创新药支付，商业健康险的下一个“战场”

Core Insights - The commercial health insurance sector is at a transformative crossroads, driven by the integration of insurance payments with innovative drugs and health management services, referred to as the "insurance + medicine" ecosystem [1][6] Policy and Market Dynamics - The Chinese innovative drug industry is experiencing rapid growth, with 43 innovative drugs approved in the first half of 2025, a 59% increase year-on-year, while the sales revenue for innovative drugs reached 162 billion yuan in 2024 [2] - The payment structure for innovative drugs is imbalanced, with personal cash payments at 49%, insurance fund payments at 44%, and commercial health insurance covering only 7.7% [2] - New policies, such as the establishment of a commercial health insurance innovative drug directory, are aimed at integrating commercial health insurance into the multi-channel payment system for innovative drugs [2][3] Market Challenges and Opportunities - The health insurance sector is under pressure, with a mere 2.3% growth in original insurance premium income in the first half of 2025, below the industry average [4] - The aging population, with 15.6% of the population aged 65 and above in 2024, is increasing the urgency for transformation in health insurance [4] - The market for innovative drug payments is expanding, with 441 innovative drugs included in commercial insurance since 2019, indicating a growing trend towards differentiated competition among insurance companies [5] Ecosystem Development - The "insurance + medicine" ecosystem is emerging, where insurance companies collaborate with pharmaceutical firms and healthcare platforms to enhance service offerings and risk management [6] - Companies are innovating products to include coverage for innovative drugs, with examples like the "TaiKang Million Drug Worry-Free" insurance policy that covers a wide range of medications [6] Service Integration and Challenges - There is a call for integrating service responsibilities into insurance policies to enhance customer experience and risk management efficiency [7] - Data silos between medical institutions, pharmaceutical companies, and insurance firms pose significant challenges to the effective implementation of innovative drug coverage [8] - Ensuring the quality of medical services related to innovative drug payments is critical, with leading insurance companies beginning to build or partner to create comprehensive medical service networks [8] Future Outlook - Companies that successfully build a closed-loop capability in the medical insurance ecosystem are likely to establish a competitive advantage [9] - The commercial health insurance sector is shifting from a price competition model to one focused on service and ecosystem development, indicating a new battleground for innovative drug payments [9]