"Life saving medicine" out of the catalog, why does Pratt & Whitney insurance become commercial insurance?
2021-11-30
Yueyue in Suzhou, Jiangsu Province is suffering from a rare disease called "mucopolysaccharide storage syndrome type (MPS Ⅱ, also known as Hunter syndrome)". The specific drug of the disease is Hercules. It was approved to be listed in China in September 2020 and included in the protection catalogue of suhuibao in March 2021. Just when the patient's family thought they saw hope, they found that the 2022 version of Su Huibao, which began to be sold in October this year, called out Hercules from the directory, "just like taking a roller coaster". Su Huibao is an inclusive supplementary commercial medical insurance (hereinafter referred to as inclusive insurance). Its name is slightly different in different places. It is called "jinghuibao" in Beijing and "suisuisuikang" in Guangzhou. Because of its advantages such as low threshold, low price, high reimbursement rate, no age limit, no restriction on registered residence, and no medical history, the introduction of Pratt & Whitney insurance is favored by the public. However, Su Huibao was questioned because he pulled out the "life-saving drug" hairisi for patients with rare diseases from the directory. In this regard, the response of the local medical insurance hotline is that Su Huibao is a commercial insurance, which is subject to the insurance company's policies, and the adjustment of the drug catalogue is the company's behavior. The underwriter said that there was little hope to include Hercules in suhuibao in 2022. It may be that this drug is not used by many people, or it may be replaced by other drugs. According to incomplete statistics, only 4 people in Suzhou have MPs Ⅱ. Due to the limited coverage of Pratt & Whitney insurance and the limited types of drugs included in the catalogue, it is not surprising that hairuisi, which has few users, was transferred out of the guarantee catalogue. Otherwise, it may affect the entry of drugs with large use into the catalogue, and then affect the universality of the insurance. At the same time, the insurance has commercial attributes. Drugs with few users occupy the catalogue, which will affect the performance of underwriting enterprises. From the perspective of inclusive and commercial, it is understandable that the drug is called out of the catalogue. However, from another perspective, it is also inappropriate for insurance companies to bring "life-saving drugs" out of the directory. First of all, the catalog adjustment is not fully considered. Full investigation and demonstration shall be carried out before transfer in, and appropriate buffering shall be carried out before transfer out, so as not to make patients happy and sad and unable to adapt. Secondly, as an inclusive insurance, it is undoubtedly different from pure commercial insurance. Insurance companies cannot be mercenary. Moreover, one of the characteristics of insurance is mutual assistance. It is impossible for every policy to make money. If Pratt & Whitney insurers only value commercial returns, then Pratt & Whitney insurance will tend to "commercial insurance". Of course, when we discuss this kind of inclusive insurance, we also need to see how much support the local government has for inclusive insurance. If the local government only provides guidance without tax, financial and other support, the insurer will have full independent decision-making power. However, if the government provides real support, the insurer cannot decide the import and export of drugs at will. Although many patients with rare diseases are a minority group and belong to "very few" compared with patients with common diseases, they should also receive corresponding welfare protection. On the one hand, we should strive to bring more specific drugs for rare diseases into medical insurance. In recent years, more and more drugs for rare diseases have been incorporated into medical insurance, which is a gratifying progress, but we still need to continue our efforts. On the other hand, local inclusive insurance should also be used as a welfare for patients with rare diseases to reduce their burden on the basis of medical insurance. In the next step, it is worth exploring whether all localities can encourage insurers to include more drugs for rare diseases into the protection catalogue of inclusive insurance with pragmatic policy support measures, and ensure the sustainability of some specific drugs. Once the government's support is strengthened, it is obvious that the voice of inclusive insurance will be enhanced. In addition, can we introduce special policies for drug use guarantee for patients with rare diseases? It is estimated that there are about 20 million people affected by rare diseases in China. This group should receive corresponding attention and care. (outlook new era)
Edit：Yuanqi Tang Responsible editor：Xiao Yu
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