多地政策接连搭台，商业健康保险能否让创新药“用得起用得上”

Core Viewpoint - The rapid development of innovative drugs and medical devices raises concerns about their affordability and accessibility for consumers, prompting regions to enhance diverse payment mechanisms for these innovations [1][3]. Group 1: Policy Initiatives - On August 6, the Shanghai Financial Regulatory Bureau and six other departments issued measures to promote the high-quality development of commercial health insurance, specifically targeting the payment for innovative drugs and devices [1][3]. - The measures include 18 initiatives that emphasize the role of commercial insurance in the payment landscape for innovative medical products, aiming to improve their accessibility [3][4]. - Chengdu's Medical Security Bureau also announced support for including more innovative drugs and devices in commercial health insurance coverage [1][3]. Group 2: Market Dynamics - The National Medical Products Administration reported that 43 innovative drugs were approved in the first half of 2025, marking a 59% year-on-year increase, indicating a significant period of innovation in the pharmaceutical industry [3][5]. - Despite the effectiveness of many innovative drugs, their high prices deter patients, highlighting the need for improved payment mechanisms [3][5]. - The commercial health insurance sector currently contributes only 7.7% to the payment for innovative drugs, with personal cash payments at 49% and medical insurance at 44% [5][6]. Group 3: Challenges and Opportunities - Commercial health insurance faces challenges such as inadequate systems, insufficient medical data sharing, and difficulties in payment settlement, which hinder its contribution to innovative drug payments [6][8]. - The insurance sector must address cost control while ensuring patient access to high-priced innovative drugs, as well as improve risk management due to limited safety and efficacy data [6][8]. - The recent measures from Shanghai encourage collaboration between insurance companies and pharmaceutical firms, potentially leading to collective procurement and better pricing negotiations for innovative drugs [7][8]. Group 4: Future Directions - The measures suggest that commercial health insurance could play a more significant role in the multi-faceted payment system for innovative drugs, with a focus on expanding funding channels and product innovation [8]. - There is a call for insurance companies to enhance their operational capabilities in areas such as actuarial pricing, product design, and customer service to better support the development of innovative drugs [8].