对外经济贸易大学保险学院孙洁解读商保创新药目录首次评审：评审筛选严格，有望成为医保“过渡池”

Core Insights - The article discusses the introduction of a new commercial insurance innovation drug directory in China, aimed at including high-value innovative drugs that are not yet covered by the basic medical insurance directory, particularly focusing on rare disease treatments [1][2]. Group 1: Overview of the Commercial Insurance Innovation Drug Directory - The new directory serves as a supplement to the basic medical insurance directory, allowing innovative drugs that cannot currently be reimbursed to be included, thereby enhancing health coverage for insured individuals [2]. - The evaluation process involves a voting system where 55 drugs are assessed, with 25 to 30 expected to move forward to pricing negotiations, including several rare disease treatments and high-cost CAR-T therapies [1][2]. Group 2: Evaluation Process and Criteria - The evaluation is conducted by a diverse group including insurance companies, medical insurance departments, universities, and third-party technology firms, ensuring a comprehensive perspective [2]. - Key evaluation criteria include the drug's innovation level, efficacy, and patient benefit, with a focus on new drugs and treatments for rare diseases [3]. Group 3: Challenges and Considerations - Insurance companies exhibit a cautious approach towards rare disease drugs due to concerns over long-term costs and the complexity of diagnosis, which may lead to claims disputes [4][5]. - The evaluation process also considers the economic aspects of drug pricing, with companies required to provide detailed cost breakdowns, and the potential for negotiated prices to be lower than those submitted by the companies [3][6]. Group 4: Future Implications and Collaboration - The commercial insurance innovation drug directory is seen as a transitional mechanism that may eventually lead to the inclusion of these drugs in the basic medical insurance directory after accumulating real-world data [6][8]. - Successful implementation requires collaboration among various stakeholders, including the medical insurance bureau, insurance companies, pharmaceutical firms, and hospitals, to address payment challenges and ensure effective policy execution [8].