China expands commercial insurance drug list to include high-cost drugs

China rolled out a commercial insurance innovative drug list on Jan 1 that expanded the healthcare coverage policy in the hopes of reducing financial burdens on patients requiring advanced treatments, particularly for cancer and rare diseases.

The launch introduced 114 new drugs to the list and singled out 19 high-cost innovative drugs for recommended coverage by commercial insurers.

Huang Xinyu, head of the National Healthcare Security Administration's medical services management department, said that new drugs must meet at least one of the following criteria to be included in the list: "filling an unmet clinical need, being superior to existing options, or offering better cost-effectiveness".

Fa Cuiwen, a medical sociologist at Tsinghua University, said the new list aims to build a stronger, multi-tiered safety net. Basic insurance would handle essential care, while commercial plans would step in where coverage falls short.

China's public system, she explained, often cannot pay for expensive new medicines. Commercial health insurance can help close that hole and respond to patients who need a wider range of treatment options.

The commercial insurance directory, a key component of this update, includes advanced drugs such as new Alzheimer's medications and treatments for rare diseases like Gaucher.

High-priced modern drugs, like a CAR T-cell therapy for cancer, which previously cost anywhere from $600,000 to over $1 million, will be included in the commercial directory. This means that patients with qualifying commercial insurance could receive substantial compensation.

Zhang Wenjie, chairman of Fosun Kairos, which develops and markets tumor cell therapies, called the move good news for both the company and its patients. He said Fosun Kairos plans to work more closely with insurers so a broader range of supplementary and commercial health plans can cover its approved drugs.

That, he added, should help speed up the rollout of future innovations.

Wang, a 54-year-old homemaker in Beijing, said coverage through commercial insurance would bring real financial relief. She has spent nearly a decade caring for her mother with Alzheimer's, a responsibility that has consumed a great amount of time and money.

The family has researched lecanemab, recently granted full approval in the United States, and expects it to be expensive. Annual costs can exceed 180,000 yuan (about $25,500), she said, a daunting sum for a single-income household. Taking a job is not an easy option, she added, because patients often need constant, close care.

Wang said she already holds some private policies for her parents and herself. If Alzheimer's drugs were to become covered, she would buy additional insurance.

Huang, from the National Healthcare Security Administration, said that while drugs on the updated list are not reimbursed by basic medical insurance, they still receive support through a "three exemptions" policy.

In practice, he said, those treatments are left out of the self-payment metrics tied to basic insurance. They are also not tracked as alternatives under centralized procurement rules, and cases involving patients who use them may be removed from diagnosis-related group payment calculations.

"Patients can now access urgently needed medications. If they have purchased corresponding commercial insurance, they can also get more of their medical expenses reimbursed," he added.

Fa, the medical sociologist, said the policy is meant to ease institutional barriers and financial worries that can make hospitals hesitant to use costly new treatments.

She said the commercial directory also carries longer-term significance, as it may work in tandem with local measures across the country and help people benefit more quickly from the emerging dual system.