取消药品加成后,为何便宜的国产仿制药仍不受青睐?

2018-05-10 张广有 毕雪立 医师报

近日央视《焦点访谈》节目关注国产仿制药遭遇的区别对待现象。 我国是仿制药生产大国,近5000家制药企业,99%都是仿制药企业,近17万个药品批文,95%以上都是仿制药。但令人尴尬的是,虽然有些进口原研药,我们已经有了可替代的仿制药。但是出于安全性考虑,在临床中,医生还是更愿意使用上市时间长、疗效确切的专利药,如果患者经济条件允许,大多数也会选择专利药。


近日央视《焦点访谈》节目关注国产仿制药遭遇的区别对待现象。

我国是仿制药生产大国,近5000家制药企业,99%都是仿制药企业,近17万个药品批文,95%以上都是仿制药。但令人尴尬的是,虽然有些进口原研药,我们已经有了可替代的仿制药。但是出于安全性考虑,在临床中,医生还是更愿意使用上市时间长、疗效确切的专利药,如果患者经济条件允许,大多数也会选择专利药。

“据国家癌症中心公布的数据,原研药吉非替尼已经进入我国1200多家医院,而国产吉非替尼仅仅进入我国200多家医院。”《焦点访谈》中,齐鲁制药集团副总裁徐元玲谈起仿制药如今在国内市场的使用,不免感慨。

药占比的区别对待

质量与原研产品一致,价格还要便宜三分之一,数量巨大的患者在迫切等待——但医院却宁愿选择更贵的原研药,其背后的直接原因只是三个字:药占比。2016年5月20日,原国家卫计委公布了《关于公布国家药品价格谈判结果的通知》,三个最终入围国家药品价格谈判的品种中,就有由阿斯利康生产的吉非替尼原研产品易瑞沙。根据当时的文件规定,各地在2016年2017年的采购周期内,对三个国家药品价格谈判品种将不再另行组织谈判议价,且鼓励优先采购和使用谈判药品。

从宏观上看,这当然是一件好事。但由于纳入药品价格谈判的品种绝大多数都是跨国药企的原研品种,且各地在执行将谈判药品不纳入药占比的政策时,并非以药品的通用名为标准,而是以具体的商品名为标准,这就使得日后相应产品的仿制药在进入市场与其竞争时,直接面临着巨大的医院准入难题。

目前,关于药占比的把控仍呈趋严之势。在这种情况下,哪些品种不纳入药占比,自然会得到绝对的市场空间。而作为这些品种的竞品,即便药物经济学表现再优异,恐怕也难以在“不占药占比”这一政策面前占到任何优势。

仿制药企待闯三关

在政策红利下,中国仿制药行业的真正崛起还需要过三关:供应关、质量关、产权关。但实际上从齐鲁制药吉非替尼首仿药当下的市场困局就可以看出,除了上述三关必须要闯过之外,还有三关更现实一些,即准入关、使用关、报销关。

“药品从企业出来到医院再到患者的使用要经过诸多的环节,首先要通过各省的集中药品采购,中标进入目录后才能够有资格进入医院。此外进入医院还必须要通过药事委员会许可。”齐鲁制药集团副总裁徐元玲表示。

但实际上,如今的仿制药概念已经发生了变化,仿制药不等于价廉质次,也不是山寨药,高质量的仿制药也绝对不是简单地把原研药拿来复制、粘贴,因此在医保报销层面,将仿制药也纳入同样报销标准的呼声近年来也日益强烈。

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  2. [GetPortalCommentsPageByObjectIdResponse(id=1681767, encodeId=7b511681e670d, content=<a href='/topic/show?id=11258e373b8' target=_blank style='color:#2F92EE;'>#药品加成#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=87373, encryptionId=11258e373b8, topicName=药品加成)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b8e927859734, createdName=longerg, createdTime=Tue Dec 25 06:43:00 CST 2018, time=2018-12-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1261411, encodeId=dade1261411b9, content=<a href='/topic/show?id=b56025592eb' target=_blank style='color:#2F92EE;'>#仿制药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=25592, encryptionId=b56025592eb, topicName=仿制药)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=08e964, createdName=drwjr, createdTime=Sat May 12 13:43:00 CST 2018, time=2018-05-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=313943, encodeId=864e313943de, content=关键是药品的质量和剂量不过关., beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Thu May 10 23:58:10 CST 2018, time=2018-05-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=313928, encodeId=60033139281e, content=学习了.谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/10/23/557c1f19aaf5459a8405411e38903c4b.jpg, createdBy=dfc02088287, createdName=cscdliu, createdTime=Thu May 10 23:02:40 CST 2018, time=2018-05-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=313919, encodeId=631531391911, content=有差距, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/30/21f1f0d02514796066d52523c747be51.jpg, createdBy=75a31960463, createdName=zdvfsadb, createdTime=Thu May 10 22:52:30 CST 2018, time=2018-05-10, status=1, ipAttribution=)]
    2018-05-12 drwjr
  3. [GetPortalCommentsPageByObjectIdResponse(id=1681767, encodeId=7b511681e670d, content=<a href='/topic/show?id=11258e373b8' target=_blank style='color:#2F92EE;'>#药品加成#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=87373, encryptionId=11258e373b8, topicName=药品加成)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b8e927859734, createdName=longerg, createdTime=Tue Dec 25 06:43:00 CST 2018, time=2018-12-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1261411, encodeId=dade1261411b9, content=<a href='/topic/show?id=b56025592eb' target=_blank style='color:#2F92EE;'>#仿制药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=25592, encryptionId=b56025592eb, topicName=仿制药)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=08e964, createdName=drwjr, createdTime=Sat May 12 13:43:00 CST 2018, time=2018-05-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=313943, encodeId=864e313943de, content=关键是药品的质量和剂量不过关., beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Thu May 10 23:58:10 CST 2018, time=2018-05-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=313928, encodeId=60033139281e, content=学习了.谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/10/23/557c1f19aaf5459a8405411e38903c4b.jpg, createdBy=dfc02088287, createdName=cscdliu, createdTime=Thu May 10 23:02:40 CST 2018, time=2018-05-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=313919, encodeId=631531391911, content=有差距, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/30/21f1f0d02514796066d52523c747be51.jpg, createdBy=75a31960463, createdName=zdvfsadb, createdTime=Thu May 10 22:52:30 CST 2018, time=2018-05-10, status=1, ipAttribution=)]
    2018-05-10 1e0f8808m18(暂无匿称)

    关键是药品的质量和剂量不过关.

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1681767, encodeId=7b511681e670d, content=<a href='/topic/show?id=11258e373b8' target=_blank style='color:#2F92EE;'>#药品加成#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=87373, encryptionId=11258e373b8, topicName=药品加成)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b8e927859734, createdName=longerg, createdTime=Tue Dec 25 06:43:00 CST 2018, time=2018-12-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1261411, encodeId=dade1261411b9, content=<a href='/topic/show?id=b56025592eb' target=_blank style='color:#2F92EE;'>#仿制药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=25592, encryptionId=b56025592eb, topicName=仿制药)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=08e964, createdName=drwjr, createdTime=Sat May 12 13:43:00 CST 2018, time=2018-05-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=313943, encodeId=864e313943de, content=关键是药品的质量和剂量不过关., beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Thu May 10 23:58:10 CST 2018, time=2018-05-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=313928, encodeId=60033139281e, content=学习了.谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/10/23/557c1f19aaf5459a8405411e38903c4b.jpg, createdBy=dfc02088287, createdName=cscdliu, createdTime=Thu May 10 23:02:40 CST 2018, time=2018-05-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=313919, encodeId=631531391911, content=有差距, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/30/21f1f0d02514796066d52523c747be51.jpg, createdBy=75a31960463, createdName=zdvfsadb, createdTime=Thu May 10 22:52:30 CST 2018, time=2018-05-10, status=1, ipAttribution=)]
    2018-05-10 cscdliu

    学习了.谢谢

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1681767, encodeId=7b511681e670d, content=<a href='/topic/show?id=11258e373b8' target=_blank style='color:#2F92EE;'>#药品加成#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=87373, encryptionId=11258e373b8, topicName=药品加成)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b8e927859734, createdName=longerg, createdTime=Tue Dec 25 06:43:00 CST 2018, time=2018-12-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1261411, encodeId=dade1261411b9, content=<a href='/topic/show?id=b56025592eb' target=_blank style='color:#2F92EE;'>#仿制药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=25592, encryptionId=b56025592eb, topicName=仿制药)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=08e964, createdName=drwjr, createdTime=Sat May 12 13:43:00 CST 2018, time=2018-05-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=313943, encodeId=864e313943de, content=关键是药品的质量和剂量不过关., beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Thu May 10 23:58:10 CST 2018, time=2018-05-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=313928, encodeId=60033139281e, content=学习了.谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/10/23/557c1f19aaf5459a8405411e38903c4b.jpg, createdBy=dfc02088287, createdName=cscdliu, createdTime=Thu May 10 23:02:40 CST 2018, time=2018-05-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=313919, encodeId=631531391911, content=有差距, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/30/21f1f0d02514796066d52523c747be51.jpg, createdBy=75a31960463, createdName=zdvfsadb, createdTime=Thu May 10 22:52:30 CST 2018, time=2018-05-10, status=1, ipAttribution=)]
    2018-05-10 zdvfsadb

    有差距

    0

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