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辅助用药目录制定 中药注射剂再评价启动 谁哭谁笑?

原作者: 梁建 |原发: 新浪医药新闻

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作为最具中国特色的中药注射剂最近一段时间一直处于处于风口浪尖之上。建国后,由于缺医少药,疾病肆虐,中药注射剂就在这种情况下应运而生,在上个世纪六七十年代,中药注射剂快速发展,到了上世纪八十年代,已经研发出1400多种中药注射剂。


但是自2015年起,有47个中药注射液被限、被要求修改说明书或临床使用限制。在这份名单里,许多“明星药”赫然在列:清开灵注射液、参麦注射剂、丹参注射剂、双黄连注射剂、香丹注射剂、血塞通注射剂、脉络宁注射剂、舒血宁注射剂、生脉注射剂和黄芪注射液、柴胡注射液。


除此之外,国家版辅助用药目录的制定和中药注射剂再评价的启动都清晰表明了官方在此问题的态度,那就是作为具有一定历史因素的产物,中药注射剂目前已经不适应当今时代的需要,在可预期的未来中药注射剂的使用限制将会越来越大,所以对于中药注射剂企业来说,未来一段时间内不管是被迫还是主动都将面临行业洗牌的前景。


中药注射剂生产企业瑟瑟发抖


对于国内的中药注射剂生产企业而言,排名最靠前的企业是在港股上市的神威药业,作为行业老大,神威药业的注射剂业务同样不好过。根据5月3日神威药业发布的今年第一季度营业额数据显示,在第一季度,神威的注射液产品的营业额减少21.4%,且神威并未在公告中披露营业额减少的原因。


实际上,目前神威生产的包括清开灵、参麦及舒血灵注射液在内的26个中药注射液产品已经被要求在二级或以上医疗机构于指定的治疗用途下使用才能报销。这或许是影响神威药业中药注射剂业绩的重要原因。


而对于其他中药注射剂企业而言其日子同样不好过,最近经常搏得媒体版面的步长制药亦是中药注射剂大户,而且亦就中药注射剂问题收到了上交所的问询函。


步长制药5月12日晚间公告称,收到上交所对公司2018年年度报告的事后审核问询函,问询函聚焦于公司核心产品中药注射剂等相关产品的产销量、收入、毛利率、疗效、是否存在媒体报道的不良反应或质量问题等13个方面的问题。


上交所在问询函中指出,近年来中药注射剂面临医保受限、辅助用药重点监控、注射剂上市后再评价等政策方面的挑战。步长制药2018年年报显示,步长制药主要产品丹红注射液的全年销售量、医疗机构实际采购量均出现明显下降,但公司并未在年报中揭示相关风险。


问询函一经公布,步长制药第二日股价跌幅达8.72%。收于每股24.69元。使得本就处于风口浪尖的步长制药更加雪上加霜。


根据去年年报显示,在2018年,步长制药实现营收136.65亿元,同比下降1.44%,其中由其拥有独家专利的丹红注射液累计销售超过9600万支,遥遥领先于步长制药的其他产品。而在步长制药上市前披露的招股书中则显示,在2013年至2015年间,丹红注射液累计销售额达113.5亿,贡献了超过30%的收入和40%的利润。


但是另一方面,步长制药的丹红注射剂又被多地限制使用,根据梳理,目前丹红注射液已经至少在11个省(市)26次被预警(严格监控)、限制使用,甚至随时面临停用风险。


可能同样是出于对中药注射剂的前景感到悲观,而步长制药本身亦减少了丹红注射剂的研发费用,年报显示,2018年=步长制药投入在丹红注射液上的研发费用为2683.01万元,同比下降26.33%。


辅助用药目录和中药注射剂再评价双管齐下


此前在新浪医药发布的关于中药注射剂的文章中有不少读者都表达了中药注射剂有效性的质疑,更有激烈者要求有关部门彻底禁止中药注射剂的生产、销售和使用。事实上,当然不能否定中药注射剂在我国的特殊历史时期起到的重要的作用,但是目前我国一些基层医院对于中药注射剂的使用泛滥问题已经到了非解决不可的地步。


根据国家药品不良反应监测中心发布的《国家药品不良反应监测年度报告(2017年)》显示,2017年中药不良反应/事件报告中,注射剂和口服制剂所占比例分别是54.6%和37.6%;2017年中药严重不良反应/事件报告按照给药途径分布,静脉注射给药占84.1%。也许正如上述读者所言,中药注射剂的历史使命确实应该结束了。


目前国家解决中药注射剂泛滥的一个重要举措是制定国家版辅助用药目录,但是,也必须认识到的是,中药注射剂作为共和国成立后长期使用的制剂,可以肯定的是,在制定国家版辅助用药目录过程中一定会遭受来自各方势力的干涉,尤其是一些中药注射剂生产企业还是某些地区的纳税大户,这也将影响到有关部门的决策。


实际上,最近就有一些生产企业通过一些行业媒体向有关部门喊话,提出辅助用药目录不应只是其唯一途径。企业方面认为,中药注射剂等泛滥的解决还需国家有部门制定临床药师使用细则等。


除了制定国家版辅助用药目录之外,中药注射剂再评价亦是加强我国中药注射剂监管的重要举措。4月9日,国家卫健委在官网发布《关于开展药品使用监测和临床综合评价工作的通知》。在这份通知中,卫健委明确指出,要求各级医疗卫生机构开展药品临床综合评价时,要充分利用药品使用监测数据,并将评价结果作为本单位药品采购目录制定、药品临床合理使用、提供药学服务、控制不合理药品费用支出等的重要依据。


可以说,这份通知的措辞明确把矛头指向了因滥用情况多发,造成医药卫生资源浪费,给患者带来严重的辅助用药。同时这份通知也为各家生产企业在国家版辅助用药制定之前打了一剂预防针,意味着在辅助用药中占据大头的中药注射剂也将迎来彻底洗牌的时刻。

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