The State Council has released a second draft proposal outlining measures to support the high-quality development of innovative drugs through medical insurance reforms. The document emphasizes the establishment of innovative drug investment funds, self-assessment mechanisms for drug pricing, and enhanced real-world research support.
Key Proposals
- Investment Funds: Encouraging commercial health insurance companies to establish funds for innovative drug development.
- Pricing Mechanisms: Exploring self-assessment for initial pricing of newly listed drugs to ensure reasonable and transparent pricing.
- Real-World Research: Strengthening support for real-world evidence to accelerate innovative drug development.
NRDL and Drug Listing
The draft mandates direct online listing of drugs in the National Reimbursement Drug List (NRDL) and Class C drug list. Medical institutions must adjust their drug catalogs promptly or establish green channels for temporary procurement to meet clinical needs. By 2025, the medical insurance fund will directly settle expenses for NRDL and volume-based procurement (VBP) drugs, gradually expanding to all listed drugs.
Tripartite Agreements
In regions with sufficient medical insurance fund balances, medical institutions, innovative drug companies, and healthcare security departments are supported to sign tripartite agreements. The medical insurance fund will prepay up to 80% of the expected annual expenses for innovative drugs within four years of their inclusion in the list, reducing corporate capital turnover pressure.
Multi-Level Healthcare System
The document highlights the acceleration of a multi-level medical security system, integrating basic medical insurance (BMI), commercial health insurance, and charitable assistance. It focuses on supporting commercial health insurance products that cover costs outside the BMI drug list, regardless of age or health status, with appropriate premiums.
Charitable Assistance and Overseas Expansion
- Charitable Assistance: Encouraging inclusion of innovative drugs in charitable programs to aid insured patients.
- Overseas Trading: Supporting Hong Kong and Macau in promoting overseas trading services for Chinese innovative drugs, leveraging their legal, financial, and technological advantages.
Fund Supervision and Prescription Management
- Fund Supervision: Strengthening oversight to prevent fraudulent insurance practices involving innovative drugs.
- Prescription Management: Guiding localities to standardize prescription practices, implement electronic prescriptions, and eliminate “fake patients” and “fake prescriptions.”-Fineline Info & Tech
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