“医保双目录”申报药品首次亮相 高价创新药冲刺商保目录

Core Points - The adjustment of the medical insurance catalog this year marks the 8th since the establishment of the National Medical Insurance Administration and introduces a commercial health insurance (commercial insurance) innovative drug catalog for the first time [1][6] - A total of 534 drugs passed the formal review for the basic medical insurance catalog, while 121 drug generic names were approved for the commercial insurance innovative drug catalog, including high-priced innovative drugs like CAR-T [1][3] - The establishment of the commercial insurance innovative drug catalog indicates a significant shift in China's pharmaceutical industry, introducing a second major buyer beyond the basic medical insurance fund [3][6] Summary by Sections Medical Insurance Catalog Adjustment - The National Medical Insurance Administration announced the preliminary review results for the 2025 medical insurance drug catalog, with 534 drugs approved for the basic insurance catalog and 121 for the commercial insurance innovative drug catalog [1][3] - The commercial insurance innovative drug catalog provides a separate application channel for high-priced innovative drugs, which have historically faced challenges in entering the basic insurance catalog [3][4] Market Dynamics and Opportunities - Participation in the commercial insurance innovative drug catalog is voluntary for pharmaceutical companies and commercial insurance firms, presenting both risks and potential first-mover advantages [2][5] - The commercial insurance catalog aims to support high-priced innovative drugs that exceed the basic insurance scope, such as CAR-T therapies and rare disease medications [3][4] Policy Support and Industry Impact - The National Medical Insurance Administration has implemented measures to support the high-quality development of innovative drugs, with a focus on integrating commercial insurance and medical insurance to create a multi-tiered payment system for innovative drugs [6][7] - The introduction of the commercial insurance innovative drug catalog is expected to enhance the market potential for innovative drugs, providing a pathway for companies to transition from commercial insurance to basic insurance as market conditions evolve [5][7] Innovation and Competition - The pharmaceutical industry is experiencing increased competition and a trend of homogenization among innovative drugs, leading to price competition and the need for differentiation in innovation [8][9] - The National Medical Insurance Administration emphasizes the importance of supporting true innovation that offers additional clinical benefits and addressing unmet medical needs [9][10]