“Science and Technology Innovation Board Daily”, March 1 (Reporter Xu Hong) “With the introduction of the '28 New Deals', we hope to achieve this kind of policy effect: let medical institutions 'dare to enter', let insured people 'dare to use', let innovative pharmaceutical companies 'dare to research', and let the capital market 'dare to invest'.” At the municipal government press conference held this morning (March 1), Xia Kejia, director of the Shanghai Municipal Medical Security Bureau, said this.

What makes medical institutions “brave”? According to Xia Kejia, this is to dispel concerns about medical institutions using innovative drugs through a series of medical insurance payment measures, such as separate payments for innovative drugs and not taking up hospital medical insurance credits.

At the same time, after more innovative pharmaceutical devices were reduced in price and included in medical insurance, since the burden of treatment was greatly reduced, all insured people “dared to use” them.

More importantly, by improving multiple back-end payment mechanisms, Shanghai hopes to stabilize the expectations and confidence of the front-end biomedical industry. In this way, the company's R & D drive, as well as the capital market's willingness to invest, will naturally be stronger.

Biomedicine is one of the three leading industries in Shanghai. According to the latest data, in 2023, the scale of Shanghai's biomedical industry was close to trillion yuan, reaching 933.732 billion yuan, a comparable increase of 4.9%.

Also to further promote the high-quality development of the city's biomedical industry, in July of last year, the Shanghai Municipal Health Insurance Bureau, together with 7 departments including the Municipal Economic and Information Technology Commission, the Municipal Science and Technology Commission, the Municipal Health Commission, the Municipal Finance Office, the Shanghai Regulatory Bureau of the State Financial Supervision and Administration, and the Municipal Data Bureau, jointly issued “Certain Measures to Further Improve Diversified Payment Mechanisms to Support the Development of Innovative Pharmaceutical Devices”, and proposed 28 measures in nine areas (“28 New Policies” for short).

According to Xia Kejia, it has been more than half a year since the implementation of the New Deal, and judging from the implementation results, the results have been remarkable. In particular, basic medical insurance and commercial insurance have joined forces to achieve full coverage of products in the Shanghai “New Premium Pharmaceutical” catalogue, making it easier for innovative drugs to be admitted. In 2023, medical institutions in the city purchased 10.8 billion yuan of innovative drugs, an increase of 73.1% over the previous year.

▌Innovative pharmaceutical devices receive more preference from medical insurance payments

As the largest buyer in the medical and pharmaceutical industry at present, health insurance policies will largely influence the development of the biomedical industry.

As the 28 new policies advance, it can be seen that innovative pharmaceutical devices have received more and more strong support from health insurance in Shanghai, mainly reflected in the fact that medical insurance quotas focus on the use of innovative pharmaceutical devices by medical institutions and the continued increase in medical insurance payments for innovative pharmaceutical devices.

According to Xia Kejia, Shanghai implemented a separate budget for the first three years for innovative drugs negotiated to be included in the national health insurance catalogue. In the fourth year, it was not included in the total hospital health insurance budget. In the fourth year, it was included in the total budget calculation base according to the usage situation in the previous three years and the highest one year.

Moreover, the inclusion of innovative devices in health insurance continues to increase. In October of last year, Shanghai added 60 types of medical consumables to the city's medical insurance payments, adding about 1 billion yuan to the health insurance fund every year.

At the same time, medical insurance payments are further skewed towards innovative pharmaceutical devices. In deepening the reform of medical insurance payment methods, payment standards for cases using new technology will be raised. There is no control ratio for high-rate cases where new technology is applied, and large-scale applications of new technology can be independently grouped. In the 2023 version of the DRG payment cluster plan, 17 separate groups were formed for new technology and new projects, involving 45,000 cases, with a separate payment amount of 500 million yuan.

On the clinical application side, for a long time, innovative pharmaceutical devices have always had pain points such as long admission cycles, low awareness rates, and difficulties in application promotion. In this regard, 28 new policies have also proposed corresponding measures in a targeted manner.

Yu Tao, deputy director of the Shanghai Municipal Health Commission, said that in order to promote the admission of innovative pharmaceutical devices, the Municipal Health Commission has strengthened guidance for relevant medical institutions and made the application of innovative pharmaceutical devices an important task.

These include requiring medical institutions to hold a pharmaceutical council meeting within one month of the publication of the “Shanghai Medical Insurance Drug Catalogue” and the “Shanghai New Premium Pharmaceutical Product Catalogue” to make full use of innovative pharmaceutical products; adjusting assessment indicators, and not adopting “drug catalogue quantity” and “drug consumption ratio” indicators for the application of innovative pharmaceutical devices.

In January of this year, statistics showed that 90% of the city's level-III hospitals and 72% of level-II hospitals purchased innovative drugs; 83% of level-III hospitals and 45% of level-II hospitals purchased innovative medical devices.

Continued policy support has also brought direct benefits to enterprises. An innovative pharmaceutical company registered in Shanghai that focuses on targeted innovative drug development. This year, two Class 1 new drugs developed independently successfully renewed the national medical insurance catalogue and were included in the Shanghai Biomedical “New Premium Pharmaceutical” product catalogue.

“Since the introduction of 28 new policies, with the implementation of relevant measures, the company's two products have entered clinical use in many municipal medical institutions. In the second half of 2023, the sales value of the two innovative drugs in the Shanghai market increased by 36% and 105%, respectively.” Shake's family said.

As a supplement to basic medical insurance, “Shanghai Huihui Insurance” also undertook payments for some innovative treatments. Therefore, Shanghai's 28 New Policies also focus on improving and strengthening the “Shanghai Huibao” brand.

According to reports, in 2023, the number of “Shanghai Huibao” insured people was 6.3 million, continuing to have the highest number of applicants for similar products in the country. At the same time, “Shanghai Huibao” also further covered innovative drugs. Up to now, 38 types of innovative specialty drugs have been included.

In particular, it is worth mentioning that, according to Cao Guangqun, deputy director of the China Financial Supervisory Administration and the Shanghai Regulatory Bureau, “Shanghai Huibao” has paid a total of 33 million dollars for one million anti-cancer drug CAR-T treatment drugs.

▌Accelerate the integration of medical insurance and commercial insurance, and cover more health insurance with innovative pharmaceutical devices

Another major focus of the 28 new policies is that there are as many as 16 support measures related to commercial health insurance, which directly address various pain points in the development of commercial health insurance, including promoting multi-party cooperation to strengthen the supply of commercial health insurance products, and empowering data to support the development of commercial health insurance products.

As one of the implementation initiatives, at the beginning of this year, the Shanghai Big Data Center, the Shanghai Health Insurance Center, and the China Insurance Federation of Science and Technology jointly launched the Shanghai Health Insurance Big Data Innovation Laboratory to explore the security and compliance sharing application of health insurance data and commercial insurance data.

“This laboratory is also the first time in the country to standardize processes and form a mechanism to open up desensitized medical insurance data to commercial insurance. The purpose is to help insurance companies measure products and price more reasonably.” Xia Kejia said that Shanghai will open up and share medical insurance data, making it a “business card” to attract more biomedical companies to invest and develop in Shanghai, forming a demonstration effect throughout the country.

Shao Jun, deputy director of the Shanghai Data Bureau and director of the Municipal Data Center, emphasized that “to promote the use of health insurance data, we must also firmly adhere to the bottom line and red line of data and personal privacy security.”

According to its claims, in order to comprehensively manage and control data security, the big data laboratory has independently set up a medical insurance data operation area, and also uses a series of technologies such as data desensitization, encryption, blockchain, and privacy calculation to achieve that the original data is not released from the domain, strict management of hierarchical authorization, and traceability throughout the process to avoid risks such as privacy leakage.

At the same time, it also reviews and checks insurance institutions' access and project data requirements, and opens basic data information to insurance institutions in accordance with minimization and rationalization requirements.

According to reports, since the establishment of the Shanghai Health Insurance Big Data Innovation Laboratory, big data calculations have been carried out for the development of various commercial health insurance products. In the next step, Shanghai will further deepen the construction of health insurance big data laboratories to make better use of the multiplier effect of health insurance data elements:

The first is to continue to strengthen laboratory capacity building, especially to strengthen comprehensive data mining, analysis and modeling capabilities; the second is to expand application scenarios and focus on key areas such as incubation of innovative insurance products, drug pricing, and medical device product innovation under existing application scenarios to promote the continuous release of the value of medical insurance data; and the third is to continue to do a good job in data security management to ensure compliance and control throughout the data application process.

According to the 28 new policies, the purchase of commercial health insurance will also receive stronger policy support, including priority support for the purchase of commercial health insurance products covering innovative pharmaceutical devices using personal health insurance account funds.

Driven by the new policy, Cao Guangqun said that the first batch of 5 new individual account products has already been launched, while the second batch of 9 new products has also been approved and will be launched one after another in the near future. Among them, various insurance products cover innovative local pharmaceutical devices. For example, Ping An Health Insurance's “Shanghai Children Insurance” covers 10 types of “New Premium Pharmaceutical Devices” for malignant tumors; China Life Insurance's Drug Safety · Global Specialty Drug Edition includes all 16 types of “New Premium Pharmaceutical Devices” for malignant tumors through a guarantee upgrade.