基本医保+惠民保+商保 创新药支付三梯度转型

Core Insights - The article discusses the financial burden of innovative cancer treatments in China, highlighting the challenges patients face in affording these high-cost medications, which can reach hundreds of thousands of yuan annually [1][2] - The "White Paper on Multi-Payment for Innovative Drugs and Devices (2025)" indicates that in 2024, China's innovative drug sales are expected to reach 162 billion yuan, with a significant portion of costs falling on patients and limited contributions from commercial health insurance [1][2][5] Payment Structure - In 2024, the expected sales of innovative drugs in China will be 162 billion yuan, with the medical insurance fund covering approximately 71 billion yuan (44%), personal cash payments around 78.6 billion yuan (49%), and commercial health insurance contributing only 12.4 billion yuan (7.7%) [1][2][5] - The current payment structure shows a high burden on individuals and insufficient support from commercial health insurance, which is critical for the sustainable development of innovative drugs [2][5] Role of Commercial Health Insurance - The article emphasizes that while "Hui Min Bao" (a popular supplementary insurance) has grown rapidly, it primarily covers basic medical expenses and has limited capacity to support high-value innovative drugs due to its low premium structure [3][5][6] - Experts suggest that commercial health insurance needs to expand its coverage and payment capabilities to alleviate the financial burden on patients and support the innovative drug industry [4][6][10] Policy Developments - Recent measures from the National Medical Insurance Administration aim to enhance the role of commercial health insurance in supporting innovative drugs, proposing a multi-layered payment system that includes charity donations and mutual aid [8][9] - The "Three Exclusions" policy allows commercial health insurance to cover innovative drugs without being counted against basic medical insurance metrics, thus providing more flexibility for hospitals and insurers [9][10] Future Directions - The article suggests that the future of innovative drug payments will involve a collaborative model where basic insurance covers essential drugs, supplementary insurance addresses high-value drugs, and commercial health insurance fills the gaps [6][10] - As Chinese innovative drugs gain international approval, there is potential for cross-border insurance products to support these drugs in overseas markets, although challenges remain in terms of recognition and reimbursement [17][19]