A Cross-Sectional Analysis of the Reimbursement Obligation for CAR-T Drugs by Huiminbao Insurances in Mainland China of 2024
Author(s)
Chunlu Wang, Candidate for Doctor1, Hongfei Gu, MS2, Baorong Yu, PhD3, Jiaqi Su, Master candidate3, Jia Zhao, Master candidate3, Jianing Ju, Master candidate3, Shengyu Xin, Master candidate3, Anthony Lacina, DHSc, MPH, MEd, CHES4.
1Massachusetts College of Pharmacy and Health Sciences, Worcester, MA, USA, 2HUO HEALTH Research division, Hexiaoduo Beijing Health Management Co., Ltd, Beijing, China, 3Center for Health Insurance & Health Services Research, University of International Business and Economics, Beijing, China, 4School of Arts and Sciences, Massachusetts College of Pharmacy and Health Sciences, Boston, MA, USA.
1Massachusetts College of Pharmacy and Health Sciences, Worcester, MA, USA, 2HUO HEALTH Research division, Hexiaoduo Beijing Health Management Co., Ltd, Beijing, China, 3Center for Health Insurance & Health Services Research, University of International Business and Economics, Beijing, China, 4School of Arts and Sciences, Massachusetts College of Pharmacy and Health Sciences, Boston, MA, USA.
OBJECTIVES: To analyze the coverage and protection level of Huiminbao insurances for CAR-T drugs, evaluate their impact on patient accessibility and market entry of high-cost drugs.
METHODS: A cross-sectional study collected data on active Huiminbao insurances in mainland China (excluding Hong Kong, Macao, and Taiwan) in 2024. The study analyzed public information on WeChat official accounts of all Huiminbao insurances, extracting data such as product names, coverage areas, eligibility, premiums, protection periods, special-drug list, deductibles, reimbursement ratios, and limits.
RESULTS: This study included 145 Huiminbao insurances , 128 of which had a special-drug list. More Huiminbao insurances are available in eastern and southern provinces, such as Guangdong and Shandong, while northern provinces have relatively higher coverage rates, with products like "Hui Meng Bao" in the Inner Mongolia Autonomous Region and "Ji Kang Bao" in Jilin Province. Among the 145 products, 90 offer CAR-T drug coverage. For healthy populations, the reimbursement ratio for CAR-T drugs is in the 50%-75% range for 37 products (41.1%) and in the 75%-100% range for 27 products (30.0%); for pre-existing condition populations, the ratios are in the 50%-75% range for 7 products (7.8%) and in the 75%-100% range for 5 products (5.6%). Regarding theoretical reimbursement amounts, 46 (51.1%) products may offer over 600,000 yuan (around 1/2 of CAR-T drug price) for healthy populations, while 4 (4.4%) products offer less than 300,000 yuan (around 1/3 of CAR-T drug price); for pre-existing condition populations, 3 (3.3%) products offer over 600,000 yuan, and 64 (71.1%) products offer no more than 300,000 yuan.
CONCLUSIONS: Huiminbao insurances have positively promoted the market entry of high-cost drugs and expanded patients' payment ability, but there are differences in geographic coverage and protection strength.
METHODS: A cross-sectional study collected data on active Huiminbao insurances in mainland China (excluding Hong Kong, Macao, and Taiwan) in 2024. The study analyzed public information on WeChat official accounts of all Huiminbao insurances, extracting data such as product names, coverage areas, eligibility, premiums, protection periods, special-drug list, deductibles, reimbursement ratios, and limits.
RESULTS: This study included 145 Huiminbao insurances , 128 of which had a special-drug list. More Huiminbao insurances are available in eastern and southern provinces, such as Guangdong and Shandong, while northern provinces have relatively higher coverage rates, with products like "Hui Meng Bao" in the Inner Mongolia Autonomous Region and "Ji Kang Bao" in Jilin Province. Among the 145 products, 90 offer CAR-T drug coverage. For healthy populations, the reimbursement ratio for CAR-T drugs is in the 50%-75% range for 37 products (41.1%) and in the 75%-100% range for 27 products (30.0%); for pre-existing condition populations, the ratios are in the 50%-75% range for 7 products (7.8%) and in the 75%-100% range for 5 products (5.6%). Regarding theoretical reimbursement amounts, 46 (51.1%) products may offer over 600,000 yuan (around 1/2 of CAR-T drug price) for healthy populations, while 4 (4.4%) products offer less than 300,000 yuan (around 1/3 of CAR-T drug price); for pre-existing condition populations, 3 (3.3%) products offer over 600,000 yuan, and 64 (71.1%) products offer no more than 300,000 yuan.
CONCLUSIONS: Huiminbao insurances have positively promoted the market entry of high-cost drugs and expanded patients' payment ability, but there are differences in geographic coverage and protection strength.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HPR6
Topic
Health Policy & Regulatory
Topic Subcategory
Insurance Systems & National Health Care, Reimbursement & Access Policy
Disease
Oncology