Exclusive: Beijing Drafts Rules to Link Private Insurance With Pricey Innovative Medicines
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China’s financial regulator is preparing to release policies aimed at integrating expensive innovative drugs into commercial insurance plans, a move designed to divert costs away from the country’s strained state-run health fund.
The National Financial Regulatory Administration plans to issue guidelines in January 2026 to facilitate the adoption of a recently unveiled commercial insurance innovative drug catalog, Caixin has learned. The policies will focus on adjusting the coverage lists of mass-market medical insurance plans, particularly for drugs where insurers currently lack sufficient data on disease incidence and treatment progression. The draft rules are currently circulating for limited feedback.
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- China’s financial regulator will issue guidelines in January 2026 to integrate innovative drugs into commercial insurance, aiming to ease pressure on state health funds.
- The commercial drug catalog offers 15%-50% discounts, with some cities already including these drugs in local medical insurance plans.
- Insurer participation is uncertain due to risk concerns, and future guidelines will clarify standards for coverage and contract terms.
- Fosun United Health Insurance
- Fosun United Health Insurance initially announced that nine of its medical insurance products would cover the new commercial drug catalog starting January 1, 2026. However, this announcement was deleted two days later, possibly due to disputes over coverage details or a decision to await unified regulatory guidance. The company's policy also excludes congenital diseases from coverage, even if the prescribed drug is in the innovative catalog.
- 2025：
- Provincial authorities begin registering innovative drugs for online procurement.
- 2025：
- Cities including Shenzhen, Ningbo, Huangshi, and Yichang integrate innovative drugs into their 2026 'Huiminbao' plans.
- 2025：
- State medical insurance annual negotiations are scheduled, focusing on updating the coverage list and demanding price cuts.
- 2025：
- NFRA shows caution, resulting in bureaucratic disputes with the National Healthcare Security Administration over the drug catalog.
- November 2025：
- Release of the specialized innovative drug catalog intended to broaden commercialization channels and relieve pressure on the state health fund.
- As of December 2025：
- Draft guidelines on adopting the commercial insurance innovative drug catalog are circulating for limited feedback.
- December 16, 2025：
- Fosun United Health Insurance announced that nine of its medical insurance products would cover the new commercial drug catalog starting January 1, 2026.
- December 18, 2025：
- Fosun United Health Insurance deleted its earlier announcement regarding coverage of the new drug catalog.
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