专访徐敬惠：商保是创新药走向普及的关键加速器 |创新药的创新支付

Core Insights - The article emphasizes the importance of commercial health insurance as a key player in facilitating access to innovative drugs in China, highlighting the need for a transformation in the payment system to ensure that the value of these drugs reaches patients effectively [1][2][3]. Group 1: Current Landscape of Commercial Health Insurance - Commercial health insurance has made significant strides in providing coverage for innovative drugs, with products like "Hui Min Bao" and "Million Medical Insurance" offering structured coverage [2]. - As of 2024, the market size for innovative drugs and devices in China is projected to reach 162 billion yuan, with commercial health insurance accounting for only 7.7% of the payment structure, significantly lower than the 49% self-pay and 44% from medical insurance [2][3]. - The potential for commercial health insurance to play a more substantial role in the payment structure for innovative drugs is considerable, especially for high-value drugs that are still recovering their R&D costs [2][3]. Group 2: Challenges and Opportunities - The payment pathways for innovative drugs through commercial health insurance remain fragmented, with low sales efficiency and limited total premium scale [4][5]. - There is a need for expanded coverage of innovative drugs within existing insurance products, as many current plans do not adequately include these drugs in their standard coverage [5]. - The lack of standardized health insurance products leads to unclear coverage and responsibilities, which hinders the efficiency and effectiveness of the insurance system [5][6]. Group 3: Future Directions - To unlock the payment potential of commercial health insurance for innovative drugs, there is a call for the establishment of a commercial insurance drug directory, which would clarify coverage and enhance transparency [7][8]. - Collaboration between pharmaceutical companies and insurance providers is essential to share payment risks, which would facilitate the inclusion of high-priced drugs in insurance coverage [7][8]. - The development of a multi-tiered and diverse product structure within the commercial health insurance system is necessary to cater to various patient demographics, particularly the elderly and those with chronic conditions [8][9].