商业健康险促创新药械“用得起用得上”

Core Insights - The approval of over 20 innovative Class 1 drugs by the National Medical Products Administration in the first five months of this year marks a record high for the same period in the past five years [1] - The commercial health insurance sector is accelerating innovation to ensure that advanced medical services are accessible and affordable for consumers [1][2] - The market size for innovative drugs and medical devices in China is projected to reach 162 billion yuan in 2024, reflecting a 16% increase from 2023 [1] Group 1: Market Dynamics - The personal out-of-pocket expense for innovative drugs and devices remains high at 49%, while medical insurance fund expenditures account for approximately 44%, and commercial health insurance only covers about 7.7% [1] - The expansion of commercial insurance coverage for innovative drugs aligns with policy directives aimed at enhancing health insurance service levels [2] Group 2: Insurance Innovations - New insurance products, such as Xinhua Insurance's "Medical Worry-Free Insurance," are extending coverage to medications and medical devices purchased outside of hospitals, addressing patient needs for advanced medical resources [3] - Ant Group's insurance platform has upgraded its "Good Medical Insurance" series to include reimbursement for over 1,500 advanced drugs and devices, enhancing coverage for imported and original research drugs [3] Group 3: Payment Mechanisms - A multi-tiered payment mechanism has emerged, primarily driven by market-oriented commercial health insurance, which includes various types of insurance such as inclusive insurance, million medical insurance, and critical illness insurance [4] - The total compensation amount for innovative drugs and devices from commercial health insurance is estimated to be around 12.4 billion yuan in 2024, representing 7.7% of the innovative drug market size [4] Group 4: Challenges and Considerations - The introduction of new drugs and technologies presents challenges for insurance companies, as they may increase treatment costs and claims [5] - Insurance companies are focusing on balancing the coverage of advanced drugs while keeping premiums affordable to ensure product accessibility [5]