after the revision of the pharmaceutical administration law, the number is likely to be open to make regulations, if the limit the number of enterprises and the proposed opening 10-20 companies, "don't open only 1-2, big drug distributors of national medicine, medicine, China resources and network platform, such as scope should be taken into account."
In addition to regulatory liberalisation, another key to selling prescription drugs online is prescription outflow. Last October, The General Office of the State Council issued a circular explicitly supporting prescription outflow and handing over the right to purchase drugs to patients. This means that patients who were originally treated in the hospital, prescribed and obtained drugs can now choose to purchase drugs in the hospital or retail drugstore after the prescription outflow, separating the treatment and purchase of drugs.
It's not just traditional retail pharmacies that can share the prescription outflow. E-commerce platforms also have a chance to grab a slice of the pie. At present, the market size of online drugs is still small, accounting for about 5% of the total retail drug market. Investors expect that this part of the e-commerce will form a new market of up to 100 billion yuan.
Data from mi net shows that in 2018, the sales of drugs in China's three major terminal and six markets reached 1713.1 billion yuan, up 6.3% year-on-year. From the sales distribution of the three major terminals that realize drug sales, the market share of public hospital terminals is the largest, accounting for 67.4% in 2018, the market share of retail pharmacy terminals is 22.9%, and the market share of public primary medical terminals has increased in recent years, accounting for 9.7%.
Prescription outflow, however, the premise is to build a platform of sharing the prescription, if the drug sales network and information system of medical institutions can not realize information sharing, the source of prescription authenticity cannot be guaranteed, the patient's medication safety problem cannot be solved, so the Internet medical enterprises and local governments is actively promoting prescription sharing platform. A few days ago, the health and health commission of gansu province officially launched the "electronic prescription information sharing platform" project, which is the first provincial-level electronic prescription information sharing platform in China.
Double benefit: Internet diagnosis and treatment included in medical insurance payment, ping an good doctor is expected to increase revenue of 2 billion
While the online sale of prescription drugs opens a window, the inclusion of internet-based treatments in medicare payments for the first time is also a major boon for the industry. On August 30, the national medical insurance administration issued guidelines, including the inclusion of Internet medical services in medical insurance payment for the first time, and clearly defined the standards for the inclusion of medical services (i.e. the main providers of medical services covered by medical insurance), the scope of medical services, and the pricing mechanism of medical insurance payment.
Ping an good doctor told reporters that this will be an important milestone in the development of the Internet medical industry. Qu xiaoliang, deputy director of wuzhen Internet hospital, also thinks the new policy is of great significance. He told reporters that in the past, Internet medical fees were paid by patients at their own expense, which is not conducive to the popularization of Internet medical treatment, but also against the wide coverage of medical insurance payment.
After the Internet diagnosis and treatment is included in the medical insurance payment, it will directly bring considerable income to the Internet medical treatment. Ping an hao doctor revealed in an earlier conference call with investors that the doctor received 656,000 visits per day in the first half of the year, half of which were offline medical visits. The other half is some counseling. According to the company's simple and rough calculation, if we calculate 300,000 visits per day and charge 20 yuan per visit, the total annual revenue will exceed 2 billion yuan.
However, the guideline defines five basic principles that access to the "Internet +" medical service pricing project should comply with, including the approval of the health authorities to carry out the project in the "Internet +" mode, providing direct services to patients, and providing services that have substantial effects on diagnosis and treatment of diseases.
QuXiaoLiang argues that Internet medical health care to pay five principles, can be said to be the basic definition of "core diagnosis", which can make a clear distinction between "online consultation" and the "online assessment", such as "has the substantial effect on the diagnosis and treatment" this principle, if the strict, there is no "electronic prescription", after the visit only guide the auxiliary examination and so on, can refuse to pay, can also lead to everywhere of specific pay differences.
As the detailed rules have not yet been issued, Internet medical companies are still waiting for the final policy implementation. Jd health officials told reporters that they expected government departments to further clarify the definition of "services that have substantial effects on diagnosis and treatment of diseases", but believed that both diagnostic online diagnosis and slow disease follow-up should be considered to have "substantial effects".