Xin Lang Cai Jing·2025-08-24 09:07Core Insights - The introduction of the first commercial insurance innovative drug directory marks a significant shift in China's healthcare payment landscape, allowing for a dual-directory system that includes both basic medical insurance and commercial health insurance [2][3] - This new model aims to alleviate the financial burden on patients for high-priced innovative drugs and provides pharmaceutical companies with more flexible pricing strategies and market coverage options [2][3] - The concept of "first commercial insurance, then basic insurance" is proposed for innovative drugs that are not yet covered by basic medical insurance, allowing for the accumulation of real-world data before negotiating for inclusion in the basic insurance directory [2][3] Industry Dynamics - The commercial insurance sector's involvement in innovative drug payments is seen as crucial for creating a complete commercial loop in the Chinese innovative drug market, which has undergone significant transformation over the past decade [3][4] - Despite the potential benefits, uncertainties remain regarding the implementation of commercial insurance policies, including fairness, price negotiation, and the lack of mature operational experience [4][5] - The current commercial insurance innovative drug directory serves as a guideline, with local execution and detailed implementation still needing observation and refinement [4][5] Pricing and Economic Evaluation - Drug economic evaluation is becoming an essential tool for drug reimbursement and payment decisions, focusing on the effectiveness, safety, economic viability, and patient benefits of drugs [6][8] - Companies are exploring differentiated pricing strategies based on economic evaluations to achieve a balance between patient access, corporate returns, and manageable healthcare costs [6][8] - The recent policy direction emphasizes the use of drug economic evaluation in determining reimbursement standards, aiming to align with China's national conditions and market status while recognizing the value of innovative drug development [8]