Price cuts trigger ‘100:100’ promotion comeback

Abnormal promotions ramp up, led by small and medium-sized pharmacies, following government’s announcement of generic drug price cuts

Company A offers “100% commission on new prescriptions from April to June”… 5–6 pharmacies revive ‘100:100’ promotions

Desperate efforts to push inventory and maintain prescriptions before implementation… criticism rises that the “government is encouraging unethical sales practices”

Amid the government’s announcement of sweeping generic drug price cuts, the so-called “100:100” promotions, where pharmaceutical companies return the full prescription amount as commission to CSOs (contract sales organizations), have re-emerged in the field.

The government’s drug pricing system reform is cited as the reason behind the revival of this distorted sales model, which involves accepting heavy financial losses. With price cuts expected as early as July, most pharmaceutical companies are facing a direct hit to profitability. As a result, the industry appears to be resorting to desperate measures to offset losses before the price cuts take effect. The core strategy behind the spread of the 100:100 promotions is to quickly clear inventory before the price cuts while using high commission rates as bait to retain prescribers and encourage them to switch to the company’s products.

“100% commission on new prescriptions”…Spread of 100:100 promotions

According to the industry sources on the 26th, Company A—a mid-sized firm with annual sales of around KRW 200 billion—recently announced on the 24th that it would implement a 100:100 promotion. The program offers 100% commission on new prescription sales for about 20 products, including its flagship dementia and hypertension combination drugs. The promotion runs from April to June, and any new prescriptions during this period will receive 100% commission for the following 3 months.

The notice also includes a condition requiring sales to be maintained for 6 months after the promotion ends. It also states that commissions will be reclaimed if sales fall below the average during the promotion period. With price cuts expected to take effect in July, the move is interpreted as an attempt to secure continued prescriptions for the company’s products even under the new, reduced pricing structure.

The so-called “100:100” promotion is now spreading across the industry. Company B, a small firm with annual sales under KRW 50 billion, is reportedly offering “100% commission for securing new clients” for highly competitive products such as lipid-lowering drugs. Company C, with annual sales of KRW 70 billion, also implemented a 100:100 promotion earlier this year for its new products. Industry sources indicate that an additional 2–3 mid-sized or small firms are currently running similar promotions.

Government pressure on generic price cuts fueling distorted sales practices?

The 100:100 model refers to a structure in which pharmaceutical companies pay CSOs commissions equal to the actual prescription volume. For example, if a CSO secures prescriptions worth KRW 10,000, the company pays the same amount (KRW 10,000) as commission.

From the pharmaceutical company’s perspective, this means that every sale results in a loss when considering manufacturing costs, labor, and logistics. While short-term losses are inevitable, this method was often employed to facilitate initial market entry and secure prescribers. However, some have pointed to it as a backdoor for providing illegal rebates.

This distorted sales model reportedly disappeared from the front lines for a while following the successive introduction of government policies aimed at improving distribution transparency, including the CSO reporting system and mandatory expenditure reports. A pharmaceutical industry insider stated, “Except for cases where a pharmaceutical company temporarily adopts it ahead of a new product launch, ‘100: 100’ promotions have been virtually nonexistent recently.”

However, as fear of drastic price cuts spreads across the industry, the model has resurfaced in the sales field.

Last November, the government announced a reform plan to lower the generic pricing rate from 53.55% to the low-40% range. Since then, a sense of crisis has intensified, particularly among small and medium-sized pharmaceutical companies, who feel that “it is impossible to maintain prescriptions through normal sales methods,” ultimately leading to the revival of the ‘100:100’ promotions.

For smaller companies, these promotions allow them to push out inventory at the highest possible price before the expected July price cut, thereby preserving revenue. At the same time, high commissions help secure prescription channels, minimizing the impact after the price reduction. This has led to criticism that aggressive government price cuts are inadvertently encouraging irregular sales practices.

Another key factor behind the resurgence is the pharmaceutical companies’ “aggressive switching” strategy that exploits the structural vulnerability of CSOs. For CSOs, which receive commissions at a fixed rate, drug price cuts mean a sharp drop in actual revenue. For example, if a CSO earns a 50% commission (KRW 500) on a product priced at KRW 1,000, a price drop to KRW 800 immediately reduces their income to KRW 400. This represents a significant blow comparable to that faced by pharmaceutical companies.

The 100:100 promotion exploits this weakness. By offering exceptionally high commission rates, companies entice CSOs to switch prescriptions from competing products to their own. By guaranteeing commissions that more than offset reduced margins, the strategy creates strong incentives for CSOs to engage in product switching.

A pharmaceutical industry insider commented, “As the government pushes aggressive price cuts targeting generics, companies have resorted to gambling, spending money to buy tomorrow’s prescriptions instead of investing in R&D. Mid-sized and small firms, which are heavily dependent on generics and face significant losses, are particularly vulnerable to the temptation of 100:100 promotions.”

Concerns are also emerging within the CSO sector. A CSO executive stated, “While high commissions may promise immediate gains, they effectively push us toward illegal rebate practices. In a situation where it’s difficult to refuse pharmaceutical companies’ offers, there is growing concern that both pharma sales organizations and CSOs could face mutual destruction, or that market order itself could be disrupted after the price cuts.”

Further spread of irregular practices expected during the “gap period” until price cuts take effect

The problem is that these sales practices are likely to intensify in the near term. The government plans to finalize generic drug price cuts through the Health Insurance Policy Deliberation Committee on the 26th. The revised pricing rate is expected to fall in the low-to-mid 40% range. The implementation is expected either in July this year or January next year.

This creates a “gap period” of 3 to 9 months before the actual price cuts take effect. During this period, pharmaceutical companies are likely to use aggressive strategies to push out existing inventory. Like those already implementing 100:100 promotions, many may view this as the last opportunity to secure prescriptions.

This is why criticism has emerged within the industry that the government’s aggressive push for drug price cuts has paradoxically disrupted the previously stable distribution order. One industry insider criticized, “The government needs to recognize the unintended side effects that price-cut-focused regulatory policies are creating in the field.”