Shanghai's insurance options promoting biochemical industry

Shen Mengdan
City's health insurance bureau director says while enterprises may view commercial health insurance as an opponent, optimization of health insurance helps enterprises and patients.
Shen Mengdan
Shanghai's insurance options promoting biochemical industry

With multiple payment options for innovative medicines and devices through basic medical insurance and commercial insurance, Shanghai has been promoting the development of its biomedical industry, according to government officials on Friday.

A press conference summarized the results achieved after the implementation of the multi-payment mechanism in terms of innovative medicines and devices as well as the plan ahead.

In July, 2023, the Health Insurance Bureau and seven other departments jointly issued "Several Measures to Further Improve Shanghai's Multi-Payment Mechanism to Support the Development of Innovative Medicines and Devices," putting forward 28 measures in nine areas to improve payment options for innovative medicines and devices.

Seven months since its release, it has realized the seamless admission of innovative medicines and devices to hospitals, and the basic establishment of Shanghai's innovative medicines and devices multi-payment guarantee mechanism.

Results are as follows:

1. Data sharing between medical insurance and commercial insurance

In January, 2024, the "Shanghai Health Insurance Big Data Innovation Laboratory" was launched to open up health insurance data for commercial insurance after the removal of private information. The lab has already calculated big data for a number of commercial health insurance products.

2. Efficiency of commercial health insurance claims processing

Since September, 2023, fast claim payment is available on "Suishenban," an online system for government services, which enables fast claim payment for commercial insurance products. So far, 26 hospitals and 61 insurance organizations have realized direct claim payment for high-end insurance.

3. Successful promotion of the commercial health insurance

(1) Clarified tax incentives

The coverage of medical insurance has been refined. Enterprises can supplement medical insurance premiums for employees who meet certain criteria.

(2) More products with individual tax incentives

Individuals purchasing those health insurance products with tax incentives can deduct the taxable base when calculating their personal tax, with a maximum deduction of 200 yuan a month.

Since August, 2023, five insurance companies have launched 11 health insurance products with tax incentives.

(3) The establishment of an online "supermarket" of individual account products for employees' medical insurance

An online spot for purchasing commercial health insurance products has been set up in the "Suishenban", with five new products added, bringing the total to 12.

(4) Expanded coverage of subsidized pharmaceutical liability insurance

The coverage of liability insurance for human clinical trials of bio-medicine has been expended. At present, the insurance has served 195 pharmaceutical enterprises and 1,124 projects in Shanghai, providing risk protection of 7.24 billion yuan (US$1billion).

4. Effective implementation of Shanghai's commercial supplemental medical insurance program "Huhuibao"

(1) "Huhuibao" does not take age and health into consideration in terms of who to apply this insurance, which benefits almost all the population.

(2) The types of innovative and special medicines covered by the medical insurance have been increased to 38.

(3) The "quick claim" service has been optimized, with an average claim settlement time of 2.3 days and a quick claim rate of 75 percent.

In 2023, there were 6.3 million people insured under "Huhuibao," the largest number under similar products in China.

5. Rapid clinical application of innovative medicines and devices

In the new version of the national drug catalog, 38 innovative drugs developed, produced and introduced in Shanghai have been added, which is among the highest in the country.

Government authorities stipulate that medical institutions should hold a pharmacy meeting within one month of the announcement of the new version of the medical insurance drug catalog, and incorporate the admission of innovative medicines and devices into the hospital's assessment mechanism.

Before the end of January this year, the city's hospitals above the second level have all held a pharmacy meeting, of which 37 hospitals were far ahead of schedule.

It has also loosened the medical insurance quota for the use of innovative medicines and devices by medical institutions; and it has simplified the process of online registration of medical devices.

Since July, 2023, 10,700 classification codes for single-use medical devices have been added, involving a total of 333 catalogs.

6. Better payment options of innovative medicines and devices for medical insurance

(1) Wide inclusion of more innovative medicines and devices in health insurance

In October, 2023, 60 types of medical consumables were newly included in the city's medical insurance payment scope, with an annual additional expenditure of about 1 billion yuan.

(2) Medical insurance payment provided preferential treatment for innovative medicines and devices.

(3) Sales channels for innovative medicines and piloted medical insurance payment for Internet drug purchases have been increased.

Since July, 2023, all designated retail pharmacies have been included in the unified management of outpatient clinics and connected to the electronic prescription platform of medical insurance, and innovative medicines are available for sale in all 2,000 designated retail pharmacies in the city.

As of February 28, 774 designated pharmacies have carried out online medical insurance settlement.

"Enterprises tend to view commercial health insurance as an opponent. In fact, health insurance is more like an ally, the optimization of health insurance not only help enterprises, but also the patients," said Xia Kejia, director of the Shanghai bureau of health insurance.

In future, Shanghai will continue to promote the union of basic health insurance and commercial insurance in the following areas:

1. Improve and consolidate the basic medical insurance support policy

  • promote the timely inclusion of eligible innovative medicines and devices into the scope of medical insurance payment
  • optimize the process of listing innovative medicines and devices on the network
  • improve the independent pricing mechanism of medical institutions during the trial period of new projects
  • innovate preferential policies for medical insurance payment of medicines and devices
  • expand the scope of medical insurance payment for Internet drug purchase

2. Enrich the supply of commercial health insurance products

  • optimize "Huhuibao" with more products being released,
  • continue to promote "Product Supermarket" on "Suishenban"
  • corporate with qualified social media platforms to increase the popularity of commercial health insurance products,
  • expand the coverage of "quick claim," "direct claim" and "active claim"

3. Promote the integration and sharing of medical insurance and commercial insurance data

  • on the premise of ensuring data security, promote the sharing of health insurance data with commercial insurance companies, innovative pharmaceutical and equipment enterprises, and medical institutions
  • make the health insurance data sharing a national model case to attract more biomedical enterprises to invest and develop in Shanghai

In 2023, the size of Shanghai's biomedical industry was 933.7 billion yuan, and the innovative medicines purchased by medical institutions valued at 10.8 billion yuan, an increase of 73.1 percent from a year earlier.

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