惠民保新趋势：重点突破特药保障目录

Core Insights - The article discusses the rapid development and evolution of urban customized commercial health insurance (Hui Min Bao) in China since its launch in 2020, highlighting its transition from "incremental expansion" to "stock optimization" for high-quality development [1][2]. Group 1: Market Development - As of July 2023, a total of 313 local Hui Min Bao products have been launched nationwide, with a market growth rate of 2.96% [2]. - The market is shifting from new product launches to optimizing existing offerings, with a decrease in the proportion of normally operating products from 74.3% to 66.78% between 2023 and 2024 [2]. - The focus is on deepening market penetration while enhancing product layers in already covered regions, with new offerings such as universal critical illness insurance introduced in Guangdong and Guangxi [2]. Group 2: Product Diversification - The need for product stratification is emphasized to meet the diverse needs of different income groups and health conditions, suggesting a clear gradient of "basic version + upgraded version + universal critical illness insurance" [3]. - The average Hui Min Bao product covers 41 types of special drugs and 28 types of indications, with over 80% of traditional products including special drug responsibilities [4]. Group 3: Special Drug Coverage - Special drug coverage has become a key innovation area for Hui Min Bao, addressing the gap in basic medical insurance for innovative and high-cost drugs [4]. - The inclusion of CAR-T therapy and local specialty drug directories aims to enhance drug accessibility and support the development of the domestic biopharmaceutical industry [4]. Group 4: Sustainability Concerns - The low premium model raises concerns about the sustainability of expanding special drug coverage, with risks of adverse selection and medical cost inflation highlighted [5]. - Future sustainability relies on refined management strategies, including setting reasonable deductibles, enhancing drug review processes, and increasing enrollment rates to diversify risk [5].