As we all know, due to the natural fit between medical care and insurance, as well as the increasing health risks brought about by aging, the state has continued to promote from the policy side in recent years, encouraging pharmaceutical companies to cooperate with commercial insurance around a series of services such as cutting-edge medical technology and innovative drug research and development, so as to increase the supply of more innovative health insurance products for the society.
This has also directly accelerated the pace of cross-border insurance for pharmaceutical companies, and the integration of medical health and insurance is also accelerating. However, at a time when cross-border has become a trend and the industry is constantly deeply integrated, the practice of commercial insurance business of pharmaceutical companies is also destined to face some barriers that need to be broken through and move forward in twists and turns.
Recently, we connected in the live broadcastMa Jie, founder and CEO of Oaktree Health, and Jiang Jiangang, head of Yiduoyun Commercial Insurance and Innovative Payment of Hengrui Pharmaceutical HoldingsAt the same time, Mr. Ma and Mr. Jiang gave very constructive opinions on the challenges faced by pharmaceutical companies in the business process of cooperating with commercial insurance, as well as the future development space of pharmaceutical insurance, and also brought us some very valuable thoughts.
What are the prospects for cross-border insurance for pharmaceutical companies?
The cross-border insurance industry can help pharmaceutical companies complete the closed loop of value in terms of services, payments, and scenario landing, which simply means that pharmaceutical companies have transformed from a simple role of drug support to an important role in promoting the overall comprehensive solution of the industry, and commercial insurance as a payer is an extremely important part of this. So, from the perspective of pharmaceutical companies, what is the future development potential of commercial insurance as a payer?What are the advantages?
First, commercial insurance as a payment method has great potential for development and should be favored and supported。From a policy perspective, in August this year, Shanghai issued the "Several Measures for Shanghai to Further Improve the Diversified Payment Mechanism to Support the Development of Innovative Drugs and Devices", which is not only to promote the construction of Shanghai's multi-level medical security system, meet the diversified security needs of citizens, and reduce the burden of medical treatment for the masses;It is also to improve the multiple payment mechanism for innovative drugs and devices, guide good development expectations, and promote the high-quality development of the pharmaceutical industry and the insurance and financial industry.
In fact, this shows very clearly that the company is still willing to promote in-depth cooperation between the pharmaceutical industry and the insurance field to provide more support for the development of the innovative drug and device market. Moreover, through cooperation with insurance companies, pharmaceutical companies can bring innovative pharmaceutical products and high-quality services to more patients to help them obtain a higher quality of life and improve their level, and at the same time, in this integration process, they also meet the expectations for the steady development of the entire medical industry.
Second, from the perspective of market demand, whether it is a pharmaceutical company or an insurance company, the core of the products launched for the market is to solve the rigid demand problem of the target object. From the perspective of pharmaceutical companies, patients have a natural demand for innovative drugs, and hope to take this opportunity to try different new methods to obtain better efficacy. However, the reality is that the R&D cost of an innovative drug is very high, which virtually makes its listing rate extremely low, and the later listing price will be higher than that of traditional drugs.
Therefore, it will be difficult for patients to make a choice in the face of innovative drugs, and they will not be able to afford the high cost of drugs for a long time, even if the state has used various methods to let many innovative drugs enter the medical insurance in the past six years, and the payment pressure of patients for some innovative drugs has been solved through medical insurance payment tools, but for different innovative drugs, it takes a time period to be included in the medical insurance after they are listed, and the scope of medical insurance coverage and the proportion of compensation are also limited. For patients who need to use relevant innovative drugs for a long time, it is obvious that they have to wait for a long time and bear high costs and payment costs, which increases the pressure.
At this time, if commercial insurance is introduced and combined with medical insurance, it will be able to alleviate the burden of medical expenses on patients and the whole family to a large extent, and also allow more patients to have the opportunity to obtain high-quality medical services and enjoy the best results brought by innovative drugs.
Of course, when a pharmaceutical company decides whether to launch or implement an innovative commercial insurance project, it also needs to consider the following five factors:
1) According to the market demand and opportunities, combined with the target customer needs and pain points of the pharmaceutical company's own products, in order to evaluate whether the innovative payment model of commercial insurance can help customers solve the demand, alleviate the payment pressure and improve the level of excellence, etc., and truly improve the acceptance of patients and their families to the new project.
2) It is necessary to comprehensively consider the experience and capabilities of partners, including the partners' service network, execution experience, refinement capabilities, risk control capabilities, etc.
3) Since the state has repeatedly issued laws and regulations from the regulatory level to regulate the development of this new type of business, pharmaceutical companies must comply with relevant laws and regulations and the requirements of financial supervision when landing commercial insurance projects, so as to achieve sustainable development.
4) A large amount of sensitive data of patients has been set up in the implementation of the new commercial insurance project, and how to effectively ensure the security of personal data is also an extremely important consideration.
5) In terms of business model and profitability, it is also a key part of whether the innovative commercial insurance project can ensure the win-win situation of insurance companies, pharmaceutical companies, TPA companies and other parties.
Creating a new win-win model for all parties is the key to realizing the integration of medicine + insurance
It is true that there will be a certain run-in period in the business process of cooperation between pharmaceutical companies and commercial insurance, and Mr. Ma believes that there will be the following three challenges to be overcome during this period:
First, due to the acceleration of the integration of commercial insurance in the field of health insurance, the premium income is also growing step by step, but the integration with the pharmaceutical industry is still in the early stage of development, which leads to an extreme lack of compound talents with rich experience in commercial insurance within the pharmaceutical industry. In particular, pharmaceutical companies and partners are facing great challenges in the process of exploring innovative payments for commercial insurance, seeking talents with relevant knowledge and experience in both the insurance and pharmaceutical industries.
Second, in recent years, the state has become more and more strict in the supervision of the insurance industry, in this context, how to make the insurance products cooperated by the two sides meet the regulatory requirements, and truly solve some of the risk needs of patients, is also a great challenge。Moreover, with the implementation of the whole project step by step, the entire economic environment is in a relatively sluggish state, the budget of pharmaceutical companies and insurance companies is limited, and there are great challenges in the pricing fee structure.
The third is how to enable the insurance products that have been implemented with the cooperation of all parties to reach a wider range of patients through appropriate channels, so that more people can know that insurance can solve the risk of disease and the cost of follow-up medicationThis is also a challenge faced by pharmaceutical companies in launching products in the market under the cooperation of commercial insurance.
In response to this problem, Mr. Jiang further added that to do any kind of innovative model, we must comprehensively consider the demands of all parties and balance the interests, and only by creating a win-win project for all parties can we maintain the long-term stable, sustainable and healthy development of the industry.
It can be seen that the market's requirements for the innovation and integration of pharmaceutical insurance are actually increasing, so what aspects need to be paid attention to in the development of this kind of business?Are there any new opportunities for the participating companies in this track?
First of all, the point to pay attention to is still on compliance requirements, that is, when launching this type of innovative businessAll participants are required to comply with various regulatory requirements, including financial regulation and drug safety regulation.
Second, it is necessary to be able to find a win-win balance for pharmaceutical companies, insurance companies and patients. As we all know, there must be a payer behind the formation of a complete business project, if it is a pharmaceutical company as the payer, it is necessary to make the corresponding ROI calculation for the patient's ability to pay, and if it is from the perspective of the patient as the payer, it is necessary for all participants to pay attention to whether the patient's follow-up cost can be effectively reduced, and whether the uncertain risk faced by the follow-up can be reasonably guaranteed.
Finally, with the continuous strengthening of the basic protection and sustainable positioning of medical insurance, commercial insurance, as a supplement to the multi-level medical security system, can effectively cover the mid-to-high-end innovative drugs and devices or new ones, which is the mission of commercial insurance in the development of China's commercial health insurance, and the imagination space is very large.
In particular, at present, all participants are committed to solving the problem of high product prices and high pressure to be included in medical insurance due to the high R&D costs of innovative special drugs. So how to find the entry point of commercial insurance payment, so as to design an innovative drug insurance plan suitable for commercial insurance, which can greatly reduce the payment pressure and payment threshold of the entire patient group and benefit from it, forming a win-win situation for all parties, which is a direction worthy of in-depth exploration for the participants of the entire track.
Under the accelerated integration, what is the future development space of pharmaceutical insurance?
It is foreseeable that in the future, more pharmaceutical companies will begin to lay out the insurance field, and continue to deeply integrate with insurance companies to develop innovative pharmaceutical insurance based on market demand. So what are the new trends and new development space for the development of pharmaceutical insurance?What opportunities are there for all pharmaceutical companies?
First, in terms of commercialization, China's commercial health insurance still has a lot of room for development in its role as a payerAt present, the proportion of the country's total public health costs that it actually pays is still low. In other words, commercial insurance, as a very important part of the multi-level medical security system, is actually an order of magnitude different from the total scale of self-payment and medical insurance.
The second is to cooperate with commercial insurance for innovative payment projectsThe first is the medical insurance products that may be relatively high in terms of user cost burden and very high pressure on patients to payThe second is the medical insurance products that will also cause a lot of pressure on the medical insurance after they are successfully included in the medical insurance, which is highly consistent with the medical needs of the entire multi-level security system to cover the middle and high-end, which also means that these products may be more suitable for pharmaceutical companies to carry out in-depth cooperation with commercial insurance New project categories.
In general, although it is very common for pharmaceutical companies to enter the insurance industry, the insurance industry is a special industry with business risks, and pharmaceutical companies need long-term matching and running-in if they want to fully integrate into it. With the deepening of people's attention to disease and health, the demand for mutual integration between the two sides will become more and more intense, and we also hope that pharmaceutical companies can bring more surprises to the market in the field of commercial insurance, and at the same time bring more imagination to the industry.
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