健保制度藥價政策對藥業競爭的影響

Abstract

我國的健保制度涵蓋99%的民眾，其給付制度與資源分配，特別是藥價政策，勢必影響整體藥品市場的發展。本文從賽局理論與波特鑽石模型分析的角度切入，並以次級資料分析與個案模擬方式，探討健保制度下的學名藥藥價政策對整體藥業競爭以及我國本土藥廠競爭力的影響。 本研究認為我國學名藥產業無論在資源與才能要素、需求條件、關聯和輔助性行業以及戰略、結構和競爭企業四個面向應有不錯的競爭體質與機會點。但因為政府的藥品價格政策對學名藥廠的決策過程造成扭轉競爭策略的影響，進而削減我國學名藥產業的總體競爭力，並造成各方利害關係人 (政府、民眾、藥廠、醫療體系) 長期的不利影響。 根據研究結論，本研究建議政府制定與執行產業政策時，應考慮全面性的影響，學名藥藥價政策的初始目的是以藥價補貼的方式意圖扶植學名藥產業。但本文發現該政策反而造成健保整體資源配置的浪費及扭曲學名藥產業競爭策略，最終逼迫學名藥產業無利可圖，必須出走才能找尋生機。另外政府在扶植學名藥產業的同時，也應考慮藥品的高度專業性產生的資訊不對稱問題，以及其衍伸對民眾用藥權益及健康照護的影響。 對藥品產業而言，由於藥品市場的高度專業管制特性，以及對國民的健康福祉的影響，藥品市場的競爭(特別是學名藥的競爭)，應該在價格與品質之間取得平衡。考量中國與印度對於成本與價格的競爭優勢，我國學名藥廠若要在國際競爭，應多強調在品質、研發創新與利基型產品的競爭。 本土學名藥產業或許在台灣的削價競爭可以在短期拓展市佔率，但長遠而言不但無法達到整體營收成長的目的，反而在強調品質把關的藥品市場中，削減品質與研發創新等其他重要的成長動能，進而影響其國際市場競爭力與良好的商譽。 對原廠而言，由於近年來國際原廠藥廠的研發動能趨緩，許多暢銷產品面對專利懸崖的困境，加上國際藥價的參考制度，都讓國際原廠對於旗下產品生命週期的經營與全球布局採取更為嚴格與保守的策略。若我國持續採取低價新藥給付以及過專利期大幅削減原廠藥價的方式，原廠可能被迫採取延緩新藥在台上市，或是提前撤出市場及削減在台投資等方式因應。

Taiwan national health insurance (NHI) system cover 99% of population. Its reimbursement system and resource allocation, especially pricing policy, will hugely impact total pharmaceutical market development. This thesis will deploy game theory and Porter diamond model, together with secondary data analysis and case simulation process, to investigate how NHI generic pricing policy change pharmaceutical market competition and the competitive advantage / disadvantage of local generic. This thesis hold the opinion that Taiwan local generic should have good competitive advantage and opportunities in terms of Porter’s four dimensions – “resource and talent (firm) conditions”, “demand conditions”, “related and supporting industries” and “firm strategy, structure and rivalry”. However, our government pricing policy changed generic competitive strategies and weaken generic competitiveness, which lead to long term negative impact to various stakeholders (government, people, pharmaceutical companies and healthcare providers). Based on research conclusion, it is suggested that government should consider overall impact when develop and implement industry policies. The original purpose of generic pricing policy is to support local generic through subsidy; however, it result in overall NHI resource waste and twist generic competitive strategy, and forced generic out of Taiwan to pursue other opportunities due to lack of profit locally. In addition, government should also consider information asymmetry under drug professionalism and protect related patient right and healthcare problems when support local generic. With respect to pharmaceutical industry, considering highly regulated environment and patients’ welfare, the market competition (especially in generic market) should find the balance between price and quality. Since China and India have cost advantage, Taiwan generic industry can focus on quality, innovative and niche product when enter into global market. Local generic may quickly grab market share through price competition in short term, but it may not sustain profit in the long run. Furthermore, it will compromise the investment in quality improvement and innovation, and jeopardize the reputation in global market, which highlight quality control. International R&D companies recently take more conservative and stricter approaches in product lifecycle management and global strategy due to slow down R&D progress, patent cliff threat and international price reference system,. If Taiwan government continues lowering new drug price and seriously cutting off-patented products to the originators, R&D companies may be forced to delay launching new product in Taiwan, to withdraw from the market or to decrease its overall investment in Taiwan.