“天价抗癌药”冲关医保双目录

Core Insights - The adjustment of the medical insurance drug catalog in 2025 has seen a significant increase in the number of drugs passing the formal review, with a new commercial insurance innovative drug catalog attracting industry attention [1][3] - The parallel submission of the basic medical insurance catalog and the commercial insurance innovative drug catalog aims to provide comprehensive coverage for different patient groups based on their payment capabilities, enhancing drug accessibility and market competitiveness [1][8] Summary by Sections Basic Medical Insurance Catalog - A total of 718 submissions were received for the basic medical insurance catalog, involving 633 drug generic names, with 534 passing the formal review [3] - The number of drugs passing the formal review from the catalog outside the basic insurance has increased significantly, with 310 out of 472 submissions approved, compared to 249 in 2024 [3] - The approved drugs cover various fields, including oncology, chronic diseases, and rare diseases, with notable entries like monoclonal antibodies and a popular weight-loss drug [3][4] Commercial Insurance Innovative Drug Catalog - The newly established commercial insurance innovative drug catalog received 141 submissions, with 121 passing the initial review, resulting in a pass rate of approximately 85.82% [5] - This catalog also includes drugs for oncology, chronic diseases, and rare diseases, primarily focusing on Western medicine, along with a few traditional Chinese medicines [5][6] - The establishment of this catalog reflects the government's commitment to building a multi-tiered medical insurance system, providing supplementary coverage for high-value drugs not included in the basic insurance [6][8] Dual Submission and Market Strategy - Several drugs have successfully passed the formal review for both the basic medical insurance catalog and the commercial insurance innovative drug catalog, indicating a strategic approach by pharmaceutical companies to expand market coverage [7][8] - The dual submission allows companies to target both broad patient groups through basic insurance and high-value innovative drugs through commercial insurance, enhancing drug accessibility and competitiveness [8]