The real trend of pharmaceutical innovation payments

As the CbRC issued the Circular on Problems and Related Risks in the Short-term Health Insurance Business of Some Property and Casualty Insurance Companies to all banking and insurance regulatory bureaus and property insurance companies, the medical insurance business of specific pharmaceutical groups carried out by insurance companies and Platforms such as Internet hospitals and medical technology was investigated and reported to the regulator

Since Medicare began to reform drug price payments, pharmaceutical companies have begun to seek new payers to make up for the loss

However, as the auto insurance business faces bottlenecks, property and casualty insurance companies need to seek new growth points, and the previously booming health insurance has become a key area

Since the main cost of China's healthcare system is drugs rather than services, this has led to a return

Packaging the pharmaceutical business into insurance products is not a new business, but the original insurance company itself is in a period of high development, there is no strong demand for such non-compliant business, and the overall market size is small

Of course, with the suspension of supervision, the drug insurance business can no longer be carried out, and this ten-billion market no longer exists, but what is left for the market to think about is whether pharmaceutical innovation payment really exists, or it is only the concept

From the perspective of the US market, the payment for pharmaceutical innovation is more concentrated in paying by effect, and commercial insurance has a clearer set of assessment models

Outcomes-Based Contracts (OBCs) refer to the fact that the payer includes a certain type of drug in the reimbursement scope within a specified period of time, and collects data on users who have already taken the drug during this period to analyze whether the drug reduces the overall medical cost, especially whether it reduces the readmission rate and re-visit rate, and some also specifically examines whether it can reduce mortality

In contrast, in the Chinese market, the positioning of commercial insurance is a supplement to medical insurance rather than a substitute, and its compensation for drugs is concentrated in the self-financing part of the medical insurance directory and some drugs outside the medical insurance directory, and the ability to pay cannot exceed the premium scale

More critically, the benefit attributes of insurance and the interest attributes of technical treatment methods such as drug consumption are contradictory

Users who really want to buy insurance protection value broad spectrum, future, and comprehensiveness as much as possible:

Broad spectrum: The coverage of insurance products needs to be comprehensive, not limited to one disease or one type of protection (such as only drugs

Futuristic: Guarantee continuous and comprehensive coverage of new technologies and products, rather than just current treatments

Comprehensiveness: Not only the breadth, but also the depth and strength of the protection should be sufficient, especially in the gap of medical insurance compensation, and there should be obvious coverage intensity

However, new technologies, new products and new services value consumption, current use, and cost are first:

Consumerity: These services and products want to drive users' continuous consumption, pursuing high frequency rather than low-frequency use

Current useability: To increase product revenue, you must drive current sales, not wait for possible gains arising from forwards

Cost is first: services and products are ready to buy, but insurance pursues risk protection, and what you hope to constrain is to buy and use

Although pharmaceutical companies, medical institutions and health management institutions have promoted many insurance product innovations in the past few years, especially in single disease or simple drug protection, none of them have been successful, either without volume or with business wandering in a gray area
.
The core of the problem is that it violates the essence of protection, just hopes to use insurance as a means of payment, and does not consider whether users need such insurance products, which leads to the inability of insurance products to appear in scale or be removed from the regulatory shelf, and there is no way to use insurance to pay
.

Therefore, if insurance is only used as a means of payment, rather than risk protection, and hopes to pay directly for drugs through insurance as a tool, such insurance innovation violates the basic principles of insurance and cannot go far
.