Connecting "Drug + Insurance + Patient" Innovation Platform To Solve The Problem Of Paying High Price Drugs At One'S Own Expense

Recently, shuidi, an online fund-raising platform for serious diseases, first disclosed the report card of its innovative drug payment platform "haoyaofu" four months after its launch. At present, it has covered 1123 DTP (direct to patient) pharmacies in 202 cities in 29 provinces in China, and cooperated with dozens of pharmaceutical enterprises to launch pharmaceutical enterprise projects, serving more than 30000 patients and saving nearly 10 million yuan of drug expenditure for patients.

It is understood that the payment of good drugs focuses on many new special drugs, serious disease drugs and chronic drugs that are not covered by the medical insurance reimbursement. Through the cooperation of pharmaceutical enterprises, insurance institutions and pharmacies, the "drug insurance patients" are connected to help patients reduce their own expenses on drugs. Shen Peng, founder and CEO of shuidi company, said that from the perspective of their platform, most of the treatment funds raised every year are used for drug purchase. Therefore, it is expected to see whether they can cooperate with pharmaceutical enterprises and pharmacies to do a "water drop volume purchase" in the market-oriented version.

Guo Nanyang, head of shuidihao's drug payment business, pointed out to the 21st century economic reporter that commercial insurance, charitable donation, drug welfare and innovative payment are very important medical payers outside the medical insurance system, and these models will play a greater role in the future.

In fact, since the "opinions on deepening the reform of the medical security system" proposed in March this year that we should speed up the establishment of a multi-level medical security system, various payment innovations have emerged in an endless stream. In addition to the above-mentioned "good drug payment", there are also a number of "Qilu insurance" universal benefit insurance launched.

Zhu Xuesong, vice president of micro medical group, pointed out to the reporter of 21st century economic report that the general benefit insurance is a transition between commercial insurance and social insurance. There are many innovative contents, such as the protection content of new special drugs and the demands of medical and health services, which can meet part of the needs of patients with serious diseases and help patients solve the payment problem under the multi-party co financing mechanism.

Pharmaceutical payment innovation platform

"According to the water drop platform data, 43.6% of lung cancer patients will use new special drugs for treatment, mainly gefitinib, icotinib, etc., as well as the proportion of targeted drugs and immune agents. In addition, the proportion of patients with rare diseases is relatively high, and the proportion of users who pay more than 40% accounts for 64.6%. More than 40% of patients have to reduce or stop taking drugs because of the cost. " Guo Nanyang said.

In recent years, the government has accelerated the entry of innovative drugs into the medical insurance payment system by means of centralized procurement of drugs and medical consumables, reducing the price of drugs and reducing the burden of medical treatment. However, there are still a considerable proportion of drugs not covered by the medical insurance. In case of serious illness, they can only pay their own expenses, especially for some anti-cancer and rare diseases, and the price is far beyond the range that an ordinary family can afford.

According to reports, at present, the focus of good medicine payment is on new special drugs, serious disease drugs and chronic drugs, because the prices of these drugs are relatively high, and many of them are not covered by medical insurance reimbursement. Users have a large demand for medical insurance and medical insurance.

According to Guo Nanyang, medical payers can be divided into basic medical insurance, patients' self payment and commercial medical insurance, accounting for 49%, 44% and 7% respectively according to the data in 2019. According to the prediction of McKinsey consulting company, the proportion of commercial medical insurance in medical payment will gradually increase. In the next five years, it is expected to achieve a compound growth rate of 29%. By 2025, the proportion of commercial medical insurance will increase to 18%, and the proportion of patients' self payment is expected to drop to 30%.

"We hope to be an innovative platform for pharmaceutical payment." Guo Nanyang said that the positioning of good drug payment is to innovate payment platform, actively cooperate with pharmaceutical enterprises, insurance institutions and pharmacies, connect "drug + insurance + patient", connect commercial medical insurance, pharmaceutical enterprises, DTP pharmacies and patients, and improve the competitiveness and customer stickiness of pharmacy partners through commercial insurance, public welfare drugs, drug insurance and innovative payment, so as to help patients reduce drug prescriptions Face to face out of pocket expenses.

Shen Peng said that in the past four years, the company has built a multi-level medical payment platform to provide users with medical payment funds by means of pre guarantee (mutual assistance + insurance) and after event assistance (fund-raising for serious illness), which plays a complementary role in medical insurance. "In order to meet the needs of the society, shuidi is carrying out more innovative exploration, expanding from medical fund supply to innovative payment of medicine and medical treatment, and then to the field of health services. The goal of good medicine payment is to help users enjoy better diagnosis and treatment and better drugs with lower costs. "

Exploration of various innovative payment modes

"Commercial insurance, charitable donations, drug benefits, and innovative payments are very important medical payers outside the medical insurance system, and we believe these models will play a greater role in the future." "As the scale of innovative payment platform continues to expand, we hope to further help patients save drug expenses and explore more comprehensive drug service solutions," Guo said

Zhang Qiang, the project manager of Baiji Shenzhou patient access project, pointed out that with the annual growth of more than 30% in the national health insurance market, what is more valuable behind the increase in premium is the growth and diversification of its current mode, such as the former focus on serious illness insurance, and now the reimbursement type, such as million medical insurance.

"The greatest feasibility and positioning of the future development of commercial health insurance, in general, is to carry out secondary reimbursement on the basis of the reimbursement of basic medical insurance, so as to relieve the pressure of some major expenses. The drugs outside the basic medical insurance catalogue have great space for commercial insurance. In some cities in Guangdong or Hainan, some drugs for nasopharyngeal carcinoma will be added to the list, and the access space for commercial insurance will be customized according to local characteristics. " Zhang Qiang said.

Jiang Jiangang, director of Hengrui pharmaceutical innovation project, also said that the combination of innovative drugs and commercial insurance can greatly alleviate the affordability of patients' medication.

Zhu Xuesong pointed out to the reporter of the 21st century economic report that this is the transition between commercial insurance and social insurance. The main reason why it is popular is that there are many innovative contents, such as the protection content of new special drugs and the demands of medical and health services.

"Affected by the epidemic situation, people's demand for and understanding of insurance is getting higher and higher. Also affected by the rapid advancement and iteration of the Internet, health insurance has been on a rapid rise in recent years. From one million medical insurance to the current benefit insurance, people's different levels of security needs can be reflected." Zhu Xuesong further explained. Inclusive supplementary medical insurance can fill the gap of large medical expenses that cannot be covered by medical insurance, and reimbursement of drug expenses for some major diseases can alleviate the problem of expensive medical treatment for people to a certain extent.

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