The Healthcare Security Administration (HSA) in Shanghai has recently released a set of Measures aimed at “Further Improving the Diversified Payment Mechanism and Supporting the Development of Innovative Drugs and Devices.” These Measures are designed to enhance Basic Medical Insurance (BMI) policies, strengthen commercial health insurance, and establish a multi-party co-payment mechanism to improve access to cutting-edge pharmaceuticals and medical devices.
Promoting Collaboration and Commercial Health Insurance Development
The Measures highlight the importance of fostering cooperation between commercial insurance companies, medical institutions, and pharmaceutical enterprises. The development of commercial health insurance is a key focus, with an emphasis on covering new and high-quality drugs, services, and out-of-pocket expenses not included in the BMI scope. The initiative particularly supports innovative drugs and devices that are highly innovative, have precise therapeutic effects, and are urgently needed in clinical practice.
Establishment of a Big Data Center Platform
A significant step in this direction is the establishment of a Big Data center platform to facilitate information sharing between medical insurance information platforms and commercial insurance platforms. This will support the use of medical and medical insurance Big Data to develop better-priced insurance products and optimize commercial insurance claims. The Measures also promote the direct settlement of high-end medical insurance.
Policy Support and Incentives for Commercial Health Insurance
Shanghai is increasing policy support for commercial health insurance, encouraging enterprises to purchase insurance for employees through tax incentives. Personal medical insurance account surplus funds are supported to be used to purchase commercial insurance products covering innovative medical devices. The scope of subsidies is set to expand, with drug liability insurance in clinical trials being extended to the clinical use period for one or two years after the launch of new drugs or the addition of new indications. The Measures also explore the establishment of premium subsidy policies for commercial insurance to support innovative pharmaceuticals and medical devices. Additionally, the Measures require the establishment of a cooperation mechanism between basic medical insurance and commercial insurance industry supervision and the enhancement of the “Huhuibao” and Shanghai’s HuiMinBao brand.
Improving Pricing Mechanisms and Accelerating Clinical Applications
The Measures also emphasize improving the pricing mechanism for innovative pharmaceuticals and devices and accelerating their clinical application. Except for national negotiated drugs and volume-based procurement (VBP) drugs and devices, other drugs and medical equipment are negotiated independently by enterprises and medical institutions. The independent pricing mechanism of medical institutions during the trial period of new projects will be optimized, and the filing and application mechanism for new projects will be improved. After the first clinical application of new projects is approved for fee approval, other hospitals can charge fees after filing. A “green channel” for innovative drug online procurement networks will be opened, and medical institutions are urged to achieve the goal of “stock drugs as much as possible.” The assessment mechanism of medical institutions will be adjusted and optimized, with hospitals not restricting the admission of innovative drugs and equipment based on the number of drug catalogs, drug/consumables hospital budget caps, and other reasons.
National Reimbursement Drug List (NRDL) and Policy Support
Innovative drugs that are negotiated to be included in the National Reimbursement Drug List (NRDL) will be subject to a separate budget for the first three years and will not be included in the total budget of the hospital’s medical insurance for that year. In the fourth year, the highest usage of the first three years will be included in the total budget calculation base. Enterprises can directly apply for online procurement of products that have obtained the national medical insurance consumables code and meet the management regulations of Shanghai’s separately chargeable consumables catalog. The government will also give more policy support to innovative medicine and equipment, and give preference to innovative medicine and equipment in many aspects, such as medical insurance negotiation, DRG/DIP payment, pharmacy outpatient coordination, and electronic prescribing circulation, to promote the rapid implementation of new drugs under national negotiation.-Fineline Info & Tech
