Qingdao's "Qindao e-Bao" product has been updated and will go on sale starting July 1, 2026. For the first time, 10 products from the national commercial insurance innovative drug list have been included in the coverage scope of the "Qindao e-Bao" Huiminbao plan. The total number of special drugs, special materials, and rare disease drugs has increased to 33, covering cutting-edge treatment areas such as CAR-T and malignant tumors. "Qindao e-Bao" is the only city-customized commercial insurance in Qingdao with government guidance and participation. From July 1, 2025, to the end of May 2026, a cumulative total of 8.48 million people purchased "Qindao e-Bao," with 135,400 insured individuals receiving claim services. The total payout amount reached 936 million yuan, of which special drugs accounted for 108 million yuan in cumulative claims.

Precise Calculations to Ensure Innovative Drugs Can "Enter and Stay Stable."

After the release of the national first-edition "Commercial Health Insurance Innovative Drug Catalog," the Qingdao Medical Insurance Bureau adhered to the principles of "precise alignment and acting within our means." It promptly communicated with local financial regulatory authorities to guide the underwriting companies in thoroughly investigating basic drug information, clinical costs, and local incidence rates of corresponding diseases. A tripartite calculation mechanism of "government guidance + insurance actuarial analysis + pharmaceutical company negotiation" was established. The medical insurance department provided data support and directional guidance, the financial regulatory department offered policy support, the insurance companies assumed primary actuarial responsibility, and pharmaceutical companies provided negotiated discounted prices to benefit the public. Under the premise of ensuring the safety and sustainability of the Huiminbao funds, the underwriting company prioritized the selection of 10 products with high clinical value, urgent public need, and controllable fund impact for inclusion in the 2026 coverage plan. This approach avoids the risks associated with pursuing a large number of varieties, forms an effective complementary connection with basic medical insurance, and ensures that patients who truly need the drugs can "use them and receive reimbursement."

Unblocking Hospital Endpoints to Allow Prescriptions to Be "Written and Transferred."

To address the issues of "hospitals not prescribing and pharmacies not stocking," a special notice titled "Notice on Doing a Good Job in the Hospital-End Implementation of Commercial Insurance Innovative Drugs" was issued. On one hand, hospitals are encouraged to stock and use commercial insurance innovative drugs. For drugs already in the hospital procurement list, the process of matching them with the medical insurance catalog should be completed as soon as possible to ensure smooth settlement channels. On the other hand, for drugs not yet in the procurement list, they are all included in the hospital's external prescription dispensing catalog, with simultaneous system integration with the electronic prescription circulation platform. Additionally, hospitals are guided to maintain their end systems properly, ensuring that doctors have "a catalog to choose from and a channel to use" when prescribing. This places the decision-making power in the hands of clinical doctors and patients, preventing commercial insurance innovative drugs from being denied simply because they are "not available in the hospital."

Strong Policy Support to Enable Hospitals to "Truly Use and Willingly Use" the Drugs.

The "three exclusions" policy is strictly implemented. Drugs included in the "Qindao e-Bao" commercial insurance innovative drug list are not subject to the basic medical insurance self-payment rate indicator assessment, are not included in the monitoring scope of alternative drugs for centralized procurement winning products, and related cases are not included in the cost accounting scope of payment by disease type. Regarding the requirement of not being included in the payment-by-disease-type scope, Qingdao has clarified in its newly introduced DRG special case single discussion policy that cases at designated medical institutions using the aforementioned drugs can declare for DRG special case single discussion on a factual basis. These cases will not count towards the institution's declared case proportion and will be paid on a per-project basis after review and approval. This policy eliminates concerns from some hospitals that using innovative drugs might increase the basic medical insurance self-payment rate, crowd out the usage of centralized procurement winning products, or inflate case costs under the payment-by-disease-type model, thereby increasing hospitals' motivation to stock and use innovative drugs.