Economic Observer reporter Zhang Ying

On May 29th, Xuan Jianwei, the director of the Institute of Medical Economics at Sun Yat sen University, proposed at the 2026 Medical Innovation Policy Forum that "supporting innovation is a powerful tool for the drug regulatory authority to grant conditional approval... This approach can accelerate innovation. Can medical insurance try conditional payments? Let innovation land as soon as possible.

Conditional payment refers to the temporary and transitional payment of newly approved innovative drugs with high clinical benefits, with reimbursement prices set by the market. After the drug has been on the market for a period of time, the medical insurance will adjust the reimbursement price or proportion based on the actual clinical value of the drug.

Xuan Jianwei said that under the traditional reimbursement method, once a drug is included in medical insurance, the subsequent additional clinical evidence is not closely related to the reimbursement price or proportion. But conditional reimbursement places great emphasis on the actual clinical value of drugs, which requires pharmaceutical companies to not only focus on data from clinical trials, but also to continuously monitor clinical evidence throughout the entire lifecycle of the drug. Currently, countries such as the United States, the United Kingdom, South Korea, and Japan have similar policies.

He believes that conditional reimbursement will not increase budget pressure for the payer. The payer will first pay a temporary price for 6 or 12 months, and then renegotiate with the company based on the quality of real-world research evidence.

Conditional payment is a good thing for society because it can indeed enable innovative drugs to enter hospitals as soon as possible and benefit patients as soon as possible. However, he also mentioned that conditional payment requires companies to constantly provide new evidence and prove the value of drugs, which is also a challenge for companies. However, it is precisely this institutional reform that can give rise to innovations that truly benefit the entire population and have evidence of benefits.

Monitoring the clinical value of drugs after they are marketed is generally referred to as real-world research. Xuan Jianwei believes that real-world research on conditional payments should not only focus on the effectiveness and safety of drugs, but also on economics.

His team conducted a real world study on the treatment of breast cancer in a 3A hospital in Guangzhou, which compared an intravenous preparation with a subcutaneous preparation. Research has found that compared to intravenous preparations, subcutaneous preparations can reduce patients' hospitalization by 32.22 days in a one-year treatment cycle, which is equivalent to allowing hospitals with limited beds to perform 3-4 more surgeries; In terms of price, subcutaneous preparations are cheaper than intravenous preparations, and with the saved hospitalization costs, they can save 110000 yuan in medical expenses per year.

Xuan Jianwei also mentioned that there are indeed many challenges in implementing conditional payments, such as uncertainty in research methods, limitations in data acquisition and quality, and uncertainty in reassessment results. To solve these problems, there needs to be unified and clear evidence standards, reliable data platforms and data quality, as well as transparent reassessment rules. At the same time, the management chain of drugs within pharmaceutical companies also needs to be adjusted to prioritize the generation of value evidence and achieve the goal of generating different value evidence throughout the entire life cycle.