嵌合抗原受体T细胞产品医保准入困境分析

Analysis on the dilemma of medical insurance access for chimeric antigen receptor T cell products

嵌合抗原受体T细胞(chimeric antigen receptor T cell,CAR-T)是一种新型肿瘤免疫治疗药物,临床疗效好,但治疗费用高昂。全球已有多个国家将CAR-T产品纳入医疗保障范围以提高其可支付性,但现阶段CAR-T产品尚未纳入我国基本医疗保险目录。该文通过梳理CAR-T产品全球治疗现状和准入情况,总结中国医保准入CAR-T产品的3个难点,提出“商保独立支付—商保协同支付—医保常规支付”的三阶段解决方案,为解决我国CAR-T产品保障问题提供助力。

As a novel cancer immunotherapy,chimeric antigen receptor T cell(CAR-T)therapy has good clinical efficacy but high treatment cost.Many foreign countries have included CAR-T in the medical insurance coverage to improve its affordability,however,CAR-T has not been included in National Reimbursement Drug List(NRDL)in China.By sorting the global CAR-T treatment status and medical insurance access situation,the paper summarized three difficulties for CAR-T access to NRDL,and proposed a three-stage solution of“independent payment of commercial health insurance-cooperative payment of commercial health insurance-regular payment of medical insurance”,providing reference to solve the CAR-T coverage problem in China.