Disease Burden and Medical Insurance Expenditure of National Price-Negotiated Drugs for Multiple Sclerosis Under Dual-Channel Model in China: A Budget Impact Model

Author(s)

Zhao Z1, Hu M2
1West China School of Pharmacy, Sichuan University, Chengdu, Sichuan, China, 2West China School of Pharmacy, Sichuan University, Chengdu, China

Presentation Documents

OBJECTIVES: To improve the accessibility of national price-negotiated drugs, the Chinese government encourages the reimbursement of these drugs through designated pharmacies alongside the regular hospital reimbursement route (named dual-channel model). Reimbursement policies through the dual-channel model may align with different medical insurance policies in each province, resulting in varying deductible lines, reimbursement ratios, and yearly caps, which may affect the medical insurance expenditure and patients’ affordability. This study aims to measure and compare the budget impact and disease burden of 4 main medical insurance policies in the context of dual-channel model on drugs for the rare disease multiple sclerosis(MS).

METHODS: A budget impact model was built to simulate 4 reimbursement scenarios and measure the medical insurance expenditures and patients’ burden for 5 national price-negotiated drugs for MS. Epidemiological data sourced from literature studies, cost data obtained from the Chinese market, and reimbursement baseline data derived from policy research. One-way sensitivity analysis was conducted.

RESULTS: For these 5 drugs, the medical insurance expenditures for the target population in 2024 would be ¥287.8 million, ¥283.62 million, ¥266.51 million, and ¥236.39 million under outpatient chronic and special disease payment policy(scenario A), dual-channel separate payment policy (scenario B), special drug policy(scenario C), and other outpatient policies(scenario D). The annual patients’ burden differs from ¥24,966 to ¥97,000 for 5 drugs. Patients under scenario A has generally less burden than other scenarios, while the most expensive drug Ofatumumab has the lowest patient burden of ¥44,100 under scenario B due to its high deductible line but high reimbursement ratio and cap line, the expenditures would be ¥701,300.

CONCLUSIONS: For MS, the outpatient chronic and special disease payment policy incurs the highest medical insurance expenditures, minimizing the patient burden. For high-priced innovative drugs, the dual-channel separate payment policy proves the most effective in alleviating patients’ disease burden.

Conference/Value in Health Info

2024-05, ISPOR 2024, Atlanta, GA, USA

Value in Health, Volume 27, Issue 6, S1 (June 2024)

Code

HPR111

Topic

Health Policy & Regulatory

Topic Subcategory

Coverage with Evidence Development & Adaptive Pathways, Insurance Systems & National Health Care, Public Spending & National Health Expenditures, Reimbursement & Access Policy

Disease

Drugs, Neurological Disorders, Rare & Orphan Diseases

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