医保目录“一年一调”第八年 这些“救命药”保障再提升

Core Insights - The National Healthcare Security Administration (NHSA) announced the 2025 version of the National Basic Medical Insurance Drug List, which includes 114 new drugs, 50 of which are innovative drugs, while 29 drugs were removed due to lack of supply or better alternatives [1][2][4] Group 1: Drug List Adjustments - The total number of drugs in the directory has increased to 3,253, with 1,857 Western medicines and 1,396 traditional Chinese medicines, significantly enhancing coverage for critical areas such as cancer, chronic diseases, mental health, rare diseases, and pediatric medications [1][4] - The new directory will be implemented nationwide starting January 1, 2026 [1] Group 2: Innovative Drug Access Challenges - Despite the inclusion of innovative drugs in the directory, there are challenges in getting these drugs into hospitals due to limited capacity in hospital drug lists, which typically accommodate only 1,500 to 2,000 drugs [6][9] - Hospitals face difficulties in deciding whether to replace existing drugs with newly added "nationally negotiated drugs," leading to a cautious approach in procurement [7][11] Group 3: Financial Implications for Healthcare Providers - The NHSA has assessed the budget impact of new drugs on the healthcare fund, indicating that the overall financial burden will remain manageable within the national healthcare budget [5] - Hospitals are under pressure to control costs, especially as high-priced innovative drugs could lead to reduced budget surpluses or even deficits [13][15] Group 4: Dual-Channel Policy for Drug Distribution - The "dual-channel" policy allows patients to access "nationally negotiated drugs" through designated hospitals and retail pharmacies, ensuring equal reimbursement rates [16][18] - This policy has successfully increased the availability of critical drugs, with sales of "nationally negotiated drugs" rising from under 4 billion yuan in 2020 to nearly 15 billion yuan in 2024 [21] Group 5: Commercial Health Insurance Innovations - The NHSA introduced the first Commercial Health Insurance Innovative Drug List, which includes 19 drugs, to complement the basic medical insurance system and address the coverage gap for high-value innovative drugs [31][34] - This new list aims to facilitate better access to expensive treatments that are not covered by basic insurance, thereby reducing the financial burden on patients [40][42]