全民健康保險制度在台灣開辦以來已經快二十年了，在全民都有保險、給付的範圍從基礎到複雜的醫療照護完整、合約醫療機構相當普遍、就醫的方便性等，得到大多數台灣民眾的肯定。 但全民健保這一路實施下來卻為台灣帶來的龐大國家赤字。健保局針對於每年五千餘億的健保費用其中的藥品費用(為第二大支出，占了其中的25%)多次長期進行多種的藥費及藥價管控措施，低廉的新藥核價加上每兩年的藥價調查後的藥價調降，國外藥廠除了要配合健保的藥價政策外，還需要面對醫療機構對於現有藥品再降價的要求。長久下來，藥廠利潤逐年下降影響甚劇。 其中以今年七月所要實施二代健保中「藥品三同」對於原開發藥廠藥衝擊最大。衛生署所實施的三同政策，即是針對健保給付超過15年的藥品，實施「同成分」、「同品質」、「同價格」，調整為同價格。此一政策倘若實施，原開發藥廠利潤嚴重下降，可能會導致會放棄台灣市場，民眾只剩下國產學名藥可以選擇。再者，三同政策最大的瑕疵，在於只單方面考慮健保給付的藥價，卻忽略了藥廠製藥成本，此舉明顯不顧成本不同卻硬性規定價格，明顯違反市場機制，也違反健保精神。 專利藥到期的原開發藥藥廠要如何因應以縮小品質及價格的爭端，只著眼於一昧砍藥價來填補健保財務虧損，不仔細思考同成分就一定同品質的問題而將藥品砍至同一價格的健保署藥物品質認定及給付標準。 本研究探討之研究問題包括: 1)在台灣健保逐年調降藥價的政策下藥品三同政策前，原開發藥廠在台的經營模式為何,2)在政府政策培育下的學名藥如何日益茁壯來影響專利藥到期的原開發藥廠市場活動，3)藥品三同政策實施後對專利藥到期的原開發藥廠的衝擊4)主要獲利的專利藥品皆到期的台灣武田藥品公司未來的經營模式從主要價值活動面該如何調整因應。 本研究以Afuah A.(2004)經營模式架構，先從過去健保政策下原開發藥廠的營運模式做說明，再以目前健保政策環境因素的變化，如何影響個案公司的市場行銷活動，而活動又如何影響公司的資源、定位及成本。 本研究發現「藥品三同」對台廠學名藥因具有較佳的成本競爭優勢，對原開發藥廠產生威脅，但因原料的不穩定性讓病患、處方醫師無法信任。所以原開發藥廠除了監督政府長期對學名藥廠品質加以把關、用訴訟延緩學名藥的上市外、另外一方面併購國內學名藥廠，以配合醫療院所對於低價高品質藥品的需求。最後，專利藥到期的原開發藥廠從健保政策中與學名藥廠價格競爭獲得利潤，就必須改變營運模式，首要的就是降低成本。如何從採購及製造方面有效降低成本著手，進一步調整有形、無形資產投入、人員配置培養與組織等策略資源，以及定價、市場區隔等定位修正，是原開發藥廠需要深入思考的問題。 / National Health Insurance (NHI) program has been implemented in Taiwan for almost 20 years. It has earned recognition for the compulsory enrollment for all residents in Taiwan, the benefits covered from basic to complicated medical care, the prevalence of contract medical facility and the convenience of going to doctors. NHI, however, has caused fiscal deficit for the past few years. Drug cost, among the over 500,000,000,000 NTD health insurance fee, is the second largest expenditure, which takes up 25 percent of health insurance fee. Therefore, Bureau of National Health Insurance has taken measures to manage and control drug cost and drug price multiple times for a long period. Foreign pharmaceuticals have cooperated on the low-priced pricing for new drugs and have lowered drug price after drug price evaluation every two year. However, there is still demand from medical institution for lowering drug price. The profit is therefore significantly affected in the long run. Among the impacts, the significant one for research-based pharmaceutical companies is “three sameness of drug” in the 2nd generation NHI, which will be implemented in this coming July. This three sameness policy is to adjust those drugs which are covered by NHI for over 15 years and are of the same ingredients and quality to the same price. If this policy is put into practice, the profit of research-based pharmaceutical companies would plunge, which may result in their leave of Taiwan market. The domestic generic drugs, as a result, would be the only choice for the general public. Moreover, the major flaw of this three sameness policy is that it merely considers the drug price NHI covers, not the costs of pharmaceutical companies. That the drug price is set inflexibly without taking costs difference into consideration is against not only market mechanism but also the essence of NHI. The questions this study aimed to investigate were: 1. What have been the operating models of research-based pharmaceutical companies in Taiwan in the circumstances of drug price drop year by year before “three sameness policy”? 2. How have the government-sponsored generic drugs affected the market activities of drug patent expiration of research-based pharmaceutical companies? 3. What have been the impacts of “three sameness policy” on drug patent expiration of research-based pharmaceutical companies? 4. How should the operating model of Takeda Pharmaceuticals Taiwan, Ltd. adapt to, from the aspect of primary value activities, the condition of drug patent expiration of its profitable drugs? Based on the framework of operating model by Afuah A.(2004), this study began with the operating model of research-based pharmaceutical companies in former NHI policy. It then elaborated on how changes of the present NHI policy have influenced the marketing activities of the case company and how these activities have influenced the company’s resources, position and costs. This study reveals that “three sameness policies” is favorable for Taiwanese generic manufacturers for their costs competition. However, the instability of raw materials could not gain the trust of patients and doctors. Therefore, in order to cooperate on the demand for low-price and high-quality drug, researched-based pharmaceutical companies supervise the government’s check on the quality of generic manufacturers, employ litigation to suspend the launch of generic drugs or merge domestic generic manufacturers. If research-based pharmaceutical companies with drug patent expiration would like to compete with generic manufacturers and make a profit in NHI policy, they would have to change their operating model. How to reduce costs of purchase and manufacture and go further to adjust the input of physical and intangible assets, strengthen professional training of personnel and organization and modify strategies for pricing and market segmentation are the main issues worth considering.

全民健康保險自1995年三月實施，提昇國人健康及疾病治療水準，有其正面的貢獻，但也影響了醫療相關的從業者甚巨。藥品的費用占率約全部健保費用的百分之二十五，是除了醫事服務相關費用之外，占率最高的費用。健康保險局，收支潛在的赤字在健保實施次年後已浮現，隨即採用多種藥費及藥價控管措施。新藥核價過低、過程耗時；已上市的藥品，除每兩年健保局的藥價調查後的全面性調降，和不定時的異常品項調查外，尚需面臨客戶端再次降價的要求。對於藥業營運已有顯著的負面影響。 再者現行的健保制度，保證醫療院所藥品的申報一律為健保給付價，無論其以多低的價格採購，中間的價差利潤皆歸之所有，俗稱藥價黑洞，外界難以了解其對醫療體系的運作的重要性，一味的譴責之！事實上於現行總額給付實施之下，可彌補醫療院所健保給付不足所造成的營運困難，使民眾得以持績享受價平質佳的醫療照護。然負面影響為無法提昇病患痊癒效率，也對醫事人員專業的養成，及産業的發展伏下隱憂。健保制度沿於現有的法源，法源不改，扭曲的現象續存，最終的受害者為全體民眾。 二代健保法於2011年元月立法院三讀通過。產業環境的遊戲規則勢必改變。經由訪談，二十家不同類型的藥品供應廠商的經營領導者，於新的健保法實施之際的應變措施，且其合計市占率已超過整體藥品市場的41 %。由深度訪談中，可了解不同類型的廠商，對新制度的看法及其因應措拖的異同，再佐以近代管理學的概念檢視對照不同的領導風格，推估其和產業的特性及未來發展生存之道的關連性，或許可提供予産業長遠發展的建議。 歸納本研究的重要結論為：台灣藥業環境變動是漸進的，易被輕忽影響度；且從事藥業廠商者眾不易形成共識，很難共同努力改善環境不利的變動；依靠新産品的開發取得，是藥業重要成長的策略。於經營者的研究結論：發現大多數的領導者的强項為執行力及銷售力，這可能和産品生命週期長，進入門檻高有關；但因之不利改變慣例，跳脱舒適圈，將公司導向更兼具靈活彈性又與環境更符合的營運模式。未來成長的契機在於領導者洞悉未來的趨勢；藥業營造有利趨勢，在於跳脱近親繁殖，取法於外。 / National Health Insurance has been launched on March, 1995. It has been recognized as the safeguard to the improvement for all country’s residents. The financial burden of BNHI has struggled to balance its books from early on. Drug costs contributed about 25% of NHI healthcare spending, therefore is controlled mainly through pricing and reimbursement policy, particularly the regular rounds of price cut. The current system allows health providers gain profit from drug purchasing under negotiations with pharmaceutical companies which subsidizes the insufficient reimbursement for other service to patients. All these system hamper the healthcare industry sound growth. Without healthcare reform cannot correct the system toward healthier operation. Winder reform in the shape of 2G NHI Act was finally passed by the Legislative Yuan in January 2011. The future NHI scheme will change in many areas. In order to understand the counter actions from pharmaceutical industry, the study is designed to interview 20 leaders in Rx companies which included different types such as MNC, domestic and agencies. The overall revenue from the 20 companies shared over 41% in Taiwan pharmaceutical industry. The study will compare and analyze the difference from each company’s actions toward the future change, from results to use modern business scholarship theory checking any particular similarity within the industry. The main findings of the study are 1) The change of environment is easily been neglected for moving slowly and gradually, 2) To shape environment toward the positive side is difficult since hard to have consensus within industry, 3) Introduction of new products is the main growth strategy, 4) The most strength leadership capability from the interviewees is the execution, and the possible explanations are longer products life cycle plus higher entry barriers from new competitors. The downside of this type of leadership is hard to flexibly move fast in developing new business model to match the environment evolution. In-depth understanding trend of leaders will be the key of future success. The industry might learn from other industries to shape the environment more effectively.