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In recent years, pharmaceutical retail has entered the fast lane. Key turning points such as the gradual normalization of volume-based procurement of drugs and high-value consumables, the deepening of the coordinated reform of the three medical systems, the introduction of innovative drugs into medical insurance, and the rise of new retail have further accelerated the development and transformation of prescription drug retail.

However, the current performance of retail pharmacies is under pressure. According to data from industry organizations, in the first half of 2024, the average sales of retail pharmacies fell by 10.6% year-on-year, of which the average customer price fell by 8.9% year-on-year. Under the influence of the reduction of individual accounts and the economic downturn, consumers have become more cautious in spending.

Liu Qian, general manager of AstraZeneca China's Omni-channel Business Unit, said that the development of the retail market should be viewed objectively and rationally, and its important role in protecting people's health and meeting the diverse needs of consumers should be recognized.

Currently, there are 600 million to 700 million chronic disease patients in China. The industry generally believes that the current domestic chronic disease management compliance rate is lower than the international level. This is not because of poor treatment plans or the low level of development in the medical field, but because of the lack of a very effective chronic disease management network centered on general practice, outpatient care, and family and health management as a system.

"With the proposal and implementation of the 'hospital-store linkage' model, there will be new breakthroughs in chronic disease management, and it will also bring huge breakthroughs to the pharmaceutical retail industry. The so-called 'hospital-store linkage' model is to let hospitals guide retail pharmacies in chronic disease management, and the association will formulate operational procedures, technical specifications and other guidance for chronic disease management of out-of-hospital patients and provide them to retail pharmacies. At the same time, pharmaceutical companies will jointly support retail pharmacies in out-of-hospital management of patients." Liu Qian said.

As an important part of the national medical and health system, retail pharmacies are characterized by large number, wide coverage of the population, and strong convenience. They are the medical service outlets and basic medical insurance closest to patients. Faced with the growing gap in demand for chronic disease management, retail pharmacies have ushered in new opportunities for development and transformation.

Entering the field of chronic disease management

Hospitals have always been the leading channel for medical treatment, meeting almost all of patients' needs in the medical process, from diagnosis and treatment to prescriptions and repeat purchases. Offline pharmacies and online platforms only take on a small part of the outflow demand. There are still a large number of patients whose outpatient disease management needs have not been fully met, especially in the field of chronic diseases.

Currently, the prevalence of chronic diseases among Chinese residents is close to 40%, which means that about 600 million to 700 million Chinese people are suffering from different types of chronic diseases, and this health problem is showing a trend of becoming younger and more popular. The characteristics of chronic diseases are that their daily symptoms are not significant and non-acute, so the standardized management of chronic diseases is often neglected. However, chronic diseases can cause lesions in multiple systems and organs of the human body, accelerate the aging of the body, and may even cause serious consequences such as stroke, directly threatening life safety.

Many clinical experts introduced the current status of chronic disease management from the perspective of different diseases.

Professor Sun Ningling, chief physician of the Department of Cardiology at Peking University People's Hospital, said: "In China, the diagnosis rate of patients with hypertension is only 52%, the treatment rate is only 39%, and the treatment achievement rate is even lower. Since the symptoms of hypertension are not obvious, patients tend to reduce or stop medication on their own. It is also difficult for hospitals to monitor and follow up the blood pressure of every patient they see, making it difficult to adjust the treatment plan in a timely manner according to the patient's condition."

Professor Zeng Longyi, director of the Department of Endocrinology at the Third Affiliated Hospital of Sun Yat-sen University, pointed out: "According to a survey of type 2 diabetes patients in the Chinese community, up to 45.6% of patients have poor compliance with self-blood sugar monitoring. Long-term failure to meet blood sugar management standards can lead to complications such as uremia, diabetic foot, and retinopathy, affecting the quality of life of patients, and even leading to serious consequences such as amputation or blindness."

It is not difficult to find that in medical practice, patients' medical treatment is random, which makes it difficult for doctors to systematically track the long-term health data of chronic disease patients, and the time of patients' follow-up visits is often uncertain. At the same time, patients also have the problem of insufficient communication time, and it is difficult to fully consult doctors. In addition, the lack of medication habits and treatment compliance has jointly led to the low standardized treatment rate and compliance rate of chronic disease patients in China. Given the large size of the patient population, it is difficult to achieve comprehensive coverage of all chronic disease patient groups by relying solely on medical resources such as hospitals, community centers and township health centers.

Many clinical experts have stated that if retail pharmacies can provide professional medication guidance and long-term follow-up management after diagnosis in the hospital, and improve patient treatment compliance through collaboration within and outside the hospital, it will help patients delay the occurrence of complications and achieve better disease management results.

At present, the number of retail pharmacies in China has reached 660,000. Pharmacies are not only widely distributed in cities, but also in rural areas, forming a huge store network, which constitutes its significant advantage. At the same time, in addition to drug supply, retail pharmacies are showing unique value in out-of-hospital disease management services. For example, convenient services such as medical insurance payment, card consumption, and dual channels can all be realized in retail pharmacies, without the need for patients to make a special trip to the hospital. In addition, retail pharmacies not only provide a wide variety of drugs, but also cover a variety of health-related products such as medical devices, as well as health management consulting services, becoming a one-stop "light medical health service outlet."

However, retail pharmacies have shown uneven levels of chronic disease management services and lack of effective guidance. Therefore, given the heavy burden of chronic diseases and the extremely severe current situation, an innovative chronic disease management model is urgently needed.

Emphasis on "institute-store linkage"

At present, my country's health management community is actively promoting the transformation from traditional physical examinations to health management, and implementing the transformation from a "treatment-centered" to a "health-centered" model.

Professor Wang Zhanshan, member of the Standing Committee and Secretary-General of the Health Management Branch of the Chinese Medical Association and Secretary-General of the National Pilot Project for Innovation and Integration of Major Chronic Disease Prevention and Control, said: "In the face of increasingly complex chronic disease management needs, it is urgent to open up the resource sinking path of large-scale hospital health management center hospitals, including community hospitals, community retail pharmacies and functional communities, give full play to their respective advantages, and build a sustainable closed-loop management system with professional guidance provided by an expert team, output of health management service plans, implementation at the grassroots level, controllable quality and evaluable effects. Establish an advanced community mechanism and actively mobilize all sectors of society to participate in the promotion. This system will realize the interconnection and interoperability of disease management data, empower retail pharmacies with new functions, enhance the chronic disease health management capabilities of retail pharmacies, and build a solid health line of defense for the people."

Regarding the current difficulties in chronic disease management, Sun Ningling pointed out that from the perspective of cardiovascular disease, first, the prevalence is high and the patient group is unclear; secondly, patient compliance is very low, and many chronic diseases may have no symptoms, but patients often choose treatment only after they have symptoms, resulting in delayed treatment and increased medical burden; in addition, patients face limited education and have a relatively weak awareness of active health.

Zeng Longyi summarized the current difficulties in diabetes management with "three highs", "three lows" and "three no's". The so-called "three highs" refer to high incidence, high growth rate and high harm; "three lows" refer to low awareness, low treatment and low control rates; and "three no's" include not paying attention to lifestyle intervention, irregular medication and no monitoring. In addition, outpatient management still cannot meet the management needs of patients.

Professor Yin Genquan, deputy director of the Department of Pediatric Respiratory Medicine at Guangzhou Women and Children's Medical Center, pointed out: "Adults can be driven internally to manage their diseases, but children need external forces to drive them. For children with respiratory diseases, the disease not only causes breathing problems, but in severe cases it may hinder their normal growth and development. At the same time, the parents of the children also bear the economic and time pressures brought by diagnosis and treatment."

In recent years, with the continuous advancement of tiered diagnosis and treatment, and the introduction of a series of policies such as allowing the outflow of long-term prescriptions for chronic diseases, the concentration and standardization of the pharmaceutical retail industry are rapidly increasing. If we can promote effective linkage between pharmacies and hospitals and allow pharmacy resources to assist hospitals in managing patients, especially for those patients who have suspended treatment, guide them to re-accept monitoring and go to the hospital for regular follow-up and reexaminations, it will help with patients' health management.

"We advocate close integration between hospitals and pharmacies, and invite authoritative hospital institutions to participate in key links such as guidance, assessment, training, licensing and monitoring, to ensure that pharmacy staff can provide standardized and professional services to patients after receiving sufficient training. At the same time, pharmacies should be equipped with necessary equipment to provide patients with timely reminders and reasonable suggestions, promptly detect abnormal signs of indicators such as blood pressure, and guide patients to seek medical treatment in time." Liu Qian suggested that widely distributed retail pharmacies can be used to promote chronic disease management.

In fact, in recent years, pharmaceutical companies have been actively supporting hospitals and retail pharmacies to establish a "health alliance" so that the pharmacy's facilities, equipment and professional pharmacist resources can provide patients with follow-up, monitoring and consulting services, form a standardized management process, and enhance the pharmacy's professional service capabilities.

So far, hundreds of pharmacies in many cities across the country are actively promoting this model, including important cities such as Shanghai, Wuhan, Nanjing, and Chengdu. There are also a large number of examples that have proven the effectiveness of the "hospital-store linkage" model in actual operations.

According to public information, many pharmacies abroad already have similar functions, such as the popular "Minute Clinic" in the United States, which sets up general practitioners in pharmacies to provide instant diagnosis and treatment services without appointments, and the diagnosis and treatment costs are low, providing patients with convenient diagnosis and prescription services. This shows that pharmacies are fully capable of carrying out certain disease management and health care functions under the guidance of hospitals.

Building a closed-loop system

From various dimensions, building a closed-loop system that is a win-win for hospitals, pharmacies and patients has become the direction.

McKinsey also believes that the construction of a closed loop of new medical retail will help the industry to promote growth. Specifically:

For insurance companies, through self-payment, minor illnesses are increasingly forming a complete system of medical services and medical consumption that combines online and offline services outside the traditional hospital system. Commercial insurance companies need to think about how to integrate with new channels, diversify protection designs to increase product attractiveness, and control costs through cooperation with platform parties (for example, developing a chronic disease drug catalog).

For pharmaceutical companies, volume-based procurement has prompted many to consider expanding into pharmaceutical retail, but simply strengthening retail channels, whether online or offline, is only a very basic part. A higher-level positioning requires grasping the diversified needs of new medical consumption, providing diversified, full-course disease management solutions, and truly improving patients' medication experience and overall health benefits.

For offline pharmacies, they should think about how to adapt to the diverse needs of consumers and focus on building differentiated advantages (such as special areas such as chronic diseases and serious illnesses) to complement online channels.

From a policy perspective, the country is actively promoting the integration of retail pharmacies into the outpatient dual-channel and medical insurance system. Currently, hundreds of thousands of outpatient pharmacies have been connected to the medical insurance payment system, which shows that the government is committed to integrating pharmacies into the overall medical ecosystem to better serve the people. The dual role of the market and policy has made retail pharmacies gradually become an important force in protecting people's health.

It should be pointed out that retail pharmacies need to upgrade their service quality and professional capabilities. Only when retail pharmacies achieve transformation and improve the service capabilities of pharmacists can we move closer to the implementation of the "Health Consortium".

Sun Ningling pointed out that many people think that pharmacists only dispense medicines, which is a very one-sided concept. With the rapid development of pharmacy, pharmacists need to improve their comprehensive capabilities. At the same time, it is necessary to strengthen the communication between pharmacists and doctors, emphasize the comprehensive management of pharmacists and doctors, and strengthen the homogeneous management of pharmacists and doctors through online training and other forms.

Zeng Longyi also believes that "we still need to empower pharmacies and provide corresponding training for pharmacists and health managers. There must also be certain standards and corresponding requirements for the homogeneity of knowledge. Some places have already made preliminary explorations. For example, if pharmacists pass the training, they can take exams and assessments and then obtain the professional pharmacist qualification certificate for 'three highs' management."

Lan Bo, chairman and president of Jianzhijia Health Chain Store Co., Ltd., added that the role of pharmacists has not yet been clearly defined at the legal level, which has also caused public doubts about pharmacists. In fact, in terms of chronic disease management, pharmacists' work is mainly divided into three aspects, namely responding to patients' medication consultations, cooperating with doctors to complete the treatment process, and helping people regulate their health.

Judging from the drug purchasing trends and habits of patient groups, the role of pharmacies in chronic disease management has been changing in recent years.

Lanbo said that according to relevant reports, the products in drugstores are currently divided into three categories: chronic diseases, common diseases and health products. This shows that people's understanding of drugstores has changed a lot.

Since the launch of China's medical reform plan, people's understanding of the health industry and awareness of their own health have been greatly improved. At the same time, with the rapid development of China's economy, people have evolved from simply pursuing material things to higher-level spiritual expectations, among which the greatest demand is the demand for health, which is reflected in the vigorous consumption of people in pharmacies in recent years.

"We firmly believe that only under the guidance of policies and the professional guidance of doctors can pharmacists' professional skills and service levels be improved, and the professional service capabilities of retail pharmacies in the field of chronic disease management can reach new heights." Liu Qian emphasized.