王国军：创新药支付体系变革的关键一步丨金融百家

Core Viewpoint - China's pharmaceutical innovation is undergoing a historic transformation, driven by the collaboration of medical insurance, healthcare, and pharmaceutical sectors, aiming to shift from a "generic drug powerhouse" to an "innovative drug stronghold" [1] Group 1: Policy Measures - The National Healthcare Security Administration and the National Health Commission released measures to support high-quality development of innovative drugs, marking a significant step in China's healthcare strategy [1][2] - A series of policy documents were issued to establish a pricing negotiation process for innovative drugs, indicating a strategic arrangement for a multi-tiered medical security system [2] Group 2: Market Dynamics - In 2024, China's basic medical insurance fund had a total income of 34,809.95 billion yuan and total expenditure of 29,675.92 billion yuan, with commercial health insurance covering less than 8% of innovative drug costs [3] - The innovative drug market in China is projected to reach 1,620 billion yuan, highlighting the underutilization of commercial health insurance in supporting innovative drug development [3] Group 3: Insurance and Pharmaceutical Collaboration - The guidelines for the insurance directory focus on "clinical value-cost effectiveness," encouraging pharmaceutical companies to shift from "Me-too" to "First-in-class" drug development [4] - The establishment of a commercial health insurance directory for innovative drugs aims to alleviate the financial burden on basic medical insurance while providing new payment channels for innovative drugs [4][5] Group 4: Benefits of the New Framework - The new insurance directory benefits pharmaceutical companies by expanding patient access and accelerating capital recovery for further innovation [5] - Commercial insurance companies can leverage shared information from medical insurance to expand their health insurance business at lower costs, ultimately benefiting patients by reducing medical expenses [5] Group 5: Future Directions - The dynamic adjustment of the commercial health insurance directory and pricing mechanisms represents a process of balancing interests among various stakeholders, including patients, pharmaceutical companies, and insurance providers [6] - The integration of medical insurance and commercial health insurance is expected to evolve towards a collaborative regulatory framework, enhancing the overall healthcare system in China [8]