CAR-T drugs have always been known for their exorbitant prices, with each injection costing around 1 million yuan. The issue of CAR-T drugs being included in medical insurance has also received much attention. Now, this situation has finally made a breakthrough. It is reported that on September 20th, the National Healthcare Security Administration announced that the expert review of the first edition of the commercial insurance innovative drug catalog has been completed. Among them, all 5 CAR-T drugs have passed the expert review and are expected to enter the scope of this year's basic medical insurance catalog and commercial insurance innovative drug catalog.
The 5 CAR-T products that have passed the expert review this time include: Fosun Carey's Yikaida (Akilensai Injection), WuXi Juno's Beinuoda (Ruiqiolonsai Injection), Kochi Pharmaceutical's Saikaize (Zewaweiolansai Injection), Reindeer Biotechnology's Fukisu (Yiqiolonsai Injection), and Heyuan Biotechnology's Yuanruida (Nacionsai Injection).
These 5 CAR-T products cover the core achievements of multiple domestic biopharmaceutical companies, representing the research and development level of China's CAR-T field. As the first CAR-T drug approved for market in China, Fosun Carey's Yikaida (Akilensai Injection) has accumulated a large number of successful cases in clinical application; WuXi Mingju Nuo's Beinuoda (Ruiqiolonsai Injection) has become an important choice for many lymphoma patients due to its excellent efficacy and safety; Keji Pharmaceutical's Saikaize (Zewawaweiolansai Injection), Reindeer Biotech's Fukisu (Ikiolansai Injection), and Heyuan Biotech's Yuanruida (Nakiolansai Injection) have also demonstrated unique advantages in their respective indications, providing more treatment options for different types of cancer patients. All five products have passed expert review, which not only affirms the innovation capability of the domestic CAR-T industry, but also signifies a crucial step forward in the construction of China's innovative drug security system.
Cancer remains a major global health challenge, and traditional treatments such as surgery, radiation therapy, and chemotherapy have limited effectiveness in treating advanced or drug-resistant cancer. Immunotherapy, such as CAR T and checkpoint inhibitors, has become a new direction. CAR T therapy is of great significance in tumor treatment by genetically engineering T cells to express chimeric antigen receptors (CAR), accurately identifying and eliminating cancer cells.
However, its complex preparation process and personalized treatment mode have pushed up costs, resulting in long-term high prices. In the past few years, CAR-T drugs have participated in negotiations for the basic medical insurance catalog multiple times, but failed to reach a consensus due to the gap between prices and the affordability of medical insurance funds, and unfortunately missed out on the medical insurance catalog. However, repeated 'passing by' has also led many patients into the dilemma of 'having medicine to treat but no money to use'.
The shift from "sky high price difficult to enter insurance" to "all 5 items pass expert review" is driven by the country's high attention to people's health and the continuous innovation of the medical insurance system. In recent years, China has continued to promote the reform of the medical security system, continuously expanding the coverage of innovative drugs through a multi-level security system of "basic medical insurance+commercial insurance supplement". The review of the first edition of the commercial insurance innovative drug catalog is an important practice of the multi-level protection system - the basic medical insurance catalog focuses on "protecting the basic", while the commercial insurance innovative drug catalog aims to "fill the gaps". The two work together to not only reduce the pressure on the medical insurance fund, but also enable high priced innovative drugs to reach patients at more reasonable prices.
At the same time, enterprises have actively responded to the inclusion of CAR-T in the commercial insurance catalog. The Yikaida of Fosun Carey has passed the review of the innovative drug commercial insurance catalog. Once officially included in the catalog, it is expected to further reduce the economic burden on patients. Taking Shanghai Huhui Insurance as an example, it has included Yikaida in the special drug protection list for four consecutive years, and insured patients can receive up to 500000 yuan in drug expense reimbursement. Over the past three years, more than 80 lymphoma patients have received treatment claims from Yikaida through Shanghai Huibao, with a cumulative compensation amount exceeding 40 million yuan. And WuXi AppTec's Beinuoda has been included in more than 70 commercial medical insurance products. The company has also responded to the public that it will actively participate in the 2025 medical insurance and commercial insurance innovation drug catalog application work.
Behind the "sky high" label of CAR-T drugs is the hope for survival for cancer patients. All 5 CAR-T drugs have passed expert review this time, opening a new door for the accessibility of innovative drugs. Industry insiders say that the establishment of the Shangbao Innovative Drug Catalog is reshaping the landscape of China's innovative drug market. With the coordinated efforts of basic medical insurance and commercial insurance, those once unattainable high priced innovative drugs are gradually moving towards a wider range of patient groups.