百万抗癌药有望报销，商保创新药目录将出炉

Core Insights - The National Healthcare Security Administration (NHSA) has completed the expert review phase for the 2025 National Basic Medical Insurance Directory and Commercial Health Insurance Innovative Drug Directory adjustments, allowing companies to check the results through the national healthcare service platform [1] - The introduction of the Commercial Health Insurance Innovative Drug Directory aims to provide new options for high-value, innovative drugs that cannot be included in the basic medical insurance directory due to their high costs [1][3] - The expert review results indicate that certain drugs are eligible for negotiation, bidding, and price consultation, marking a significant step in the integration of innovative drug payment mechanisms [4] Summary by Sections Expert Review and Directory Adjustments - The NHSA received 718 submissions for the basic medical insurance directory, with 535 passing the formal review, while 141 submissions for the commercial health insurance directory saw 121 approved [3] - The commercial health insurance directory is particularly focused on high-cost drugs, including CAR-T therapies and rare disease treatments, which are seeking new payment pathways [3][5] Rare Disease Treatment and Payment Mechanisms - Experts emphasize that the payment for rare disease treatments in China relies on a multi-layered support system, with basic medical insurance and the new commercial health insurance directory playing crucial roles [2][5] - The commercial health insurance directory is expected to open new avenues for rare disease treatments, although the actual implementation remains a key concern [2][6] Challenges in Implementation - Experts highlight the need for a multi-faceted payment approach that includes various stakeholders such as major illness insurance, medical assistance, and charitable donations to effectively address high-cost drug payments [6][7] - The lack of a clear communication and coordination mechanism among stakeholders, including insurance companies, pharmaceutical firms, and regulatory bodies, poses significant challenges to the successful rollout of the commercial health insurance directory [7][8] Pricing and Hospital Access - Pricing negotiations are ongoing, with expectations that the prices for drugs in the commercial health insurance directory will be significantly lower than those in the national negotiation process [8] - The ability of these high-value drugs to enter hospitals will depend on specific policies and the circumstances of individual hospitals, despite some regulatory frameworks aimed at easing access [8]