Recently, the reporter learned from the "Zhaohuibao" project team that the insured person, Mr. Li (pseudonym), successfully received a 944,000 yuan claim for "Zhaohuibao" and completed the first CAR-T therapy claim in Shandong Province.

Recently, the reporter learned from the "Zhaohuibao" project team that the insured person, Mr. Li (pseudonym), successfully received a 944,000 yuan claim for "Zhaohuibao" and completed the first CAR-T therapy claim in Shandong Province.

"Zhaohuibao" is a general commercial supplementary medical insurance customized for Liaocheng medical insurance participants, guided by Liaocheng Medical Insurance Bureau and supervised by Liaocheng Supervision Branch of the China Banking and Insurance Regulatory Commission. Since its launch, it has attracted widespread attention from all walks of life and has won the favor of nearly 660,000 Liaocheng citizens. Mr. Li is one of them.

It is reported that in mid-June 2021, Mr. Li (40 years old+), the insured person of "Zhaohuibao", was diagnosed with diffuse large B-cell lymphoma. He was treated many times in outpatient and hospitalized in Shandong Cancer Hospital. The effect was poor after routine treatment and his condition was repeated and unstable. At the beginning of this year, doctors recommended CAR-T therapy, prescribed Yikaida, and injected treatment, and the condition improved significantly.

On July 4, 2022, Mr. Li submitted a claim application online through the WeChat official account of "Zhaohuibao". The "Zhaohuibao" special pharmacy claims staff actively assisted the patient's family in collecting claims information and completed the payment of the entire claim case as quickly as possible. According to the application for Yikaida (Akilensai Injection), the unit price of the drug is 1.2 million yuan, and after deducting the deductible of 20,000 yuan, the compensation will be paid at 80% of the previous patients, with a compensation of 944,000 yuan. [1.2 million yuan-20,000 yuan (annual deductible)] *80%=944,000 yuan.

CAR-T cell therapy is an individualized treatment method that utilizes the human body's own immune system to eliminate tumor cells more accurately. As a brand new tumor treatment method, CAR-T has the characteristics of personalized customization, one-time therapy, and predictable healing effects, bringing new hope to patients. However, since CAR-T is a product formulated for patients in an individual manner, one patient corresponds to a production batch, the production cost is very high, resulting in the cost of treatment. Currently, CAR-T therapy drugs are not within the scope of medical insurance reimbursement.

On June 22, 2021, China's first CAR-T cell therapy product Yikaida (Akilensai Injection), was officially approved for market launch in China. Yikaida is mainly used to treat patients with relapsed or refractory large B-cell lymphoma after receiving second-line or above systemic treatment. Although this product has brought hope for treatment to many cancer patients, the price of 1.2 million yuan per injection has discouraged many people.

Mr. Li, who is insured by "Zhaohuibao", was unfortunately diagnosed with diffuse large B-cell lymphoma. However, the unfortunate thing is that the upgraded "Zhaohuibao" adjusted the pharmacological claims standard for CAR-T treatment to unlimited previous symptoms, and all of them were compensated at an 80% compensation ratio, with a maximum guarantee amount of 1 million yuan. Through an affordable guarantee, 89 yuan was exchanged for compensation of 944,000 yuan, effectively avoiding the heavy blow to the family due to serious illness.

As an important part of Liaocheng's multi-level medical insurance system, "Liaohuibao" aims to meet the people's diverse medical insurance needs, further improve the ability of Liaocheng medical insurance participants to deal with high medical expenses, and effectively prevent the people from becoming poor due to illness. On July 1, 2022, "Zhaohuibao" once again improved its people-friendly attributes, ensuring comprehensive upgrades, increasing compensation ratios, and increasing the number of special drugs.

First, the insurance amount is high and the threshold is low. The "Zhaohuibao" special medicine responsibility is up to 1 million yuan guaranteed, and the compensation is paid at a ratio of 80%. The core purpose is to enable patients to dare to use good medicine and receive better treatment.

Second, there are many special medicines and a wide coverage. The responsibility for the special drug protection of "Xiaohuibao" has been comprehensively upgraded, and the number of drugs has increased from 30 to 38, covering high-incidence malignant tumors such as lung cancer, liver cancer, gastric cancer, and breast cancer. The upgraded "Zhaohuibao" of

no longer distinguishes whether there is a previous medical history, and increases the 0% compensation ratio of patients with previous symptoms of specific high-value drugs to 80%, greatly reducing the financial burden of cancer patients and providing a new solution for special pharmacy claims.

The third is to be able to afford innovative therapies and follow public opinion. Since the CAR-T therapy was approved to be launched in China in June 2021, it has been widely exposed by major online platforms. The people have high attention and full expectations. "Xiaohuibao" follows public opinion and has included this therapy in the scope of protection, so that more patients can "afford" innovative therapies.

(Reporter Zuo Fengqi, Correspondent Li Liang, Reported)