Yearbook of patient assistance in China 2021

The report

On October 30th, Deloitte China and the China Patient Assistance Alliance (CPAA) released the Yearbook of patient assistance in China 2021 at the 3rd Chinese Physicians Assembly for Humanity. This report includes an overview of China’s national policies, major players, and programs of patient assistance. It also analyzes the industry drivers and pain points in patient assistance, and predicts four future trends.

Viewpoints / key findings

The protection and assistance of patients with major diseases is a critical issue for every country. In recent years, China has issued a host of policies on patient assistance, providing a stable development environment for the operation of related programs. In 2020, the State Council’s Opinions on Deepening Reform of the Medical Security System highlights the prominent role charitable donations have to play in medical security. 

Charitable organizations are leveraging enterprise donations to help more patients. Patient Assistance Projects (PAPs) are a typical form of medical charitable donation program. Following years of development and innovation, patient assistance has evolved to diverse models, including early screening, patient education, patient care, and post-illness care. Numerous representative cases have emerged with breakthroughs in the type of medication used, population covered, and project mechanism.

Status of the patient assistance industry in China 

Accoding to the public information, the number of active patient assistance programs in China almost doubled from 72 in 2016 to 135 in 2020, with a cumulative value of around RMB96.6 billion. Currently, drug assistance programs are mainstream. Drug assistance programs remain the mainstream of PAPs. Among the programs still in operation in 2020, there were 115 drug assistance programs, accounting for 85%. And the number of financial assistance programs is edging upwards. The number of financial assistance programs increased from 7 in 2016 to 20 in 2020, with the corresponding proportion rising from 10% to 15%.

Inclusion into the national medical insurance medicine catalog is no longer the focus of PAPs, and the proportion of assistance programs already in the national medical insurance medicine catalog has increased significantly. In 2020, 86 programs in operation were in the national medical insurance medicine catalog, accounting for 75%, while in 2016, there were only 3 drug assistance programs in this list, accounting for 5%. In recent years, the speed of approval and implementation of PAPs has accelerated. From 2016 to 2020, the proportion of programs with a cycle of one year or less and those with a cycle of two to three years rose from 3% and 21% to 20% and 39%, respectively.

The population base of the assistance recipients has been expanding, across diverse regions and disease types. The number of patients receiving assistance programs has increased by 124.8% in the recent years and is expected to keep rising in the future. In terms of the absolute number of PAP recipients, the number in third-tier cities and below increased rapidly from 673 in 2016 to 24,041 in 2020 at an average CAGR of 144%. In terms of targeted diseases, assistance programs for malignant tumor, rare disease, and chronic disease are present in the largest quantity, while the programs for malignant tumor and leukemia have received the highest donation amount. The number of patients receiving malignant tumor assistance soared to 118,315 in 2021. The corresponding proportion of recipients with malignant tumor increased from 23.8% in 2020 to 49%. When it comes to the total donation value of the PAPs, malignant tumor related PAPs  are accounting for 56% in 2020. The donation value of leukemia PAPs accounted for nearly one-third of the total assistance amount in 2020.

Drivers and obstacles in industry development 

Continuous support of national policies, enhanced reach to the patients, and the publicity and promotion of warm-hearted personages, are the major forces driving rapid development of the industry. However, PAPs are facing certain obstacles, mainly around the patients' misunderstanding about the drug assistance programs and the absence of a unified program management system among charitable organizations among others.

Future trends and directions in development

National policies make it clear that the proportion of medical charitable donations, an important part of the medical insurance system, will continue to rise in the future. There is a great scope for improvement as compared to the amount of donation of the PAPs in 2020, i.e. RMB12.3 billion.

• Comprehensive patient assistance platform emerges, and the formulation of industrial standards and norms is enhanced.
  The personal appeal drug platforms represented by "We Solicit Drugs", have put in place a set of standardized project release processes and procedures for patients' online applications. Patient side, doctor side, and pharmacist side are all internet-based and realize electronic information in application, review, and drug obtainment. This has upgraded PAP development to a new development stage.
• The assistance programs will gradually develop into patient-centered full-cycle assistance services with improved status of the patients. 
  PAPs have developed into patient-centered programs that provide assistance from multiple perspectives and at multiple levels. It would possibly lead to a decline in the proportion of programs of donation in kinds, while multiple innovative forms of patient assistance will be constantly explored and developed in the future.
• Breakthroughs in donations to the PAPs will make the launch of drugs for rare diseases possible. 
  Given that many PAPs for listed medicines have been highly effective, it is possible to explore the possibility of PAPs for yet-to-be-marketed drugs in the future. This would bring a gleam of hope for survival to those patients who may become disabled and even lose their lives, because they cannot afford the treatment expense of yet-to-be-marketed medicines.
• With the efforts made across multiple channels, the PAPs will help in addressing the “last mile” payment issue for patients. 
  Against the backdrop that the government vigorously promotes and supports the establishment of the multi-tiered medical insurance system, PAPs that once assumed the prepositive role of medical insurance will exist as an important supplementation to the medical insurance system. Therefore, post-inclusion assistance programs will gain traction down the road.