Core Insights - The high cost of innovative drug treatments, such as CAR-T cell therapy, is a growing concern for patients and their families, with single treatment costs exceeding one million yuan [1][2] - There is an increasing societal focus on ensuring that expensive innovative drug treatments do not hinder patient access to necessary care [2][3] Payment System Development - The establishment of a sustainable and efficient payment system is crucial for the widespread application of innovative drugs [2][3] - Recent government policies aim to support the inclusion of innovative drugs in basic medical insurance and commercial health insurance directories, enhancing payment capabilities [2][12] - The multi-payment system for innovative drugs includes commercial health insurance, charity funds, and high-end medical insurance, which helps reduce the financial burden on patients [2][3] Market Growth and Trends - China's innovative drug market reached approximately 162 billion yuan in 2022, with a year-on-year growth of 16% [4] - The trend of new drugs being launched in China has increased significantly, with 29% of new drugs debuting in China in 2023, up from 9% in 2017 [4] Challenges in Coverage - Basic medical insurance currently covers only 16% to 25% of the innovative drugs applied for, indicating a gap in coverage [5][6] - Despite the establishment of a universal healthcare system, basic insurance is insufficient to cover high-priced innovative drugs, necessitating the exploration of new payment models [6][9] Insurance and Policy Initiatives - The commercial health insurance sector is expected to provide approximately 12.4 billion yuan in compensation for innovative drugs in 2024, with direct reimbursements amounting to 6.6 billion yuan [3][7] - The introduction of the commercial insurance innovative drug directory is seen as a significant step towards integrating commercial insurance with the pharmaceutical industry [13][14] Collaborative Efforts - Various stakeholders, including insurance companies, pharmaceutical firms, and local governments, are working together to address challenges in the innovative drug payment system [17][20] - New models of risk-sharing and payment mechanisms are being explored to enhance the accessibility of innovative drugs [18][19] Regulatory Framework - The establishment of clear regulatory frameworks and operational guidelines is essential for the effective implementation of the multi-payment system for innovative drugs [9][19] - The "three exclusions" policy aims to facilitate the integration of commercial insurance with innovative drug coverage, impacting pricing negotiations and compliance [19][20]
百万级抗癌药，谁来买单？
3 6 Ke·2025-08-28 01:44