The constantly upgrading and iterating health insurance has seen new developments, and medication protection has become a new competitive point.

On September 10th, JD Insurance, JD Health, and Ping An Property and Casualty Insurance jointly released the "Good Drug Insurance 3.0 Universal Version". Compared with the previous version, the Good Medical Insurance 3.0 universal version further reduces the insurance threshold, with a minimum monthly premium of only 18.8 yuan, 2 reimbursements per month of 30 yuan each time, and a maximum annual reimbursement of 720 yuan.

Coincidentally, Zhong'an Insurance's flagship product, the "Premium E-Life · Mid to High end Medical Insurance 2026 Series," has recently upgraded its medication coverage, including eligible "super indication drugs" in its coverage responsibility. For senior title physicians with authorized qualifications in tertiary hospitals, relevant prescriptions issued based on the patient's actual condition can be compensated according to the product liability agreement.

With the advancement of the DRG (Disease Group)/DIP (Disease Group Score) medical insurance payment reform, the scenarios and scale of patients' self funded expenditures have changed accordingly. Their expectations for health insurance are no longer limited to the medical environment, but hope that insurance can cover more newly added treatment scenarios.

Taking "Good Medicine Insurance" as an example, after purchasing drugs on JD.com, users click "Go to Reimburse", and the system automatically calculates the reimbursable amount, submits claim materials, reviews, and compensates to the JD account. In the past year, this product has completed over 170000 claims, with a cumulative reimbursement of drug value exceeding 50 million yuan.

The demand scenario for upgrading product protection by Zhong'an Insurance is that in clinical cancer treatment, drug instructions are often updated behind clinical guidelines. When authoritative guidelines have recommended the use of drugs but the indications have not been updated in the drug instructions, patients may face a practical problem where doctors believe they can be used, but insurance may not be able to compensate.

It is worth noting that not long ago, there were cases in the insurance industry where claims were denied due to medication beyond the indications. A patient with acute lymphoblastic leukemia was recommended medication according to the guidelines of the Chinese Society of Clinical Oncology (CSCO), but was denied insurance compensation due to "not meeting indications", ultimately bearing a cumulative self payment of 800000 yuan.

For insurance companies, there is a significant demand gap in the field of medication protection, which is also an important lever for achieving differentiated competition. Traditional health insurance has long had pain points such as cumbersome claims processes, complex and difficult to understand terms, and inaccurate pricing, resulting in serious product homogenization. Putting effort into drug security is expected to slow down the growth rate

(Author Jiang Xin)