On February 12, the Beijing Medical Insurance Bureau and the Beijing Local Financial Supervision Administration jointly released several measures to support the high-quality development of commercial health insurance in the city. The document proposes establishing a collaborative development platform to foster coordination between commercial health insurers and innovative pharmaceutical companies. This initiative aims to facilitate information sharing and demand alignment for innovative drugs and medical devices. It encourages insurers to include reasonably priced innovative medical products—such as those for oncology, cell and gene therapies, rare diseases, and high-value diagnostics not covered by basic medical insurance—into their coverage plans to enhance protection against major illnesses. The measures also support the formation of insurance consortiums for specific risk categories and explore the creation of risk-sharing mechanisms for innovative medicines to aid the pharmaceutical industry's growth.
The policy further advocates for innovative payment models for new drugs and devices. It calls for improving the selection and access mechanisms for commercial health insurance drug formularies, promoting negotiated pricing between insurers and pharmaceutical enterprises through a combination of company applications and expert reviews. This approach is intended to speed up the implementation of the commercial health insurance innovative drug list. Insurers and drugmakers are encouraged to explore diverse payment methods, such as outcome-based pricing and installment payments.
Additionally, the measures encourage commercial insurers to increase investment in innovative medical products through market-based channels, including venture capital and equity investment funds, with a focus on early-stage, long-term funding to support the growth of the innovative pharmaceutical sector.
To support the clinical application of innovative drugs and devices, the policy allows commercial health insurance-covered innovative medicines to be quickly listed through a green channel, excluding them from basic insurance self-pay rate indicators and centralized procurement monitoring for substitutable products. Hospitals are prohibited from restricting the use of these drugs based on formulary quotas or drug expenditure proportions. These innovative drugs are exempt from the "one product, two specifications" rule and can be supplied through designated medical institutions or pharmacies under a dual-channel mechanism. Eligible expenses for new drugs and technologies will be paid separately and not included in DRG payment standards. Cases involving commercial health insurance innovative drugs may be excluded from basic insurance DRG payment systems and reimbursed after review.