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- Zhejiang refines rare disease treatment reimbursement
Zhejiang refines rare disease treatment reimbursement
Zhejiang province’s Healthcare Security Administration (HSA) bureau released a draft proposal in relation to rare disease medical insurance, taking effect from January 1, 2020. The document covers rare disease drug accessibility and reimbursement ratios.
Zhejiang will establish a rare disease healthcare security fund, sourced from Critical Disease Insurance (CDI) funds and provincial subsidies. Local CDI funds will make an annual one-time transfer to the provincial HSA at a rate of RMB 2 (USD 0.29) per holder of basic provincial medical insurance. The fund will implement special account management and independent financial accounting.
A dynamic adjustment mechanism for rare disease drug pricing will be established according to the national rare disease list. The program will include drugs marketed in China which demonstrate clear efficacy, are in urgent demand, and are not covered by basic medical insurance or CDI schemes. Regular negotiations will follow the principle of “expert argumentation, price negotiation, and dynamic adjustment”, and consider the economic and social situation in the province, along with the balance of the fund.
Rare disease insurance reimbursement ratios are to be calculated annually, paid by installments, and will have caps on contributions. The reimbursement rates are as follows: 80% for RMB 0-300,000 (USD 0-43,000); 90% for RMB 300,000-700,000 (USD 43,000-100,000); and 100% for RMB 700,000 (USD 100,000) and above.