Two 'Million-Dollar-Per-Dose' CAR-T Cancer Therapies Listed in Commercial Insurance Innovation Drug Directory Achieve Hospital Access in Over 150 Institutions, While Peer Products Remain Unavailable

The new edition of the basic medical insurance drug list and the commercial insurance innovative drug list has been implemented on January 1, 2026. After the official implementation of the commercial insurance innovative drug list, the inclusion of listed drugs into hospitals and their commercialization have become key focuses.

Recently, the National Healthcare Security Administration (NHSA) issued a document stating that, in order to promote the implementation of negotiated medicines and facilitate insured individuals in querying and purchasing medicines, the NHSA has organized relevant enterprises to submit the list of medical institutions equipped with newly negotiated medicines and commercially insured innovative medicines included in the 2025 edition of the National Reimbursement Drug List (NRDL). The administration has focused on scheduling baseline information regarding the allocation of newly negotiated medicines added to the NRDL and commercially insured innovative medicines in 2025.

In terms of the commercial insurance innovative drug list, according to data published by the National Healthcare Security Administration, as of January 11, 2026, among the 19 commercial insurance innovative drugs, 16 have information on equipped institutions. Among them, more than 30 provinces are equipped with Ipilimumab Injection, over 20 provinces are equipped with seven drugs, and over 10 provinces are equipped with 12 drugs.

According to the statistics of equipped institutions as of January 11, more than 300 institutions are equipped with lecanemab injection for Alzheimer's disease treatment and ipilimumab injection for cancer treatment. Over 200 institutions are equipped with two CAR-T drugs: idecabtagene vicleucel injection and zevor-cel injection. Meanwhile, three commercial insurance innovative drugs in the catalog have not yet been allocated to designated institutions.

The National Healthcare Security Administration also stated that it will focus on the varieties not yet equipped in designated medical institutions, strengthen monitoring, and supervise enterprises to ensure the drug rights of insured individuals.

Regarding the possible reasons why some drugs have not been equipped with designated institutions, Jin Chunlin, Director of the Shanghai Health Development Research Center, pointed out in an interview with the Times Weekly reporter that first, some drugs require injection or cold chain delivery, but pharmacies may lack the corresponding facilities and conditions.

Secondly, the catalog contains many drugs for rare diseases or specific conditions, with a small patient population and demand limited to a few large hospitals, resulting in restricted availability. Moreover, the decline in drug prices has led to thin profit margins, reducing the willingness of pharmaceutical institutions to stock them. Additionally, special treatments like CAR-T cell therapy are difficult to implement in regular pharmacies or small hospitals.

Image Source: Tuchong Creatives

Significant Differences in the Availability of Certain Medications

The Commercial Insurance Innovative Drug List aims to fill the coverage gaps in the National Basic Medical Insurance Drug List, meeting patients' diverse medication needs. However, the inclusion of drugs from the list into hospitals and their actual implementation remain issues of widespread concern within the industry.

According to the specific statistics on drug allocation institutions published by the National Healthcare Security Administration, there are significant differences in the hospital entry situations of various products. The coverage of provinces and the number of equipped institutions for similar drugs also vary considerably.

In the highly anticipated "million-dollar-a-shot" CAR-T products, as of January 11, IASO Bio's Equecabtagene Autoleucel Injection covers 24 provinces in China, with 167 designated medical institutions and 58 designated retail pharmacies.

CARsgen Pharma's (02171.HK) Zevor-cel injection covers 22 provinces in China, with 162 designated medical institutions and 58 designated retail pharmacies. The number of provinces and allocated institutions for these two products is higher than other CAR-T products.

In addition, Fosun Kite's Axicabtagene Ciloleucel Injection, under Fosun Pharma (600196.SH; 02196.HK), covers 10 provinces in China, with 10 designated retail pharmacies, but has not yet been allocated to designated medical institutions.

Relma-cel Injection from JW Therapeutics (02126.HK) and Narta-cel Injection from Hoin Biotechnology have not yet been distributed to designated medical institutions and designated retail pharmacies, with zero provinces and designated institutions equipped.

In the commercial insurance innovative drug catalog, there are two drugs used to treat mild cognitive impairment and mild dementia caused by Alzheimer's disease, and the availability of these two drugs varies.

As of January 11, Eisai's lecanemab injection has been distributed across 29 provinces in China, with 115 designated medical institutions and 214 designated retail pharmacies, the highest number of equipped institutions among the 19 commercial insurance catalog drugs. In contrast, Eli Lilly's (LLY) donanemab injection covers five provinces, with 11 designated medical institutions and no designated retail pharmacies currently equipped.

Among the medicines for rare disease treatment, there are six drugs in the commercial insurance innovative drug list used to treat high-risk neuroblastoma, hyperphenylalaninemia, malignant pleural mesothelioma, short bowel syndrome, Gaucher's disease, and other rare diseases.

Among them, Bristol-Myers Squibb's (BMY) Ipilimumab Injection has the widest coverage in terms of provinces and equipped institutions, covering 30 provinces, with 140 designated medical institutions and 168 designated retail pharmacies. The indications for Ipilimumab Injection are not limited to rare diseases; apart from malignant pleural mesothelioma, it also includes relevant indications for colorectal cancer and hepatocellular carcinoma.

Sai Life Sciences' Naxitamab Injection is used to treat high-risk neuroblastoma, covering 19 provinces in China with a total of 70 designated institutions. BeiGene's (06160.HK; 688235.SH) Danyelza (Dinutuximab Beta) Injection is also used to treat high-risk neuroblastoma, and the drug covers six provinces in China with eight designated medical institutions.

Among other rare disease drugs, Shandong New Era Pharmaceutical's sapropterin hydrochloride tablets for the treatment of hyperphenylalaninemia cover 19 provinces, with a total of 30 designated institutions; Takeda Pharmaceutical (TAK)'s teduglutide injection for short bowel syndrome covers 10 provinces, with a total of 23 designated institutions; CANbridge (01228.HK)'s velaglucerase alfa injection for type I and type III Gaucher disease covers 9 provinces, with 11 designated retail pharmacies.

Why Are There Differences in the Availability of Similar Drugs?

Regarding the regional coverage of innovative commercial insurance drugs, Professor Zhu Junsheng, a postdoctoral fellow in applied economics at Peking University, pointed out in an interview with the Times Weekly that since the commercial insurance catalog is based on惠民保and there are differences in funding levels across regions, pharmaceutical companies need to pay attention to the progress of commercial insurance implementation in different areas and the corresponding drug coverage.

"After a drug is successfully included in the commercial insurance catalog, it does not mean full coverage across China, but rather depends on local regions deciding whether to include it based on their actual conditions. Therefore, pharmaceutical companies' market promotion strategies must pay more attention to regional differences," analyzed Zhu Junsheng.

Significant differences exist in the number of institutions equipped with drugs in the commercial insurance innovative drug directory, influenced by various factors. Jin Chunlin pointed out to reporters from the Times Weekly that, firstly, differences in drug characteristics and treatment plans play a role. For instance, CAR-T cell therapy requires high drug stability, preparation time, sterile environments, and specialized medical teams, limiting the number of hospitals capable of offering it.

Secondly, regarding the mode of administration and patient management, some drugs that require regular intravenous injection impose high demands on hospital infusion centers and patient compliance, whereas oral medications are easier to promote. In terms of clinical evidence and expert recognition, new drugs need to be included in medical insurance before entering hospitals; medical institutions are not familiar enough with them, and expert recognition and recommendations need to be gradually established.

The difference in market entry times is also a contributing factor; drugs that enter the market earlier gain access to hospitals more quickly, while those that enter later face higher barriers and greater competitive pressure.

In addition, it is the selection of hospital levels. Innovative drugs mostly target high risks or complex diseases and are often concentrated in national or regional medical centers, which are difficult for general hospitals to equip.

"The differences in the availability of similar drugs are the result of the combined effects of drug characteristics, market strategies, payment environments, and timeframes. It is necessary to promote direct connections between commercial insurance and hospital information systems, improve the prescription circulation mechanism, optimize hospital evaluations, and enable real-time calculations to facilitate reimbursement linkages," analyzed Jin Chunlin.

Equipping entry into medical institutions is one of the key steps for the commercial insurance innovative drugs to be implemented, and it is an important factor affecting the commercialization effect of the drugs. However, at the same time, there are many other steps in the implementation of commercial insurance innovative drugs that need attention.

Zhu Junsheng pointed out that for the 19 drugs successfully included in the commercial insurance directory, pharmaceutical companies need to closely monitor several key aspects during the process of aligning with commercial insurance and market promotion, such as pricing, regional coverage, coordination with medical insurance policies, claims and settlement procedures, market education, real-world evidence support, and policy changes.

"Through refined market strategies and flexible adjustments, pharmaceutical companies can steadily promote the market promotion and coverage of drugs within the framework of commercial insurance catalogs, maximizing the market potential of products," said Zhu Junsheng.

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