商保创新药目录靴子落地：价格“谈判”改“协商”

Core Points - The release of two significant documents by the National Medical Insurance Administration and the National Health Commission marks a pivotal moment for the commercial health insurance sector in China, particularly regarding innovative drug pricing and inclusion in insurance directories [2][4][12] Group 1: Policy Changes - The newly published "Measures to Support the High-Quality Development of Innovative Drugs" indicates that the settlement prices for drugs in the commercial health insurance innovative drug directory will be determined through "consultation" rather than "negotiation" [7][21] - The "Work Plan for Adjusting the National Basic Medical Insurance, Maternity Insurance, and Work Injury Insurance Drug Directory and the Commercial Health Insurance Innovative Drug Directory by 2025" outlines a basic process for price consultation, although specific details remain to be finalized [3][19] - The commercial health insurance innovative drug directory, previously referred to as the "Category B Drug Directory," has been officially announced, and its first version will be developed in conjunction with the 2025 national negotiations [4][5] Group 2: Role of Insurance Companies - Insurance companies will have a significant decision-making role in the development of the commercial health insurance innovative drug directory, with the National Medical Insurance Administration emphasizing the importance of their participation in various stages, including expert reviews and price consultations [13][27] - The transition from "negotiation" to "consultation" regarding pricing has led to mixed reactions, with some industry insiders perceiving it as a step back for the National Medical Insurance Administration [14][15] - The final decision on whether a drug will be included in the directory and its pricing will involve a collaborative process with input from insurance experts and the National Medical Insurance Administration [11][17] Group 3: Pricing Mechanism - The pricing mechanism for drugs included in the commercial health insurance innovative drug directory will involve expert assessments and on-site price consultations, with successful negotiations leading to inclusion in the directory [17][20] - The current framework indicates that the specifics of the price consultation rules and agreements will be determined after soliciting opinions from relevant parties [19][31] - The National Medical Insurance Administration aims to ensure that different insurance companies do not face varying prices for the same drugs, promoting a unified "consultation price" for the directory [20][26] Group 4: Market Implications - The commercial health insurance innovative drug directory is expected to provide a structured approach to pricing and inclusion of innovative drugs, potentially leading to a more standardized pricing model across the sector [25][28] - The directory's implementation is seen as a strategic move to enhance the market for commercial health insurance, despite the current limited uptake of such insurance products among the population [24][30] - The National Medical Insurance Administration plans to support insurance companies through data sharing, synchronized settlements, and regulatory collaboration to facilitate the smooth operation of commercial health insurance [28][29][30]