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On December 8th, a major milestone was reached as the first-ever Commercial Health Insurance Innovative Drug List was unveiled, featuring five cutting-edge chimeric antigen receptor-T cell therapies. These therapies reprogram a patient’s own white blood cells to identify and combat cancer, marking a pivotal advance in developing a multi-layered healthcare insurance system.
Out of 121 drugs reviewed through a formal process, only 19 made the list, with 24 entering into price negotiations. This new catalog is set to come into force starting January 1st, according to the National Healthcare Security Administration announced at a conference in Guangzhou on December 7th.
Cancer treatments dominate this list, with 14 options included. The list also features therapies aimed at Alzheimer’s disease, which predominantly affects aging populations, as well as treatments for rare pediatric diseases, such as Gaucher disease and neuroblastoma.
Unlike the publicly funded national medical insurance drug list, this commercial list emphasizes innovation and state-of-the-art therapies. While basic health insurance typically covers safe, well-established drugs with proven efficacy, the commercial list targets more innovative medicines with significant clinical value that are outside the scope of basic coverage, experts explained.
These selected therapies exemplify recent breakthroughs in pharmaceutical technology, including popular targeted treatments like CAR-T, T-cell engagers, and bispecific antibodies. The five CAR-T therapies, mainly used for hematologic cancers, were developed by biotech firms including Fosun Kite, JW Therapeutics, Gracell Biotechnologies, Legend Biotech, and CARsgen Therapeutics. These five account for over half of the eight CAR-T products approved in China.
Pricing varies significantly for these therapies. Gracell Biotech’s CAR-T therapy is priced at CNY999,000 (roughly USD141,300) per infusion. The other four therapies are each priced above CNY1 million, with JW Therapeutics’ product reaching CNY1.3 million (about USD183,875) per infusion.
According to Lu Lulu, founder and CEO of Gracell Biotech, the process of getting these drugs listed took nearly a year from initial contact to inclusion. She emphasized that as commercial insurance coverage expands, improved payment capacity alongside increased clinical experience will create a positive cycle, making these innovative treatments more accessible in lower-tier markets.
The establishment of a negotiation mechanism for commercial insurance coverage marks a significant milestone for the accessibility of advanced drugs in China. As companies like Fosun Kite deepen their cooperation with health insurance providers, they aim to include these drugs in more local benefit insurance schemes and explore links between benefit reimbursement and basic medical insurance.
The inclusion of these five CAR-T therapies in the national list signifies that the Chinese government has created a sustainable and predictable pathway for accessing high-cost, high-value medicines. This authoritative reference list will support insurance providers nationwide, fostering wider availability of such advanced therapies, according to a researcher at Jinan University.
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