Core Viewpoint - The article highlights the challenges in enforcing antitrust laws in the pharmaceutical industry, where the profits from monopolistic practices often outweigh the penalties for violations [1][5][19]. Summary by Sections Antitrust Violations and Penalties - Xianju Pharmaceutical was fined 195 million yuan for its involvement in a monopoly case concerning dexamethasone phosphate raw materials [1]. - In another case, three pharmaceutical companies colluded to raise the price of methacholine injection by 11 to 21 times, resulting in a total penalty of approximately 223 million yuan [2][5]. - The enforcement of antitrust laws in China's pharmaceutical sector has been historically lenient, with the revised Antitrust Law in 2022 introducing personal liability for executives, but actual penalties remain low compared to the profits gained from such practices [5][19]. Price Manipulation and Market Impact - The price of methacholine injection surged from 2-3 yuan to over 30 yuan per unit over a few years, before being included in a national procurement list at a price below 1 yuan [6][11]. - The sales revenue for methacholine injection exceeded 1 billion yuan in 2023, with one company holding over 69% market share [7][16]. - The article discusses how the collusion among companies not only inflated prices but also led to drug shortages, adversely affecting patients who rely on these medications [9][10]. Mechanisms of Collusion - The collusion involved explicit agreements among companies to raise prices and divide markets, which is described as a "composite monopoly agreement" [12][14]. - The article notes that such practices are not uncommon in the industry, with multiple companies engaging in similar behaviors over the years [13][14]. Enforcement Challenges - The difficulty in calculating illegal gains and the limited resources of enforcement agencies hinder effective implementation of antitrust laws [5][16]. - The penalties imposed often do not reflect the scale of the illegal profits, leading to a perception that the risks of engaging in monopolistic practices are low [15][16]. - The introduction of personal liability for executives is a step towards improving enforcement, but the effectiveness of this measure remains to be seen [18][19].

Core Viewpoint - The article highlights the issue of pharmaceutical companies engaging in price-fixing and monopolistic practices, leading to significant price increases for essential medications, particularly the drug "新斯的明" (Neostigmine), which has seen price hikes of 11 to 21 times due to collusion among three companies [2][3][19]. Group 1: Price Manipulation and Regulatory Actions - Xianju Pharmaceutical was fined 195 million yuan for its involvement in a monopoly case related to dexamethasone phosphate raw materials [1]. - The price of Neostigmine injection surged from 2-3 yuan to over 30 yuan per unit, representing an increase of over 10 times [6][10]. - The sales revenue of Neostigmine in public medical institutions exceeded 3 billion yuan in 2020, with a year-on-year growth of 446.81% [10]. Group 2: Impact on Patients and Market Dynamics - Neostigmine is critical for treating myasthenia gravis and has no alternative medications, making its price increase particularly harmful to patients [4][14][16]. - The drug was included in the National Shortage Drug List, which pharmaceutical companies used as a pretext for price hikes [11][13]. - By the end of 2024, Neostigmine was included in the tenth batch of centralized procurement, with prices dropping to below 1 yuan per unit, exposing the previous price inflation as unjustified [17][18]. Group 3: Monopolistic Practices and Legal Framework - The collusion among the three companies involved not only price increases but also market division to maintain their market shares [19][20]. - The penalties for monopolistic behavior have historically been light, with the revised Anti-Monopoly Law in 2022 introducing personal liability for executives, marking a shift in enforcement [5][29][35]. - The fines imposed on companies often do not reflect the substantial illegal profits gained from monopolistic practices, leading to calls for stricter enforcement and higher penalties [27][30].