The status quo of the protection of special medicines for "Huiminbao", big data interpretation of 126 products!

Pharm.
com, September 2nd.
Inclusive insurance (ie, the "Benefit People Insurance" series of products) will experience explosive development in 2020
.
Among them, special medicine protection is an important selling point of "Benefiting People's Insurance", and it is also an important supplement for the protection gap of high medical expenses outside the catalog
.
Currently, major medical expenses outside of China's basic medical insurance directory is still of major disease patients poverty caused by illness is a huge risk, the treatment of major diseases, cure chronic diseases, and many other innovative drugs in the health insurance directory Outside
.
The special drug protection of universal insurance breaks through the limitation of basic medical insurance and provides supplementary protection.
Compared with ordinary commercial health insurance, universal insurance can cover the elderly and non-healthy people and is more universal
.
This article summarizes the status quo of the special drug protection of "Huiminbao" products in the market from three aspects: the types of special drugs contained in the product, the level of protection and the protection effect
.
According to incomplete statistics, 99 of the 126 "Benefits for People's Insurance" products that have been launched, a total of 99 products provide special drug protection, accounting for nearly 80%
.
From the perspective of the combination of protection, the “Human Insurance” products on the market can be roughly divided into five categories (see Figure 1 for details).
Among them, the protection content of “in-catalog hospitalization responsibility + special drug responsibility” is favored by most products
.
It can be seen that special medicines have become an important guarantee for the "Benevolent People's Insurance" products for the insured groups
.

　　Na Rute number of drugs 　　most "Waste holding" into 15 ~ 25 Species Laid drugs
"Waste protection" encompasses drug Laid drugs number 15 to 25 in most species, the average and median values are about 20 species (see FIG.
2 ) .


Among them, "Beijing Inclusive Health Insurance" and "Lecheng Special Drug Insurance" cover the most types of drugs, with a total of 100 types, including 75 overseas special medicines and 25 domestic special medicines　　


　
.
In addition, 11 products contain more than 25 types of specialty drugs, and 7 products contain more than 30 types of specialty drugs
.

　　The types of special medicines included are basically irrelevant to product pricing
.
After analyzing nearly 100 special medicines for "Huiminbao" products, it is found that the types of special medicines included in inclusive insurance are basically irrelevant to the pricing (funding level) of the products.
(Table 1 randomly selects 5 inclusive insurance products in different price ranges)
.

　
At the same time, the compensation limit and payment ratio of the "Huiminbao" liability for special drugs are also not closely related to product prices
.

　　Special medicine protection level
　　compensation ratio  over 90% of the products pay 70% and above.

Most of the "huiminbao" products have set a million insured amount, but the main factors that actually affect the effect of claims are the compensation ratio and deductible
.
In terms of the compensation ratio, more than 90% of the products pay 70% or more of the liability benefit for special drugs, more than half of the products set the compensation ratio at 80%, and a very small number of products have reached the 100% compensation ratio
.
Inclusive insurance usually does not distinguish between the compensation ratios of drugs in and out of the medical insurance catalog, but there are also products that divide the liability
.
For example, the "Benghuibao" of Bengbu City distinguishes the payment ratio of special medicines in the catalog and out of the catalog.
The special medicines in the catalog are reimbursed for 100%, while the compensation ratio for special medicines outside the catalog is 80%
.

　　Deductible  half of the products implement "0 deductible".

In terms of deductible, it is different from the general hospitalization medical liability deductible of about 20,000 yuan.
About half of the products will implement "0 deductible" for special drug liability.

.
In addition, about a quarter of the products implement the model of sharing deductibles with other insurance content, that is, package the deductibles of special drug liability and general hospitalization liability to lower the protection threshold of special drugs
.

　　Pre-existing disease compensation limit  A few products are not limited
except for the ratio of compensation and deductible extra.
"Whether the patients with pre-existing disease can be compensated" is also an important standard to measure the actual level of coverage of inclusive insurance , and it is also an important standard for the actual protection level of inclusive insurance .
An important difference between the protection effect in the sense and ordinary commercial health insurance
.
According to incomplete statistics, there are currently more than 80 products that limit the payment of special drugs for pre-existing conditions: most of these products do not provide special drug compensation for insured persons with pre-existing conditions, and a small number of products reduce the compensation standard for patients with pre-existing conditions, such as Eleven products such as Zhuhai City’s “Great Love Without Borders” differentiated the payment ratios for groups with or without pre-existing diseases (see Table 2 for details)
.

　
There are also a small number of products that do not have pre-existing disease restrictions (that is, patients with pre-existing disease enjoy the same reimbursement ratio as those without pre-existing disease)
.
This type of product mainly has the following characteristics: 1) The product price is relatively high
.
Most products cost one hundred yuan or more, surpassing the average level of about sixty or seventy yuan for most "huiminbao" products on the market
.
2) The ratio of compensation is relatively low
.
Except for "Ping An Buddha Medical Insurance", the payment ratios of other products that do not restrict the liability of special medicines are below 80%, which is lower than the median level of about 80% of the "Huiminbao" products as a whole
.
3) The level of government participation is relatively high
.
The operation of all products that do not exclude pre-existing diseases from the payment of special drugs has the participation of relevant government departments such as the Medical Insurance Bureau
.
Among them, "Yuehui Insurance" of Shaoxing City has four government departments, namely the Medical Insurance Bureau, the Finance Bureau, the Taxation Bureau, and the Banking and Insurance Regulatory Bureau, as instructors.

.
It can be seen that in order to control the large expenditures, the price and the proportion of compensation need to be adjusted accordingly to release the compensation of the special drug liability for the past disease
.
The participation of relevant departments such as the Medical Insurance Bureau will effectively help the main body of product operation to prevent the risks of the sick population
.

　　Covering disease types
　　Anticancer drugs are preferred over rare disease drugs
At present, most of the special drugs covered by universal insurance are aimed at tumors, and a small number of drugs are aimed at the treatment of rare diseases
.
According to incomplete statistics, the top ten special drugs with inclusive insurance coverage are all anti-tumor drugs
.
Among them, Baizean (Tilelizhu), Taishengqi (Atilizhu) and Zele (Nilapali) are the three most favored drugs of "Huiminbao" products (see Table 3 for details)
.

　
At present, it is reasonable and necessary for the drug indications covered by the "Huiminbao" products to be mainly tumors
.
First of all, this is based on the actual needs of a large base of cancer patients and high treatment costs
.
Studies have shown that from 2012 to 2014, the average treatment cost for patients with a high incidence of cancer in China has reached 9739 US dollars (based on the average exchange rate in 2014, equivalent to 60,000 yuan), which exceeds the entire annual income of cancer patients and is about the same as that of China’s urban residents.
2 times disposable income
.
At the same time, the incidence of cancer in China is also increasing
.
According to official data released by the World Health Organization in 2020, China has 4.
57 million new cancer cases, becoming the world's number one
.
The burden of cancer incidence and economic burden in China is very serious, but the accessibility of treatment and medicine cannot be matched with it
.
At present, the number of people entering the social basic medical insurance catalog through national talks is still very limited.
There are only 52 anticancer drugs in the medical insurance drug catalog updated in 2020
.
Combining the incidence of cancer and the level of treatment costs, multiple cancer types (indications) are selected as the starting point for the expansion of medical insurance
.
For rare diseases, although drugs for the treatment of rare diseases also have the characteristics of high prices, considering the extremely low incidence of rare diseases and the large number of rare diseases, in the initial stage of the promotion of universal insurance, most experts believe that the coverage of guarantee responsibility Should pay attention to the insured person's sense of compensation
.
Therefore, at this stage, anti-cancer drugs will be included in the list of special drugs in preference to rare disease drugs
.
With the maturity of inclusive insurance, drugs for rare diseases and other serious diseases can also be included in the list of special drugs according to the actual situation of the fund's operation
.

　　Focusing on
the drugs outside the medical insurance catalog, most of the medicines covered by inclusive insurance products are outside the medical insurance catalog, and some products only cover special medicines outside the medical insurance catalog to play a supplementary role to social insurance
.
Among the top ten medicines with universal insurance coverage, 7 have not yet entered the medical insurance catalog
.
It should be noted here that "whether to enter the medical insurance catalog" is determined based on the latest version of the medical insurance catalog in 2021
.
The vast majority of products that include the other three special drugs in the top ten with coverage rates that have entered the medical insurance catalogue will be on the market in 2020.
These drugs were not in the medical insurance catalogue when the insurance was opened, and they were out-of-list drugs at that time
.

　　Overseas specialty drug protection, the next topic.

At present, the types of specialty drugs included in Huiminbao products are basically drugs that have been marketed in China, but some products are also included in the protection of overseas drugs that have not yet been approved by the China Food and Drug Administration
.
Hainan first launched the "Hainan Free Trade Port Boao Lecheng Global Special Drug Insurance" (hereinafter referred to as "Lecheng Global Special Drug Insurance") with the help of the dividends of the free trade port construction
.
The 2020 version of the product’s first drug list includes 49 foreign special drugs and 21 domestic medical insurance special drugs; the 2021 version has expanded the drug list to 100, including 75 overseas special drugs and 25 domestic medical insurance.
Foreign special medicine
.
On this basis, Hainan’s "Huiqiongbao" has also included reimbursement for overseas special drugs, implementing designated medical institutions, designated physicians, and designated pharmacies.
The "three fixed" management model
.
The "Beijing Pratt & Whitney Health Insurance" , which was opened for insurance on July 26, 2021, also includes overseas special medicines and is expected to include 75 overseas special medicines
.
These 75 special medicines are consistent with the overseas medicine scope of Hainan's "Lecheng Global Special Medicine Insurance"
.
The exploration of overseas specialty drugs may become a topic of discussion in the next stage of the market
.
Author: Kong Weizheng, Jia Yufei, Jiang Laiyu Baorong (Insurance College, University of International Business and Economics)