2025国家医保局拟调整医保药品目录，首设商保创新药目录

Group 1 - The National Medical Insurance Administration has officially launched the adjustment of the national basic medical insurance, maternity insurance, and work-related injury insurance drug catalog, as well as the commercial health insurance innovative drug catalog, starting from July 11, 2023 [1] - The newly added commercial health insurance innovative drug catalog focuses on high innovation, significant clinical value, and substantial patient benefits, which cannot be included in the basic catalog due to exceeding the "basic insurance" scope [1][4] - The adjustment aims to enhance the multi-tiered medication security system, better meet the diverse medication needs of the public, and provide stronger economic support for the development of innovative drugs [1][4] Group 2 - The adjustment criteria for traditional Chinese medicine (TCM) have been clarified, allowing eligible TCM decoction pieces to be included in the adjustment scope [2] - Specific conditions for TCM drugs to be included in the basic catalog include those approved by the National Medical Products Administration between January 1, 2020, and June 30, 2025, and those with significant changes in indications or functions [2][3] - The adjustment will also consider removing TCM drugs from the basic catalog if they have not supplied the market as agreed or have no transaction volume on the national medical insurance information platform [3] Group 3 - The commercial health insurance innovative drug catalog will be submitted and adjusted simultaneously with the medical insurance catalog, reducing the administrative burden on pharmaceutical companies [4][5] - The establishment of the commercial health insurance innovative drug catalog is intended to clarify the boundaries of basic medical insurance coverage and provide more development space for commercial health insurance [4] - The National Medical Insurance Administration will ensure the connection between the medical insurance drug catalog and the commercial health insurance innovative drug catalog, providing stable outlets for innovative drugs [5]