China's Dual-Track National Reimbursement Drug Negotiation: Five CAR-T Therapies Vie for Inclusion in Innovative Drug List
Juventas
Innovative Cell Therapy Drug Developer
Once priced at millions, making it unaffordable for ordinary patientsCAR-TCell therapy sees a turning point in the 2025 National Medical Insurance negotiation, making its first appearance at the negotiation site and participating."Commercial Insurance Innovative Drug List"Price Negotiation.
Commercial Insurance Innovative Drug List Debuts, Third Payment Channel for High-Value Drugs Opens
On September 20, the National Healthcare Security Administration announced the 8th adjustment to the medical insurance directory, marking the first time a commercial insurance innovative drug list was added outside the basic medical insurance directory, featuring 5 drugs.CAR-TAll drugs have passed expert review, but they failed to be included in the basic medical insurance catalog multiple times before.
Screenshot source: National Healthcare Security Administration
November 2,Fosun Karryand many otherCAR-T Pharmaceutical company representatives participate in the "Commercial Insurance Innovative Drug List Price Negotiation".JuventasTheNaciorl InjectionNegotiation succeeded, becoming the first CAR-T product to make progress via the commercial insurance pathway. In the past decade, China's innovative drug industry has "exploded," but "payment capability" has become an obstacle between patients and new drugs.
China's Basic Medical Insurance Rejects Over 70% of High-Cost Innovative Drugs from 2020-2024 Due to High Prices, Patients Face Heavy Burden in Paying for Expensive Treatments like CAR-T. The establishment of a commercial insurance innovative drug list targets the pain points of the innovative drug payment system. For enterprises, it means clearer market expectations and diverse access pathways, providing a sustainable innovation return mechanism that incentivizes R&D investment. Its pricing mechanism adopts confidential negotiations, balancing the protection of corporate trade secrets with the international competitiveness of China-produced innovative drugs.
Dual-Track Approach: CAR-T Drugs May Open the Door to Medical Insurance
The major breakthrough in China's national medical insurance negotiation system this time lies in the adoption of a "basic medical insurance + commercial insurance directory" dual-track parallel model, providing a "buffer zone" to achieve a progressive access path of "commercial insurance first, then medical insurance."
This year, a total of 121 drugs passed the formal review for inclusion in the commercial insurance catalog, of which 79 applied for inclusion in both catalogs. This system design maintains the "basic protection" positioning of basic medical insurance while establishing a dedicated payment channel for high-priced innovative drugs, achieving multi-level protection. The commercial insurance catalog is also accompanied by several innovative support measures: innovative drugs included in the catalog may not count towards the self-payment rate index of basic medical insurance, and eligible drugs may be exempt from diagnosis-based payment systems, eliminating management concerns for medical institutions using high-value innovative drugs.
As of now, the five CAR-T drugs launched in China have achieved a certain level of reimbursement coverage through commercial insurance channels, mainly relying on惠民保, million medical insurance, and mid-range medical insurance for payment, including Juventas.
IfNaciorlase"Successfully passing the test" will become the first CAR-T drug to enter China's national medical insurance system, marking a groundbreaking milestone. It signifies the transformation of the medical insurance system from "basic protection" to "supporting innovation," breaking the implicit threshold of "no negotiation for drugs over 500,000 yuan and no inclusion for those over 300,000 yuan," providing a new model for the payment of high-value innovative drugs. If high-priced CAR-T drugs can be included in medical insurance, it will boost the confidence of local biopharmaceutical companies, encourage investment in high-value cell therapy research and development, promote standardized and regulated application of therapies, and foster coordinated development across the upstream and downstream industrial chain.
Overall, whether CAR-T cell drugs can be included in medical insurance is not only a drug access event but also a comprehensive reflection of China's medical insurance system's payment for high-value innovative drugs, industrial support, and patient protection capabilities. Once successful, it will become the "first medical insurance drug" in China's cell therapy field, providing a demonstration and confidence for the subsequent inclusion of CAR-T products in medical insurance. We are waiting for the official announcement.
Medicare Negotiations Advance, Commercial Insurance Innovative Drug List Price Consultations to Begin. Five CAR-T products, multiple rare disease drugs, and other innovative medicines await new pathways to patients. The birth of the commercial insurance innovative drug list opens a new payment window for high-value drugs, marking the transformation of the medical insurance system towards "multi-party co-payment." Driven by policy and industry, China's innovative drug sector is entering a new era of high-quality development.
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