2025医保、商保双目录公布：医保新增50种一类创新药，多款CAR

Core Insights - The National Healthcare Security Administration (NHSA) and the Ministry of Human Resources and Social Security have issued a new drug directory for basic medical insurance and commercial health insurance, effective from January 1, 2026, which includes 114 new drugs, with 50 being innovative drugs, marking an 88% success rate compared to 76% in 2024 [2][12] Group 1: Commercial Health Insurance Drug Directory - The first edition of the commercial health insurance innovative drug directory includes 19 drugs, with a price reduction range of 15% to 50%, significantly lower than the basic medical insurance negotiation intensity [3][13] - Among the 19 drugs, there are 5 CAR-T products, 2 Alzheimer's drugs, and 6 rare disease medications, primarily focusing on high-cost treatments for catastrophic diseases [3][14] - The inclusion of CAR-T therapies in the commercial insurance directory represents a significant milestone, with all 5 domestic CAR-T therapies successfully entering the directory [3][13] Group 2: Innovative Drug Characteristics - The commercial health insurance directory emphasizes high innovation, significant clinical value, and substantial patient benefits, particularly for drugs that exceed basic medical insurance coverage [4][14] - Notable drugs include Takeda's injection of teduglutide for short bowel syndrome and North Sea Kangcheng's injection of velaglucerase alfa for Gaucher disease, which could significantly reduce treatment costs for patients [5][15] Group 3: Policy Support and Market Implications - Drugs included in the commercial health insurance directory will benefit from the "three exclusions" policy, which provides a more favorable environment for clinical application and timely treatment for patients [6][16] - The new drug directory is seen as a positive development for new drug launches, with commercial insurance attempting to address issues related to medical insurance funds [7][17] Group 4: Additional Drug Listings and Market Dynamics - The 2025 national medical insurance directory also includes drugs that fill gaps in basic insurance coverage, such as Sanofi's innovative blood cancer drug, which is the first of its kind approved in China [8][18] - Some high-profile drugs did not make it into the directory, highlighting the competitive nature of the approval process [8][19]