商保“单目录”申报仅约四成，药企抉择背后有何考量

Core Insights - This year, several high-priced innovative drugs that were previously excluded from the basic medical insurance directory due to the "invisible threshold" have passed the preliminary review for the commercial insurance innovative drug directory [1][2] - Over 60% of the drugs included in the preliminary review for the commercial insurance innovative drug directory are also applying for the basic medical insurance directory, indicating a dual strategy among pharmaceutical companies [1][4] - The National Medical Insurance Administration has published a list of 121 innovative drugs that passed the preliminary review for the commercial insurance innovative drug directory, reflecting a significant interest from pharmaceutical companies in gaining access to broader insurance coverage [3][8] Summary by Categories Innovative Drug Directory - A total of 141 applications were received for the commercial insurance innovative drug directory, with 121 passing the preliminary review, marking the first year this directory has been included in the adjustment process [3] - Approximately 40% of the drugs that only applied for the commercial insurance innovative drug directory are primarily rare disease medications, newly approved drugs with limited clinical data, and high-priced innovative drugs that do not meet the basic insurance entry threshold [2][4] Dual Directory Applications - About 80 drugs, or roughly 60% of those in the commercial insurance innovative drug directory, have also applied for the basic medical insurance directory, suggesting that the commercial directory serves as a transitional option for many innovative drug companies [4][9] - The drugs that opted for "single directory" applications are often those with high innovation and clinical value but priced significantly above the acceptable threshold for basic medical insurance [4][5] Pricing and Market Dynamics - The pricing of innovative drugs is a critical factor, with some drugs being priced at levels that are already the lowest globally, yet still not qualifying for basic medical insurance [6][8] - The competitive landscape for oncology drugs is intensifying, with companies considering the potential for inclusion in the commercial insurance directory as a means to enhance product attractiveness without significantly raising premiums [9][10] Future Considerations - The expert review phase for the drugs that passed the preliminary review will begin soon, with a focus on whether these drugs can be included in the commercial insurance directory and the basic medical insurance directory [9] - There is a growing sentiment in the industry that innovative drugs with uncertain clinical benefits may initially enter the commercial insurance directory before being reassessed for basic medical insurance inclusion based on real-world data [7][10]