Presentation (CTI)

OBJECTIVES: Urban Customized Commercial Medical Insurance(UCCMI),a form of social-commercial integration insurance, represents an important component of the multi-level medical security system in China. Given this context, this study aimed to analyze the coverage status and the accessibility of anti-cancer drugs within UCCMIs.
METHODS: Data were sourced from the PharmaCube database and included 2020-2024 UCCMI insurance coverage and high-priced drugs. Descriptive statistical analysis was used to identify key characteristics of anti-cancer drugs. Affordability analysis was conducted on drugs were included in ten or more 2024 UCCMIs. Affordability ratios were defined as the out-of-pocket cost per patient divided by the 2024 urban household non-food consumption expenditure. Availability ratios were defined as the regional coverage of drugs.
RESULTS: 219 anti-cancer drugs were analyzed, corresponding to 115 UCCMI products and 208 specialty drug coverages. 42.9% (94) were listed in the National Reimbursement Drug List (NRDL). Across 108 cancer types covered, drugs for non-small cell lung cancer(n=42) were most frequently included. Regarding specialty drug coverage, deductibles (¥0-¥50,000, median ¥0) and pay-out caps (¥50,000-¥3.6 million, median ¥1 million) generally fixed amounts, while reimbursement rates were typically differentiated by pre-existing (median 80% for non-pre-existing, 30% for pre-existing). Affordability analysis showed that among 33 NRDL-listed drugs, the number of affordable drugs rose from 10 to 13 (non-pre-existing) and to 32 (pre-existing) after being reimbursed stepwise by both basic medical insurance and UCCMI. Among the remaining 43 non-NRDL drugs, only 4 and 11 were affordable under UCCMI alone. Eastern regions had the highest concentration (54 products), covering 75.3% of anti-cancer drugs, whereas northeastern regions had relatively few (2 products), covering only 29.2%.
CONCLUSIONS: UCCMI has substantially enhanced the accessibility of anti-cancer drugs in China; however, the affordability of certain expensive drugs and regional disparities in availability remain to be improved.