1. Shanghai is piloting a new medical insurance reimbursement model that could reopen access to brand-name drugs in public hospitals, potentially reshaping China's pharmaceutical market.[para. 1]2. From May 1, Shanghai's policy ties insurance payments to prices of drugs from the 11th national volume-based procurement, reimbursing only up to the generic price; patients pay the difference for pricier options like imported originals.[para. 2]3. This departs from the prior fixed-percentage reimbursement of total drug prices on mainland China.[para. 3]4. The 11th procurement included 453 drugs from 272 companies for infections, tumors, allergies, asthma; e.g., metformin-empagliflozin at 6.8 yuan ($1) per 60-pill box vs. Synjardy at 75 yuan, with insurance covering 70% of 6.8 yuan (4.28 yuan) for outpatient employee plans, patient paying rest.[para. 4]5. Out-of-pocket ratios rise for five drugs like olaparib and dapagliflozin: +20% for essentials, +30% for others when using non-procured versions.[para. 5]6. Jin Chunlin notes these high-value, long-term, expensive targeted drugs strain funds without controls on non-procured use.[para. 6]7. Reforms urged since 2019 State Council directive for patients to pay differences; progress slow, only first three procurement batches fully adjusted elsewhere.[para. 7]8. Jin says lifting restrictions on non-procured drugs is inevitable; Shanghai's high patient willingness-to-pay makes it ideal pilot for national rollout.[para. 8]9. Pharma executive praises market-oriented approach: patients choose between paying extra for originals or generics, beyond lowest-bid wins.[para. 9]10. Shift raises out-of-pocket costs, potentially reversing drop from 60% to under 30% over two decades.[para. 10]11. Zhao Heng predicts patients switch to cheaper options, challenging high-price original models; cites Germany's reference pricing compressing premiums by >80%.[para. 11]12. Original drugs vanished due to insurance-hospital conflicts; solution is relaxing clinical metrics.[para. 12]13. Hospitals prioritized procurement targets with 1:1 ratios; DRG reforms penalize expensive drugs via quotas.[para. 13]14. By 2025, 11th round allows brand reporting, drops 60-80% exclusive use; Shi Zihai affirms non-procured use.[para. 14]15. Shanghai doctor cautious: procurement targets limit original drug space; hospital shifted to domestics, redirects patients to pharmacies.[para. 15]16. Policy prioritizes standard-priced drugs but exempts primary care from ratios; community centers stock Norvasc, Lipitor.[para. 16]17. Jin: Grassroots stocking bottlenecked hierarchy; clinics avoided non-procured due to lists/procurement, crowding big hospitals.[para. 17]18. Commercial insurers like CPIC may cover original differences in group plans, adapting policies.[para. 18]AI generated, for reference only