Breaking down barriers among four parties, commercial insurance partners with innovative medical devices.

**Shanghai Introduces 18 Measures Supporting Commercial Insurance and Innovative Medical Device Development**

On August 6, Shanghai's Medical Insurance Bureau released "Several Measures on Promoting High-Quality Development of Commercial Health Insurance to Support Biopharmaceutical Industry Innovation" (referred to as "Measures"). The Measures propose building a multi-layered commercial health insurance product system, including incorporating supply-demand matched new medical technologies, new drugs, new devices, and new consumables into coverage scope, and developing multi-layered commercial health insurance products and services.

The policy continues to optimize and strengthen "Shanghai Huibao," supporting the inclusion of innovative drugs and devices in coverage based on foundational data support. It encourages the development of health insurance products targeting different groups and covering more innovative drugs and devices.

In July this year, the National Healthcare Security Administration initiated adjustments to the 2025 National Basic Medical Insurance and Commercial Health Insurance innovative drug catalog. Based on past experience, after the innovative drug medical insurance catalog and commercial insurance catalog are implemented, the medical insurance catalog and commercial insurance catalog for innovative medical devices may also be scheduled.

In recent years, commercial insurance has gradually been viewed by the industry as the "second engine" for pharmaceutical and device innovation. Shanghai's Measures focus on various bottlenecks in the connection process between the two and coordinate with multiple healthcare reform policies.

For example, the innovative medical device field has long faced "data silos" issues. Commercial insurance companies find it difficult to accurately assess device performance and clinical value, lacking confidence in including them in coverage scope. The development logic and pricing standards for related insurance products have not yet been established.

According to the Measures, Shanghai will encourage medical institutions and pharmaceutical companies to promptly provide commercial insurance companies with disease and indication scope data for innovative drugs and devices, along with clinical trial data as pricing references. It encourages developing group health insurance products with unified employer coverage where employer contribution ratios are not less than a certain percentage, covering innovative drug and device cost protection, and settling simultaneously with basic medical insurance.

The policy explores establishing innovation incentive mechanisms and providing positive support and guidance for the insurance industry. Additionally, it will explore mechanisms for insurance institutions and pharmaceutical companies to form collective drug price negotiations, new drug launch communications, pay-for-performance arrangements, and installment payments to enhance accessibility and affordability of innovative drugs and devices.

**Building Multi-Element Payment Models to Accelerate Innovative Medical Device Hospital Access**

Beyond addressing insurance company concerns at multiple levels, multi-element payment models represent important market expansion opportunities for innovative drug and device companies, with more accessible hospital channels being one manifestation.

The Measures propose exploring the establishment of multi-element payment and multi-party collaborative mechanisms including medical insurance payments, commercial insurance compensation, charitable organization participation, and proactive pharmaceutical company cost-sharing to accelerate clinical application of innovative drugs and devices and facilitate their "hospital entry," "catalog inclusion," and "prescription access."

Additionally, it encourages medical institutions to reasonably use innovative drugs and devices within medical insurance catalogs. For cases unsuitable for standard disease-based payment, it supports medical institutions in independently applying for special case negotiations.

Payment mechanism reforms will activate hospitals' motivation to use innovative drugs and devices. For insurance companies and pharmaceutical device companies, increased product usage directly correlates with positive development. According to the "China Innovative Drug and Device Multi-Element Payment White Paper (2025)," China's innovative drug and device market size reached approximately 162 billion yuan in 2024, with personal out-of-pocket expenses accounting for about 44%, basic medical insurance expenditures about 50%, and commercial health insurance compensation about 7%.

Based on the significant disparity between out-of-pocket and commercial insurance proportions, and comparing with horizontal data from developed countries like Europe and America, commercial insurance still has enormous untapped potential in the innovative drug and device field. Research indicates that currently, most commercial insurance products including medical devices in coverage scope belong to high-premium premium commercial insurance with certain consumer thresholds. As diverse commercial insurance products emerge, this will benefit continued expansion of innovative medical devices.

In recent years, national policies supporting innovative medical devices have been continuously implemented, optimizing the entire chain from research and development to approval and hospital access. According to National Medical Products Administration statistics, China approved 43 innovative drugs and 45 innovative medical devices in the first half of 2025, representing year-over-year increases of 59% and 87% respectively.

As supply enriches and production capacity improves, market demand for multi-element payment will become more urgent. Based on Shanghai's latest Measures, barriers among medical insurance, commercial insurance, enterprises, and hospitals will accelerate dissolution. As production, payment, and usage ends move toward deep cooperation, the industrial ecosystem and value chain of innovative medical devices will undergo reshaping.