Hainan Lecheng Global Special Drug Insurance Debuts at International Medical Device & Drug Expo with Hospital-Insurer Direct Settlement and Pharmacy Claim Reimbursement

On April 10, 2020, the “Healthy Hainan – Lecheng Tour and the Opening Ceremony of the ‘Never-Ending’ International Pharmaceutical and Medical Device Exhibition” was held as scheduled in the Hainan Lecheng Pilot Zone. At the event, the “Boao Lecheng International Medical Tourism Pilot Zone Insurance Comprehensive Service Platform” (hereinafter referred to as the “Insurance Comprehensive Service Platform”), jointly established by the Lecheng Pilot Zone and Yuanxin Huibao, was officially unveiled.

Boao Lecheng International Medical Tourism Pilot Zone and Yuanxin Huibao Jointly Establish the “Boao Lecheng International Medical Tourism Pilot Zone Integrated Insurance Service Platform”

On the day of the conference, the Integrated Insurance Service Platform also launched “Hainan Lecheng Global Special Drug Insurance,” an inclusive medical insurance product for Hainan that provides cost reimbursement for special drugs sourced both domestically and abroad. This insurance features numerous highlights: in addition to its affordable pricing, no age or health status restrictions, and coverage of special drugs approved overseas, it enables patients to receive immediate reimbursement at the point of care through direct settlement between hospitals, social commercial insurers, and pharmacies. Whether obtaining medications at a hospital or a pharmacy, patients can enjoy real-time reimbursement. The launch of Hainan Lecheng Global Special Drug Insurance drew significant attention from participating pharmaceutical companies and attendees alike.

Led by the Boao Lecheng Pilot Zone Administration, Achieving Full Coverage of Global Specialty Drugs in Lecheng and the Goal of “No Need to Leave the Island for Major Illnesses”

“Hainan Lecheng Global Special Drug Insurance” (hereinafter referred to as “Lecheng Special Drug Insurance”) is an inclusive medical insurance product providing cost compensation for special drugs from both domestic and international markets, available in Hainan. Spearheaded by the Administration Bureau of Boao Lecheng International Medical Tourism Pilot Zone, under the guidance of regulatory bodies including the Hainan Provincial Bureau of Banking and Insurance Regulation and the Hainan Provincial Healthcare Security Administration, and developed in collaboration with Yuanxin Huibao, the policy is underwritten by China Life Property & Casualty Insurance Company Limited.

The Lecheng Special Drug Insurance covers nearly 40 special drugs approved for marketing both domestically and overseas, with a maximum claim limit of RMB 1 million. Eligibility for enrollment is open to any individual who was enrolled in Hainan’s local basic medical insurance scheme in the previous year, with no restrictions on age or health status. The product has already been filed with the China Banking and Insurance Regulatory Commission.

Photo of Peng Xuan, Co-CEO of Yuanxin Huibao, Discussing the Boao Lecheng Special Drug Insurance with Relevant Officials

Lecheng Special Drug Insurance will provide comprehensive pharmaceutical solutions for special drugs available both domestically and internationally. As the first domestic insurance product tailored to the policies of the Lecheng Pilot Zone, it extensively references claim incidence and settlement data from basic medical insurance and critical illness insurance when finalizing its drug formulary, ensuring broad coverage across multiple cancer types. The launch of this product is expected to become a benchmark project within the Boao Lecheng International Medical Tourism Pilot Zone, offering a model example for fostering innovative development in health insurance and building a multi-tiered healthcare security system. It will also facilitate the collection of more real-world clinical research data, further solidifying the Pilot Zone’s position as the gateway for the latest global pharmaceuticals entering China.

Yuanxin Huibao: Connecting key medical institutions and pharmacies across the province, enabling direct settlement of social and commercial insurance within hospitals and direct reimbursement for pharmacy medications

It is understood that Yuanxin Huibao, as the operator and service provider of an integrated insurance service platform, will engage in deep collaboration with relevant authorities such as the Healthcare Security Administration and the Health Commission. It aims to gradually integrate with medical insurance and hospital settlement platforms, thereby facilitating the implementation of direct in-hospital pharmaceutical expense settlement and out-of-hospital drug claim reimbursement across all designated medical institutions and pharmacies in the province through the use of electronic insurance enrollment credentials.

The Boao Lecheng Special Drug Insurance will subsequently coordinate with relevant departments of the Hainan Provincial Government to promote the launch of direct settlement services for in-hospital medication costs at 32 medical institutions across the province. Once a claim is approved, insured individuals can present their commercial insurance credentials at designated hospitals to achieve direct settlement for medication costs covered under the commercial insurance policy within the hospital. If treatment requires special drugs approved only overseas, insured individuals must receive treatment at designated hospitals in the Boao Lecheng International Medical Tourism Pilot Zone. Upon approval of the claim, they can complete the direct settlement for overseas medication costs by presenting their commercial insurance credentials, without needing to pay out-of-pocket for the overseas drugs.

For medications not available within the hospital but accessible externally, insured individuals who have passed claims review can utilize direct payment services for these drugs at designated pharmacies by presenting their commercial insurance credentials and relevant prescriptions.

 RWSI Initiative: Facilitating Real-World Studies on Unapproved Drugs and Off-Label Use of Marketed Specialty Drugs in China

“RWSI Program” is the abbreviation for the “Hainan Boao Lecheng Global Special Drug Insurance and Real-World Study Insurance Plan” launched by Yuanxin Huibao. RWSI (Real World Study Insurance) is derived from Real World Study (RWS). Yuanxin Huibao aims to collaborate with global pharmaceutical manufacturers in the product design of the Hainan Boao Lecheng Global Special Drug Insurance, expand the list of foreign medications, and obtain clinical data on the use of cooperative foreign drugs that are not yet registered in China but are urgently needed for clinical import among the overall insured population. This data will be converted into real-world data to accelerate the registration and approval of new drugs in China, enabling more patients to access foreign medications at an earlier stage.

Peng Xuan, Yuanxin Huibao: Expanding the Lecheng Model Nationwide to Achieve Seamless Integration of National Insurance Policies with Hospitals at All Levels

“The opening of social insurance and commercial insurance reimbursement channels at hospitals within Hainan Province has resolved patients’ financial concerns, enabling them to access medications better suited to their medical conditions without worrying about the economic burden that out-of-pocket expenses for non-covered drugs may impose on individuals and families. Meanwhile, the establishment of these in-hospital reimbursement channels for both social and commercial insurance has significantly reduced the time cost associated with claims processing, greatly enhancing the reimbursement service experience for the Hainan Boao Lecheng Global Special Drug Insurance and social insurance, thereby achieving truly seamless integration.” Peng Xuan, Co-CEO of Yuanxin Huibao, stated, “With the Lecheng Special Drug Insurance as our starting point, Yuanxin Huibao plans to expand this model to more cities in the future, allowing residents across additional regions to benefit from treatment options involving drugs not yet launched in China, similar to the access currently available in Hainan.”

As a subsidiary of Beijing Yuanxin Technology Co., Ltd., Beijing Yuanxin Huibao Technology Co., Ltd. has established branches in Beijing, Shanghai, and Guangzhou. Leveraging its parent company’s advantages and resources in the pharmaceutical sector, it utilizes over 200 self-operated pharmacies located near hospitals and DTP (Direct-to-Patient) pharmacies across 70 cities in China, along with more than 100,000 cooperating physicians from Miaoshou Internet Hospital, to serve major domestic and international insurance companies. It provides insurers with high-quality services, including specialty drug coverage and online consultation with medication delivery, thereby helping insurers enhance risk control capabilities and improve user experience.