Generally speaking, brand-name drugs are high in Mao Lijiao in production and low in Mao Lijiao in circulation. On the contrary, in terms of generic drugs, the gross profit of manufacturers is not high, while the distribution channels in Mao Lijiao are high. In this way, the price difference between brand-name drugs and generic drugs is mainly due to the production price, not the circulation and retail prices. Therefore, the international price control of brand drugs is mainly the control of their ex-factory prices, while the price of generic drugs is mainly the control of their circulation and retail prices.
The price of generic drugs is generally 50% ~ 70% lower than that of brand-name drugs, and with the expiration of patented drugs, the output of generic drugs will increase and the price will continue to decline. After generic drugs flood into the market, the price of expired patented drugs will continue to decline. When an innovative drug enters the market, the price will often be high due to the improvement of quality, and pharmaceutical companies will adopt the strategy of skimming fat and gradually reduce the price.
Griliches and others reported that the market share of patented drugs generally decreased by about 50% after two years of patent period. Even though generic drugs and brand-name drugs with expired patents are the same in bioequivalence, doctors and most drug buyers have different attitudes and preferences towards these two kinds of drugs. Doctors like to prescribe brand-name drugs, and some patients are loyal customers of brands. Therefore, in price management, brand drugs and generic drugs that have passed the patent period should still be classified and managed.
Some countries allow pharmacists to use generic drugs instead of branded drugs when dispensing drugs in pharmacies, but the situation is different in different countries. In Australia, pharmacists do not need to inform doctors when using generic drugs, unless the prescriber indicates in the prescription that brand drugs cannot be replaced. In some provinces of Canada, doctors can't object to the compulsory substitution of generic drugs. Germany is the largest market for generic drugs in Europe, but the use of generic drugs is only allowed if the doctor indicates it on the prescription.
Due to the competition of Indian generic drug manufacturers and the influence of domestic drug policy, the prices of generic drugs and branded drugs in Europe are generally suppressed.
In addition, the prices of generic drugs vary greatly among European countries, which is not only related to the production and circulation costs, but also related to the different legislative environments of generic drug pricing and compensation in various countries. The prices of generic drugs in Britain, France, the Netherlands and Germany are higher than those in the Nordic countries. The prices of generic drugs in these countries are mainly set in the form of discounted returns in circulation, not necessarily through price competition.
It is reported that the wholesale price in France has a discount of 20% ~ 70%. In Britain, the maximum discount exceeds 50% of the drug tax. At present, France has stipulated the discount rate of circulation channels. European governments' intervention in drug prices is not as effective and transparent as the market price competition mechanism; The competition of generic drugs will also be affected by the reference price.
Pricing of innovative drugs
With the emergence of new drugs and the development of biotechnology, it is necessary to publicize the concept of "value" in order to make new products enter the market. The international trend is to develop the so-called "innovative pricing" concept, that is, to urge pharmaceutical companies and payers to reach the same understanding of value goals, so as to increase the accessibility of new treatment methods for patients and adopt different pricing indicators for drugs.
This pricing method is based on the cost of each patient and the price of each treatment. For example, in Italy, the financial risk sharing agreement is adopted for expensive cancer drugs, which urges pharmaceutical companies to invest more time and resources in drug production and reduce the risk in pricing. Especially when the traditional pricing and compensation negotiation mechanism breaks down and new drugs can't get compensation, this pricing method can help new drugs create an environment for competition with other brand drugs and generic drugs.
Innovative drug pricing methods need time and resources to explore, and small-scale trials can be carried out in relatively small countries, limited treatment populations and certain diseases; It also involves the laws of different countries, pricing procedures, the wishes of the masses and the government, and cultural influences. In the field of treatment, priority should be given to diseases that have not yet met the needs of clinical treatment.
The change of drug price is influenced by the quality, efficacy, safety, convenience and competitiveness of generic drugs. Berndt and others used the method of hedonic regression equation to study the pricing of drugs.
Price negotiation (price negotiation)
Negotiation pricing is a new development direction in recent years, mainly aiming at the prices of newly listed patented drugs, medical devices and vaccines. The application of expensive new technology is a challenge to pricing, so the government and pharmaceutical companies conduct effective price negotiations to reduce the price of new drugs produced by new technology. In order to make the government in a very strong and bargaining position, the government needs to grasp reliable information, including the cost of producing drugs, the pricing and quality of other generic drugs, and the prices, bidding and procurement and drug registration in other countries.
From the international experience, the Indian government set up a price negotiation committee in 2007, which is composed of doctors, pharmaceutical factory representatives and medical experts.
India's Ministry of Health and Family Welfare has developed a negotiation model. According to the international reference price system and the lowest price in the international market, 10 kinds of cancer drugs sold in India were negotiated. One negotiation is to determine the market price, and the other is to determine the prescription price of public hospitals. Usually the latter is 40% ~ 70% lower than the former. On the other hand, Brazil has a compulsory licensing system. For example, the annual price of generic drug efavirenz (produced by Merck) paid to AIDS patients is set at $65,438+$065, which is cheaper than the price negotiated with Merck ($580).
Negotiating the price of AIDS drugs can obviously save the cost of treatment, which can save about $25 million a year. Since 1997, Italy has been negotiating the price of all new drugs. Pharmaceutical companies can freely set prices and set different prices for different hospitals through negotiations without government intervention. In the Netherlands, local governments have the responsibility to negotiate prices with pharmaceutical companies. Prescription drug price negotiation is also used in American medical insurance and veterans insurance programs.
Consultation mechanisms can be divided into three categories:
The first category is the financial utilization model. The price-quantity agreement discussed earlier is the embodiment of this model. After reaching the market share target, pharmaceutical companies can give kickbacks.
The second category is the result-based pricing model, which adopts different compensation prices according to the response and results of treatment. Actually, it is performance pricing.
The third is a risk-based pricing model, which adopts different compensation prices according to the patient's treatment indications, treatment history and risk factors.
The government (or the third party pays) signs a risk-sharing agreement with the pharmaceutical factory. According to the principle of performance-based payment in economics, the cost of medicine can only be paid if the treatment is effective, so there are certain risks in pharmaceutical companies. It plays a signal role for pharmaceutical companies. In the long run, it can encourage pharmaceutical companies to invest in the future and develop safer, more effective and high-quality new drugs. This method has some defects, that is, the judgment of the payer and the provider on the treatment result is often different.
There are many factors that affect the price negotiation, such as the profits of pharmaceutical companies (such as Britain), the influence of drug prices and budgets in other countries, whether there are similar products in the market, sales volume and specifications, competition, etc., which have a great influence on the price negotiation.
In France, the application materials of pharmacoeconomics can help new drugs to set higher prices in the price negotiation process. In the negotiation of pricing and compensation in Spain, it is necessary to consider the budget impact, and forecasting the future sales volume is also a factor that affects the final decision. In short, we should jointly take various ways to reduce the price of drugs, such as batch bidding, price negotiation and compulsory licensing. So as to obtain a fair drug price.