On December 13, the dust settled on the results of the 2023 national medical insurance negotiations, and 121 varieties were successfully negotiated, setting a record high. At the same time, one of the most watched varieties in medical insurance negotiations over the years, CAR-T **, has once again stopped medical insurance negotiations.
As one of the most effective means for patients with end-stage tumors, up to now, there have been 4 CAR-T** models on the market in China, namely axileucel injection, relma-cel injection, ig-cel injection and nalcelle autoleucel injection, and the price of one injection is 1.2 million yuan, 1.29 million yuan and 116 yuan respectively60,000 yuan and 9990,000 yuan.
On November 17, at the scene of the 2023 medical insurance negotiation, representatives of pharmaceutical companies walked down the stairs, some happy and some worried. Photo by Xu Shiyu.
Millions of anti-cancer drugs" sprint to medical insurance for the third time.
According to the reporter of the people's ** health client, this year is the third consecutive sprint to medical insurance for CAR-T**.
In the process of adjusting the medical insurance catalogue in 2021, Axileucel injection passed the preliminary formal review of medical insurance, but finally failed to sit at the negotiation table. In the 2022 medical insurance negotiations, relma-cel injection was the only CAR-T** that passed the preliminary examination of medical insurance, but in the end it was out because of the high price.
In the preliminary list of medical insurance released by the National Health Insurance Bureau this year, Axileucel injection and relma-cel injection are impressively listed, and this list once aroused heated discussions in the pharmaceutical industry about whether CAR-T can enter the medical insurance this year, but in the end, both CAR-T ** failed in the medical insurance negotiations.
In fact, for this result, many industry insiders told reporters that they were "not surprised". "After the initial review of the drug, it will also pass the comprehensive review of experts, which involves pharmacy, clinical, pharmacoeconomics, and medical insurance management. In addition, the high pricing is also a hurdle between medical insurance and car-t**. The person in charge of strategic planning and business development of a listed pharmaceutical company analyzed to the reporter of the people's health client that the annual cost of high-value drugs negotiated by medical insurance over the years is basically within 300,000, and the current production process of personalized customization of CAR-T drugs determines that it is unrealistic to reduce it to less than 300,000.
With the emergence of more and more innovative drugs and medical technologies, the common goal of medical insurance payers and doctors and patients is to include more good drugs and new drugs to fill the clinical gap and enrich drug choices. But what we can't avoid is that medical insurance is limited, and before realizing a 'valuable purchase', it must first be a 'purchase in line with national conditions'. Should drugs priced at millions be paid for by Medicare?How do I pay?These are all questions. Ding Jinxi, executive vice president of the Graduate School of China Pharmaceutical University and a member of the expert database of the National Health Insurance Administration, believes that we still have a long way to go to answer this series of questions.
Medicare is not the only way out for high-value drugs.
At present, there are many innovative payment mechanisms for innovative medical technologies or pharmaceutical products in the world, such as the use of 'annuity' method of installment payment, 'risk sharing' payment mechanism, etc., in China, innovative pharmaceutical companies have also taken steps to explore innovative payment methods. Xuan Jianwei, director of the Institute of Pharmaceutical Economics of Sun Yat-sen University, said in an interview with the People's Health Client reporter.
On August 30, at Fosun Pharma's performance exchange meeting, Wu Yifang, Chairman of Fosun Pharma, said that his company continued to communicate with the National Health Insurance Administration on the issue of innovative payment for Fosun Pharma's CAR-T drugs, and the National Health Insurance Administration is also actively considering whether there are more innovative ways to solve the payment problem.
According to Fosun Kite's official news, it actively explores cooperation with all parties in innovative payment, and at present, Axileucel injection has been included in more than 60 commercial health insurances and more than 80 urban "Huimin Insurance". JW Therapeutics is also actively seeking cooperation with major insurance companies, and as of December 31, 2022, relma-cel injection has been included in 56 commercial insurance products and 75 local** supplementary medical insurance plans.
Innovent Biologics and IASO Biologics have also publicly stated that at present, Igeka Autoleucel Injection has been included in Nanjing Ninghuibao and other cities in China Huimin Insurance, and some patients have passed the commercial insurance claim review and obtained the full compensation qualification of Igagi Autoleucel Injection, and the form of compensation is paid directly by the insurance company, and there is no need for patients to pay in advance.