Analysis of Factors Influencing Medical Insurance Access for Indications of Nationally Negotiated Anti-Tumor Western Medicines

doi:10.19546/j.issn.1674-3830.2026.8.005

China Health Insurance ›› 2026, Vol. 0 ›› Issue (8) : 41-47. DOI: 10.19546/j.issn.1674-3830.2026.8.005

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Abstract

Objective: The paper analyzes the medical insurance access characteristics of Western antitumor drugs and their indications that passed the preliminary formal review during the 2022-2025 National Reimbursement Drug List (NRDL) adjustment, and explores the key factors influencing indication access decisions. Methods: A total of 140 Western anti-tumor drugs and their corresponding 176 indications were included. Using whether the indication was included in the NRDL as the dependent variable, multivariable logistic regression was performed to assess the impact of patient population size, line of therapy, overall survival (OS) benefit, progression-free survival (PFS) benefit, Chinese Society of Clinical Oncology (CSCO) guideline recommendations, consistency between marketing approval and submission year, and publicly available pharmacoeconomic evidence on reimbursement access. Results: Of the 176 indications, 104 were included in the NRDL. Multivariable logistic regression showed that PFS benefit (OR = 2.13, P = 0.032) and lack of pharmacoeconomic evaluation evidence (OR = 2.86, P = 0.025) were independent facilitators of indication access, while the other variables did not emerge as independent influencing factors. Conclusion: PFS benefit is an important independent factor influencing the access of antitumor drug indications. The link between availability of published pharmacoeconomic evidence and access decisions points to a possible evidence gap between what is published and what is used in medical insurance review.

Key words

antineoplastic Western drugs / medical insurance access / preliminary formal review / influencing factors

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Analysis of Factors Influencing Medical Insurance Access for Indications of Nationally Negotiated Anti-Tumor Western Medicines[J]. China Health Insurance. 2026, 0(8): 41-47 https://doi.org/10.19546/j.issn.1674-3830.2026.8.005

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