天价药困局：谁来支付下一个“救命创新”

Core Insights - The high cost of CAR-T cell therapy is a significant concern for patients, with single treatment costs exceeding one million yuan, leading to financial strain on families [2] - The establishment of a sustainable and efficient payment system for innovative drugs is increasingly recognized as essential for improving patient access [2][3] - Recent government policies aim to support the development of innovative drugs and enhance their accessibility through various payment mechanisms [2][9][11] Payment System Development - The multi-payment system for innovative drugs includes commercial health insurance, charity funds, and high-end medical insurance, which are crucial for reducing the financial burden on patients [2][3] - In 2024, commercial health insurance is expected to cover approximately 12.4 billion yuan for innovative drugs, with direct reimbursements amounting to 6.6 billion yuan [3] - The current multi-payment system faces challenges such as policy uncertainty, pricing negotiations, and compliance issues [3][8] Market Growth and Trends - China's innovative drug market reached approximately 162 billion yuan in 2022, with a year-on-year growth of 16% [5] - The percentage of new drugs launched in China has increased from 9% in 2017 to 29% in 2023, indicating a growing trend of global innovative drugs entering the Chinese market [5] - The aging population and increasing healthcare demands are driving China's position as the second-largest pharmaceutical market globally, with an annual growth rate exceeding 3% [4] Insurance and Policy Initiatives - The basic medical insurance system currently covers only 16% to 25% of innovative drugs, highlighting the need for commercial insurance to play a more significant role [6] - The introduction of the commercial insurance innovative drug directory is seen as a strategic move to enhance the integration of insurance and pharmaceutical industries [13][14] - Recent policies aim to clarify the operational guidelines for commercial insurance in relation to innovative drugs, addressing compliance and pricing negotiation challenges [8][19] Collaborative Efforts - Various stakeholders, including insurance companies, pharmaceutical firms, and local governments, are exploring new collaborative models to enhance the payment system for innovative drugs [17][20] - Risk-sharing mechanisms based on financial and efficacy outcomes are being tested to improve the affordability and accessibility of innovative therapies [18][20] - The "three exclusions" policy aims to facilitate the integration of commercial insurance with innovative drug coverage, impacting pricing negotiations and compliance operations [19][20]