辉瑞谈崩后，替代品来了
大包王朝编者按：
大包王朝转发这篇文章，不代表认同这篇文章的全部观点。
转发这篇文章的原因：
1、是中国网警将此文删除了
2、是此文可能是网络流行语“不是辉瑞这药不值这个价钱，是你不值这个价钱”的原始出处。
3、大包王朝修改了文中的四个字，将原文的“中国台湾，香港地区”修改为“台湾，香港”。
小文
“不是辉瑞不值，是你不值。”
这话扎心但却非常有道理，毕竟，在一个急需药品救命的时刻，大家希望辉瑞Paxlovid进医保，不仅是或者说不是想着这个药能降价，而是希望进了医保之后，这个药的供应能够得到保障，重症风险高的人能及时用上。
纵使阿兹夫定和清肺排毒颗粒谈成了，从进一步刻意强调涉及新冠还有600多个药物在医保名录就能看出，比起Paxlovid这两种药的分量还是轻了一些。
价格太高谈崩了，到底是现行的1890元还是600多元，保密协议的存在让我们无法真正得到一个底数，不过，就像媒体引述的辉瑞CEO艾伯乐原话所称：“中国是世界上第二大经济体，我认为他们付的价格不应该低于萨尔瓦多。”在他看来，中国所要求的价格低于辉瑞向大多数中低收入国家的开价是不可接受的。
说实话，辉瑞谈崩了不算啥事，你可以说这是救命，也可以说是生意，就算是救命作为药商的辉瑞似乎也没有道义把价格降到买家希望的水准，那样的话也不需要谈判了，直接给一张空白支票让买家自己填就行了。从北京到南京，买的没有卖的精，这话绝对是亘古不变的道理，古今中外概莫能外。
生意没做成，辉瑞还顺带摆出萨尔瓦多恶心人就有点不厚道了，要知道，这个中南美洲国家前几年刚刚与我们建交，世界货币基金组织披露的该国2021年GDP世界排名是101位，排在尼泊尔、柬埔寨等国之后。人均GDP差异就更能显示两国差异了，中国为12556美元，排名全球第22位，萨尔瓦多仅为4408.5美元，别说在全球，就是在美洲大陆也是后几名。
辉瑞CEO以这样一个小国为例，你说他无非是想说中国应当为Paxlovid支付高价也好，是想证明辉瑞就值这个价格也好，不同立场的人可能存在着不同解读。唯一可以确认的是，未来一段时间，只能在医保体系之外销售的辉瑞Paxlovid可能还会持续处于紧缺状态，一药难求。
1890元一盒的辉瑞Paxlovid，无论是贵还是便宜，似乎不能抛开现实疗效去谈，梳理香港数据可以发现，80岁以上的未接种疫苗老年群体，感染后病死率达到14%，用Paxlovid保守一些估计降低80%病死风险。100个80岁以上未接种疫苗的老人感染，不用Paxlovid死亡14人，用了死亡大概是3人，救下来的这11条人命，就是给这100个疗程Paxlovid定价时可以参考的价值。
另外，对于打过疫苗的老年群体而言，Paxlovid至少能把感染者的住院风险降低了六七成，无论是单纯从医疗挤兑还是节省医保开支的角度而言，似乎也应该是讨论Paxlovid定价时需要考量的因素。
当然，在谈崩了之后，更贱的替代品也来了，这就是在中国上市的第二款进口新冠小分子口服药，美国默沙东莫那比拉韦（Molnupiravir）在中国的首发报价已出炉，将以低于海外主要国家的价格——每瓶1500元人民币在国内销售。
1月10日，天津市医药采购中心通告显示，莫那比拉韦胶囊每瓶（40粒）首发报价是1500元，进口到岸价（不含税）介于1100 元和1200 元之间，而在美国、日本、韩国等主要国家是712美元（约合人民币4800元）。
也就是说，莫那比拉韦胶囊在中国的报价，不仅是主要国家的1/3，亦低于辉瑞Paxlovid在上海等地的临时医保支付价1890元/盒。
虽说Paxlovid和莫那比拉韦胶囊这两款获准的药物都是用于若染疫可能恶化为重症的高风险患者，并在出现染疫症状后3天至5天内服用，但Paxlovid可降低住院或死亡风险高达89%和88%，而莫那比拉韦只能降低30%至50%的住院风险，并可降低89%至100%的死亡风险。
基于药效因素考量，作为替代品出现的莫那比拉韦到底能比辉瑞Paxlovid便宜多少钱，具有数学计算能力的网友可以计算一番，在这里就不赘言了。
只是想多说一句，网络上流传的Paxlovid公开采购价来看，美国政府的采购价为每盒529美元，欧洲国家采购价为每盒600美元-700美元，台湾、香港采购价每盒700美元左右。对于根据各国收入水平定价的辉瑞而言，可能在中国市场的价格已经趋近于较低水准。
至于大家喜欢用的那句美国有“特效药”怎么还死了100多万来佐证辉瑞药效，其实，这里面涉及一个时间线问题，Paxlovid是2022年才批量进入市场销售的，在这之前，美国因新冠死亡人数已经达到85万余人。在奥密克戎流行期间，Paxlovid有效降低了至少一半以上的死亡人数。
当然，有些时候可能并不是钱的事，如果我们只把目光锁定在价格和拯救生命上，就显得过于肤浅和天真了。
发布于 2023-01-11 23:40・IP 属地山东
Dabao Dynasty Editor’s Note:
Reposting this article by Dabao Dynasty does not mean agreeing with the viewpoint of this article.
Reasons for forwarding this article:
1. It was the Chinese internet police who deleted this article
2. This article may be the original source of the Internet catchphrase “It’s not that Pfizer’s drug is not worth the price, it’s that you are not worth the price”.
3. The Dabao Dynasty modified four words in the text, and changed the original text “Taiwan, Hong Kong” to “Taiwan, Hong Kong”.
Xiaowen
“It’s not that Pfizer is worthless, it’s that you are worthless.”
These words are heart-wrenching but very reasonable. After all, at a moment when medicines are urgently needed to save lives, everyone hopes that Pfizer Paxlovid will enter the medical insurance. The supply can be guaranteed, and people at high risk of severe illness can use it in time.
Even if Azvudine and Qingfei Paidu Granules are negotiated, it can be seen from further deliberately emphasizing that more than 600 drugs related to the new crown are on the medical insurance list, and the weight of these two drugs is still lighter than Paxlovid.
The price is too high to talk about. Is it the current 1890 yuan or 600 yuan? The existence of the confidentiality agreement prevents us from getting a real bottom line. However, as the original words of Pfizer CEO Aberle quoted by the media said: “China is the world’s largest The second largest economy, I don’t think they should pay less than El Salvador.” In his view, it is unacceptable for China to ask for a price that is lower than what Pfizer offers to most low- and middle-income countries.
To be honest, it’s not a big deal that Pfizer’s talks collapsed. You can say it’s life-saving, or it’s business. No need to negotiate, just give the buyer a blank check and let the buyer fill it out. From Beijing to Nanjing, what you buy is not as good as what you sell. This is an eternal truth, and there is no exception in ancient and modern China and foreign countries.
The business didn’t work out, and it’s a bit unkind for Pfizer to show the disgusting people in El Salvador. You know, this Central and South American country just established diplomatic relations with us a few years ago. The World Monetary Fund’s 2021 GDP ranking of the country is 101. , after Nepal, Cambodia and other countries. The difference in per capita GDP can even more show the difference between the two countries. China is 12,556 US dollars, ranking 22nd in the world, and El Salvador is only 4,408.5 US dollars. Let alone in the world, even in the American continent, it is also the last few.
The CEO of Pfizer took such a small country as an example. You said that he just wanted to say that China should pay a high price for Paxlovid, or to prove that Pfizer is worth the price. People with different positions may have different interpretations. The only thing that can be confirmed is that Pfizer Paxlovid, which can only be sold outside the medical insurance system, may continue to be in short supply for a period of time in the future, making it hard to find a drug.
A box of Pfizer Paxlovid at 1,890 yuan, whether it is expensive or cheap, seems to be impossible to talk about the actual efficacy. After combing the data in Hong Kong, it can be found that the case fatality rate of the unvaccinated elderly group over the age of 80 reaches 14%, and Paxlovid is used conservatively. Some estimates reduce the risk of death by 80%. If 100 unvaccinated people over the age of 80 were infected, 14 people died without Paxlovid, and about 3 people died with Paxlovid. The 11 lives saved are the value that can be referenced when pricing the 100 courses of Paxlovid.
In addition, for the elderly group who have been vaccinated, Paxlovid can at least reduce the risk of hospitalization of infected people by 60 to 70%. Whether it is purely from the perspective of medical run or saving medical insurance expenses, it seems that it should be the time to discuss Paxlovid pricing. Factors to consider.
Of course, after the talks collapsed, cheaper alternatives also came. This is the second imported small-molecule oral drug for the new crown launched in China. The first quotation of Molnupiravir (Molnupiravir) in China has been released. , will be sold in China at a price lower than that of major overseas countries – 1,500 yuan per bottle.
On January 10, Tianjin Pharmaceutical Purchasing Center announced that the initial quotation of monabigravir capsules (40 capsules) was 1,500 yuan, and the CIF import price (excluding tax) was between 1,100 yuan and 1,200 yuan. In major countries such as the United States, Japan, and South Korea, it is 712 US dollars (about 4,800 yuan).
In other words, the quotation of Monabigravir capsules in China is not only 1/3 of that of major countries, but also lower than the temporary medical insurance payment price of Pfizer Paxlovid in Shanghai and other places of 1890 yuan/box.
Although the two approved drugs, Paxlovid and Monabigravir Capsules, are used for high-risk patients who may develop severe disease if infected, and are taken within 3 to 5 days after the onset of symptoms, Paxlovid can reduce hospitalization. Or the risk of death is as high as 89% and 88%, while monabigravir can only reduce the risk of hospitalization by 30% to 50%, and can reduce the risk of death by 89% to 100%.
Based on the consideration of pharmacodynamic factors, how much cheaper Monabigravir, which appears as a substitute, can be compared with Pfizer Paxlovid, netizens with mathematical computing skills can calculate it, so I won’t go into details here.
I just want to say something more. According to the public purchase price of Paxlovid circulating on the Internet, the purchase price of the US government is 529 US dollars per box, the purchase price of European countries is 600-700 US dollars per box, and the purchase price of Taiwan and Hong Kong is 700 US dollars per box. about. For Pfizer, which is priced according to the income level of each country, the price in the Chinese market may have already approached a lower level.
As for the phrase that everyone likes to use in the United States, how can more than 1 million people die to prove the efficacy of Pfizer’s drug? In fact, this involves a timeline issue. Paxlovid will only enter the market in batches in 2022. Before that , The death toll in the United States due to the new crown has reached more than 850,000. During the Omicron epidemic, Paxlovid effectively reduced the number of deaths by at least half.
Of course, sometimes money may not be a matter. If we only focus on price and saving lives, it will be too superficial and naive.
Published on 2023-01-11 23:40・IP belongs to Shandong