Chega de Esperar por Medicamentos Eficazes: Reforma na Saúde Acelera o Ritmo do Desenvolvimento de Medicamentos Inovadores na China
Em 1º de julho de 2025, a Administração Nacional de Seguro Médico e a Comissão Nacional de Saúde lançaram as "Várias Medidas para Apoiar o Desenvolvimento de Alta Qualidade de Medicamentos Inovadores", marcando uma nova fase no ecossistema chinês de inovação farmacêutica. Este documento de política adota uma abordagem sistemática para abordar os três principais pontos problemáticos no desenvolvimento de medicamentos inovadores — desafios em P&D, adoção hospitalar e reembolso — aproveitando o seguro médico para impulsionar a modernização industrial e fornecer robusto apoio à construção de uma China Saudável.
Mecanismo de Ajuste Dinâmico Reconfigura a Lógica de Acesso ao Seguro Médico
Ao projetar as regras de renovação, as autoridades de seguro médico demonstraram sabedoria institucional: as renovações simplificadas apresentaram uma redução média de preço de apenas 1,2%, com quase 80% de medicamentos renovados pelos preços originais. Medicamentos inovadores da categoria 1 podem ser renegociados para responder às mudanças do mercado. Esse "ajuste flexível" protege a segurança do fundo, evitando ao mesmo tempo cortes excessivos de preço que poderiam sufocar o impulso à inovação. Como afirmou Huang Xinyu, Diretor da Agência Nacional de Seguro Médico: "Precisamos garantir que os medicamentos inovadores verdadeiramente valiosos do ponto de vista clínico recebam retornos razoáveis".
Sistema de Pagamento Multinível Rompe Impasse no Pagamento
Suporte em toda a cadeia libera o impulso da inovação
Avanços Inovadores no Contexto Global
The synergistic innovation between medical insurance and commercial insurance is even more groundbreaking: data sharing enables “one-stop settlement,” allowing patients to seamlessly coordinate medical insurance and commercial insurance payments at healthcare facilities; intelligent supervision platforms ensure fund security, preventing commercial insurance from becoming a target for fraud. This model, where “data runs the errands while patients reduce their burden,” is fundamentally reshaping the underlying logic of healthcare security.
Full-chain support unleashes innovation momentum
On the R front, the opening of medical insurance data marks a milestone. Through disease spectrum analysis and aggregation of medication needs, pharmaceutical companies can strategically align their R pipelines, avoiding homogenized competition. In 2024, China approved 48 Class 1 innovative drugs—a fivefold increase from 2018—a surge directly empowered by policy. The synergy between national science and technology initiatives and healthcare policies has forged a complete chain from “basic research to clinical translation to market application.”
Reforms in clinical application are equally noteworthy: breaking the “one drug, two specifications” restriction, enforcing a three-month adjustment requirement for pharmaceutical committees, and establishing a case-by-case negotiation mechanism—these measures directly address the persistent issue of drugs being covered by insurance but not adopted in hospitals. When DRG/DIP payment reforms are combined with special case negotiations, healthcare institutions’ enthusiasm for using innovative drugs is fully mobilized. In 2024, fund expenditures for negotiated drugs during the agreement period exceeded 100 billion yuan, validating the effectiveness of these policies.
Innovation Breakthroughs in a Global Context
China’s innovative drugs are transitioning from “following” to “leading.” Over 90 overseas licensing deals totaling more than $50 billion in 2024 signify that Chinese pharmaceutical companies have attained global competitiveness. Medical insurance authorities safeguard the overseas expansion of innovative drugs through price confidentiality mechanisms and the development of cross-border transaction platforms.
In this global competition, the unique advantages of Hong Kong and Macao, China, are becoming increasingly prominent. Leveraging the international capital and intellectual property protection systems of Hong Kong and Macao, China’s innovative drugs are accelerating their integration into the global industrial chain. This “dual circulation” strategy not only consolidates the domestic market foundation but also enhances China’s voice in shaping international rules.
Challenges and the Future
Despite remarkable achievements, China’s innovative drug development still faces challenges such as homogenized competition and insufficient payment capacity. Data indicates that in 2024, per capita funding for resident medical insurance reached only 1,070 yuan, while utilization rates for commercial health insurance funds remained below 50%. The multi-source payment system urgently requires refinement. In response, policies explicitly advocate “supporting genuine innovation and differentiated innovation,” guiding resources toward high-value innovations through health technology assessments and real-world data applications.
Looking ahead, medical insurance reform will continue to function as a “strategic purchaser”: dynamic adjustment mechanisms will become more precise, commercial insurance directories will serve as key outlets for innovative drugs, and data empowerment will reshape R paradigms. When medical insurance, healthcare, and pharmaceuticals synergize, China’s pharmaceutical industry will achieve a historic leap from a “major producer of generic drugs” to an “innovation powerhouse.”
The ultimate goal of this reform is to ensure every patient timely access to quality medicines. As Wang Guodong, Deputy Director of the National Healthcare Security Administration’s Medical Insurance Center, stated, “Every penny of the medical insurance fund must be spent where it matters most.” As innovative drugs become powerful tools for safeguarding lives and multi-tiered protections weave a safety net for health, the vision of a Healthy China is rapidly becoming a reality.