首版商保创新药目录完成专家评审 5款“天价”CAR-T过评

Core Insights - The National Healthcare Security Administration (NHSA) announced the completion of expert review for the 2025 National Basic Medical Insurance (BMI) catalog and the commercial insurance innovative drug catalog adjustments, marking the 8th adjustment since the NHSA's establishment and the first inclusion of a commercial insurance innovative drug catalog [1] Group 1: Drug Approval Process - A total of 644 drugs passed the formal review, with 534 approved for the basic BMI catalog and 121 for the commercial insurance innovative drug catalog, noting that some drugs applied for both [1] - The expert review phase saw less than half of the submitted drugs approved, with low approval rates for both the basic BMI and commercial insurance innovative drug catalogs [2] Group 2: Expert Review Insights - The expert review was conducted by a diverse group including NHSA, insurance companies, universities, and third-party technical firms, with a broad coverage of innovative drugs prioritized for inclusion [2] - Five CAR-T drugs received unanimous approval from experts, despite their high costs, which range around 1 million yuan per injection, and previous unsuccessful attempts to enter the basic BMI catalog [2] Group 3: Future Considerations - The expert review process includes a metric for "expert opinion consensus rate," which increases the likelihood of approval for drugs with broader expert support, while rare disease drugs are approached with more caution [3] - Future payment models for innovative drugs may involve using the commercial insurance innovative drug catalog as a transitional phase before potential inclusion in the basic BMI catalog, allowing for real-world data collection [3] - The NHSA plans to hold a face-to-face communication meeting in Beijing with companies involved in negotiations, bidding, and price discussions [3]