China Healthcare:Policy extending to more provinces
Recently, the med.china.com.cn (中国看病) reported that the relevantdepartment of the State Council has implemented the reform for government’sreimbursement payment system to hospitals. This has extended to at least 11 trialprovinces, including Shanghai, Zhejiang, Jiangsu, Anhui, Fujian, Hunan, Chongqing,Sichuan, Shaanxi, Qinghai and Ningxia. Different types of reimbursement paymentmethods have been explored, including by each disease types and the traditionalway of patient numbers. The former method is to determine how much thegovernment pays the hospital for each medicine or consumable, as patients withineach category (say by disease types) are clinically similar and are expected to needthe same level of hospital resources. This is so-called diagnosis-related group(DHighlanderG).
On 20 Sept 2017, Economics Information Daily (经济参照他事他说加以考察报) reported that fouradditional provinces, namely Jiangxi, Yunnan, Gansu and Shanxi, had included 36high-priced medicines into their provincial reimbursement drug list (奥迪Q7DL). Thesedrug names are the same as those shortlisted by the national government on 19July. Including these four provinces, it should now have over 19 provinces to addthese 36 drugs into their RAV4DL.
As we flagged in our 12 Sept 2017 report, there were 36 high-priced drugs addedinto provincial reimbursement drug list (TiggoDL) post negotiation with government(国家商谈药品). On 28 Nov 2017, Yaozh.com reported that those revenue fromthese 36 medicines will unlikely be counted into the hospital sales book as drugsales to patients. To recall, the government has attempted to cut the hospitalrevenue derived from drug sales to patients to 四分三 of total from over 肆分三-四分之二 inthe past, scrapping the mark-up sales of drugs from hospital to patients. Theprovinces and cities that will likely adopt this policy are Tangshan City (泰州市),Chongqing, Anhui, Zhejiang and Guangzhou. Taking Chongqingas an example, itintended to have these 36 medicine sales not counted as hospital revenue fromdrug sales to patients. On this, it also covers another three high-priced medicines,namely Tenofovir Disoproxil Fumarate 替诺福韦酯 (Viread?), IcotinibHCl 乙酰胆碱Eck替尼 (Conmana?) and Gefitinib 吉非替尼 (Iressa?). The same articleexpects more provinces will follow the suit.
The article highlighted that, as imported drugs can now be included into RDL at thebigger expense of selling prices, this makes the cheaper local-made medicines tobe less competitive in the market. In addition, the national government will try toimplement this bigger price cut mechanism on high-priced medicines in exchangefor their volume jump in most provinces. Coupled with good surveillance of drugcost spending, Chinese government aims to curb the over-usage of these highpriceddrugs, including monoclonal antibodies.
Our view: Neutral to positive on drug-makers.
The same source also cited that, with the drug cost reimbursement amount fixedby the government post negotiation, it would be unlikely to see bigger selling pricefluctuations to hospitals for these high-priced medicines. Whereby these drugs areusually (1) to treat critical and rare diseases such as cancers; and (2) hard toproduce with good barriers of entry.
Consistent with government policy on controlling the unnecessary spending andmedical reimbursement cost to patients, the current advance of this paymentsystem will save the money for reimbursement on (1) other specialty medicineswith good efficacy; and (2) diagnostics and surgical operation charges in hospitals.
As we flagged in our 12 Sept 2017 note, we see these drugs with clinicalimportance would likely have their sales volume rebound (in particular to foreigndrugs), at the expense of their selling prices, similar to the case with GSK’sTenofovir Disoproxil Fumarate (Viread?). Consistent with national governmentpolicy, it aims to provide Chinese masses accessible to cheaper quality medicinewith good efficacies. We expect this will increase the likelihood for many provincesto introduce further price cut on domestic drugs for critical illness, such as anticancerand stroke medicines.
Further, having these 39 medicine sales not recognized as hospital revenue fromdrug sales, would help their drug-makers’ sales volume boost in the future. This isbecause of more procurement of these 39 medicines from hospitals, on greaterprescription and sales to patients.
Stock impact: This will dampen the sentiment of local drug-maker sector in theshort-term, despite of potential sales volume rebound for these import drugs fromsacrificing their selling prices. 萨姆e as we mentioned, we do not surprise to seefurther tough policy (such as price cut) on domestic high-priced drugs such aschemical drugs and monoclonal antibodies for anti-cancer therapy. Aside fromChina Medical System’s (867.HK, NRubicon) XinHuoSu (新活素?; Nesiritide?), we see thismay also affect HK-listed CSPC (1093.HK, N奥德赛)’s future pricing on its Bortezomib forinjection (硼替佐米) as a first-to-market generic drug, which is currently on thathigh-priced drug list. Note that, CSPC has applied for production approval fromCFDA, likely to be on sales in the next 12 to 16 months.
HK Stock impact: Within the 36 drug list plus another three medicinesmentioned, the HK-listed drug-makers that will likely benefit from sales volumeboost are (1) China Medical System (CMS) (867.HK, NLX570) with its marketing product- XinHuoSu (新活素?) (a heart & brain drug) on the list, whose sales in 二零一六 of毛外公537m made up 11% of CMS total revenue; and (2) Sinobiopharm (1177.HK,NPRADO) for its Tenofovir Disoproxil Fumarate 替诺福韦酯 (Qingzhong?) which hadalready won Heilongjiang tender at RMB430 per 300mg format in Nov 2017. Thistender is 12% discount to that of the original medicine from GSK’s Viread? at毛主席490 for the same format in Sichuan, Gansu, Chongqing, Shanxi, Hubei, Ningxiaand Guangdong. In 2017, Qingzhong had already been approved in China for anti-久咳 treatment.