Improving Access to High-value Cancer Drugs for Chinese Patients by Innovative Payment Methods

Published May 3, 2022

On March 11 2022, Professor Wu Depei, Member of CPPCC National Committee, Director of the Department of Hematology of the First Affiliated Hospital of the Suzhou University, and Chairman of the Chinese Medical Association Hematology Branch, Professor Yu Baorong of the School of Insurance and Economics, University of International Business and Economics, Gu Hongfei, Founder of China Lymphoma Home and invited participant of ISPOR HTA Roundtable and Patient Representative Roundtable, Ding Junfeng, Vice President of Taikang Online Property Insurance Co., Ltd, and Huang Hai, CEO of Fosun Kite Biotechnology Co., Ltd. were invited to an oncology drug session of People’s Daily Health Client 2022 to discuss about innovative payment methods for high-value cancer drugs and how to improve patient access to these new treatment. This brief summarized a couple of reflections from these experts.

Cancer Diagnosis and Treatment Face Many Challenges and CAR-T Cell Immunotherapy Brings Revolutionary Changes

Professor Wu Depe mentioned that the emergence of CAR-T therapy has brought remarkable changes from mechanism innovation to clinical efficacy, which is a revolutionary change for cancer patients. Innovative payment should be explored and used to improve access to new treatments for the future. At present, an international analysis of relapsed and refractory diffuse large B-cell lymphoma shows that the clinical remission rate of patients is only 26%, the median overall survival is only 6.3 months, and innovative drug treatment are urgently needed in clinical practice. CAR-T cell immunotherapy helps the patient's own T cells restore their specific killing activity by introducing specific antigen receptors that can recognize tumors. Once they encounter tumor cells expressing the corresponding antigen, they will be activated and destroy the tumor cells.

As a lymphoma patient, Mr. Gu Hongfei knows exactly what the patient will experience. Mr. Gu and his team have conducted a survey and the results indicated that lymphoma patients often face many difficulties during seeking medical treatment, which is time-consuming and prone to misdiagnosis. The situations of being out of school and unemployment, and poverty due to illness often occur, especially in recurrence and refractory patients. They should receive more attention because the existing conventional treatment have little effect on them. It is obvious that the overall health status of relapsed and refractory patients has a significant decrease than that of the initial treatment patients, and their life is also severely affected by disease recurrence, the treatment cost has also increased significantly, which is 2-3 times higher than that of non-relapsed patients. To maintain life, they must undergo various chemotherapy repeatedly, which costs a lot of money and resources. The patients experience unimaginable suffering. Mr. Gu Hongfei recalled a story that one patient started to receive CAR-T treatment since 2017. It has been 5 years and she is still healthy. For her, this is a rebirth. Many cancer patients are very sensitive to CAR-T therapy and the degree of acceptance of this type of drugs is relatively high. However currently the overall cost of treatment is high, and hopefully access to these drugs can be improved as soon as possible.

Innovative Payment Methods and Establishment of Multi-level Medical Insurance System

As the first company getting a CAR-T drug approved in China, Fosun Kite is very representative of the industrialization and commercialization of cell therapy in China. CAR-T has brought new treatment options for lymphoma patients. Mr. Huang Hai shared his thoughts on how to improve patients access to this treatment. The first is to establish treatment centers. Currently nearly 75 hospitals in 25 provinces and cities across the country have built CAR-T therapy centers, and patients can receive CAR-T therapy programs in cancer hospitals in provincial capital cities. The second is to actively expand product indications to bring more benefits to cancer patients. The last is to promote the inclusion of CAR-T cell therapy drugs in commercial insurance and Huimin Insurance program and establish a multi-level medical insurance system and innovative payment methods.

Professor Yu Baorong pointed out that from the perspective of pharmacoeconomics, for such high-value innovative cancer drugs, we should first look at its efficacy and then its cost. At present, to a certain extent, some charitable projects, commercial insurance and Huimin insurance programs have alleviated patient’s burden. Currently many cities have included CAR-T in the reimbursement catalog of Huimin Insurance, but that is difficult to sustain. Professor Yu also emphasized that we should continue to promote the emergence of innovative products and treatment methods, to strengthen the financing of social medical insurance on the payment side, explore other new payment models and to establish a multi-level medical insurance system from social mutual assistance, commercial insurance for charities, etc.

In February 2020, the State Council issued the "Opinions on Deepening the Reform of the Medical Insurance System", which repeatedly mentioned the establishment of a multi-level medical insurance system. Taikang Online Property Insurance Co., Ltd. is also exploring this. Vice President Ding Junfeng said that from 2016 to the present, the commercial medical insurance has covered more than 100 million people, and Huimin Insurance has been popularized in more than 100 cities across the country in the past two years. A very important part of commercial medical insurance is the insurance claims for specialty drugs. In 2019, Taikang Online specially launched insurance program for specialty drugs. It costs patients roughly 100 yuan a year and those specialty drugs can be reimbursed, which greatly reduces the burden on patients. Last year, Taikang Online reimbursed 100% of the cost of CAR-T for two patients.

To improve patient access to high-value new cancer drugs and meet their clinical needs, Mr. Huang Hai believed that it is important to strengthen communication with mature commercial insurance companies, and at the same time, to promote coverage scope of Huimin Insurance and social medical insurance. In terms of innovative payment, enterprises, health technology platforms, and commercial insurance companies have jointly developed innovative payment models such as installment payment and payment based on efficacy to reduce the pressure on patients. The last is to cooperate social forces among various foundations, charitable organizations, and public welfare organizations and to explore different approaches.

Professor Wu Depei commented that CAR-T cell immunotherapy has shown exciting prospects, and more measures are also making these innovative drugs enter clinical treatment as soon as possible to benefit more patients. It is necessary to continue to promote the establishment of a multi-level medical insurance system, explore innovative payments, and improve patient access."

This article is translated from the original article which is available here
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