深度｜商保创新药目录完成协商后的下一步：谁来承接，如何打通创新药入院

Core Insights - The introduction of a dual-track payment system for innovative drugs, combining public health insurance and commercial health insurance, marks a significant shift in China's healthcare financing landscape [3][4][12] - The commercial health insurance directory for innovative drugs aims to address the high costs of innovative treatments that cannot be included in the basic health insurance directory due to their pricing [3][4] Group 1: Policy Changes - The establishment of the commercial health insurance innovative drug directory is a historic turning point, officially integrating it into the annual health insurance adjustment framework [3][4] - The new policy allows for a more structured approach to including innovative drugs in the commercial insurance system, enhancing the efficiency of the approval process [5][12] Group 2: Market Dynamics - The innovative drug market is projected to reach 162 billion yuan in sales by 2024, with public health insurance covering approximately 71 billion yuan, representing 44% of the market [4] - Commercial health insurance currently contributes only 7.7% to the payment for innovative drugs, indicating a significant gap in coverage [4] Group 3: Implementation Challenges - The successful implementation of the commercial health insurance directory requires collaboration among health insurance authorities, pharmaceutical companies, and insurance providers [7][8] - There are concerns regarding the low reimbursement rates of existing commercial health insurance products, particularly for innovative drugs, which may hinder their adoption [8][12] Group 4: Future Considerations - The need for innovative commercial insurance products is emphasized to ensure that the multi-tiered payment system can effectively support the coverage of innovative drugs [8][12] - Establishing a direct compensation mechanism and improving data sharing between health insurance and healthcare providers are critical for the successful integration of innovative drugs into the healthcare system [10][12]