Guangzhou, Sept 1, 2026 — Guangzhou implemented an updated medical insurance separate payment policy, refining how nationally negotiated drugs are reimbursed for Category I outpatient-specific diseases such as hypertension while maintaining existing rules for general outpatient care and Category II disease clinics.

Policy Snapshot

Attribute	Detail
Effective date	Sept 1, 2026
Location	Guangzhou, Guangdong Province
Policy name	Improved Medical Insurance Separate Payment Management Policy
Scope	Nationally negotiated drugs (including agreement-period and converted catalog drugs; bid-winning drugs)
Key change	Category I outpatient-specific diseases (e.g., hypertension) now require a designated separate payment institution
Unchanged	General outpatient care and Category II outpatient-specific disease separate payment rules

How Separate Payment Works

Under the separate payment mechanism, costs for nationally negotiated drugs are not counted toward general outpatient or outpatient-specific disease benefit caps. Instead, the basic medical insurance pooled fund settles these costs separately with designated medical institutions, bypassing standard reimbursement limits.

Patient Access Pathways

• Pathway 1 (General & Category II): Insured patients visiting their selected general outpatient institutions, specialized designated hospitals, or Category II outpatient-specific disease institutions can obtain separate payment drug prescriptions without changes to existing reimbursement rules.
• Pathway 2 (Category I): Insured patients with Category I outpatient-specific disease benefits must select one designated separate payment institution for each condition. Prescriptions for separate payment drugs issued at the selected facility qualify for the separate payment benefit. Patients who fail to register a separate payment designation or visit non-selected institutions cannot access the separate payment benefit and must claim reimbursement under original Category I disease caps.

Hypertension Adjustment Example

Under the new rules, a hypertension patient previously able to obtain specialty drugs at both Hospital A and Hospital B must now designate only one facility as their hypertension separate payment institution. At the selected hospital, hypertension drugs qualify for separate payment—reimbursed at inpatient rates without counting toward the hypertension benefit cap. At non-selected hospitals, the same drugs are reimbursed at standard outpatient-specific disease rates and count toward the annual cap.

Market Impact Analysis

The policy tightens patient routing controls for high-cost nationally negotiated drugs used in chronic disease management, steering hypertension and other Category I patients toward single-institution loyalty. By requiring a designated separate payment facility, regulators are creating a closed-loop system that simplifies fund settlement for insurers while concentrating prescription volume at selected hospitals.

For pharmaceutical manufacturers, the change means drug uptake for hypertension therapies on the national negotiation list will increasingly depend on whether hospitals secure separate payment designation status and successfully attract patient registrations. Hospitals with strong primary care networks and chronic disease management programs are positioned to capture patient volume, while smaller facilities may see negotiated drug prescriptions migrate to competitors.

The inpatient-level reimbursement rate for separate payment drugs removes the financial ceiling that previously constrained long-term hypertension therapy adherence, potentially improving patient persistence on premium antihypertensive agents. However, the single-institution restriction limits patient choice and may reduce competitive pricing pressure between hospitals for chronic disease drug dispensing.

Forward-Looking Statement

Healthcare analysts expect Guangzhou’s separate payment model to be monitored closely by other tier-one cities as a template for managing nationally negotiated drug costs within outpatient chronic disease frameworks. If the single-institution designation proves effective in controlling fund leakage and improving settlement efficiency, similar restrictions could roll out across the Pearl River Delta by mid-2027. Pharmaceutical companies with hypertension and diabetes assets on the national negotiation list should prioritize partnerships with hospitals likely to secure high patient registration volumes under the new designation system.-China Health Reform Pulse

Policy Source: https://www.gd.gov.cn/zwgk/zdlyxxgkzl/ylws/content/post_4950117.html