“救命药”进医院,最后一公里咋破

Core Insights - The 2025 version of the National Basic Medical Insurance, Maternity Insurance, and Work Injury Insurance Drug Directory has been officially released, adding 114 new drugs, including 50 innovative drugs, while removing 29 drugs that are either not clinically available or can be replaced by better alternatives [1][2] - The total number of drugs in the directory has increased to 3,253, with significant improvements in coverage for key areas such as cancer, chronic diseases, mental health, rare diseases, and pediatric medications [1] - The new directory will be implemented nationwide starting January 1, 2026 [1] Group 1: Drug Inclusion and Economic Impact - The adjustment of the drug directory is a response to public health needs, with the inclusion of innovative and life-saving drugs for conditions like non-small cell lung cancer and cervical cancer [2] - Experts have assessed the budget impact of the new drugs on the medical insurance fund, suggesting that the overall effect will not be significantly detrimental [2] Group 2: Challenges in Hospital Access - Despite the inclusion of "nationally negotiated drugs" in the insurance directory, there are challenges in their availability in hospitals due to limited capacity in hospital drug lists, which typically accommodate only 1,500 to 2,000 drugs [3] - The rapid increase in the number of "nationally negotiated drugs" complicates decisions for hospitals regarding which drugs to include, especially when alternatives already exist [3][4] Group 3: Financial Management and Policy Recommendations - The current budget control system for hospitals means that higher sales of expensive innovative drugs could lead to reduced surpluses or even budget overruns, making hospitals cautious about purchasing "nationally negotiated drugs" [4] - Experts recommend improving incentive mechanisms for the use of "nationally negotiated drugs" and increasing investment in healthcare resources to alleviate financial pressures on hospitals [4] Group 4: Dual-Channel Policy and Payment Innovations - To address the issue of "drugs available in insurance but hard to find in hospitals," a "dual-channel" policy was introduced, allowing patients to access "nationally negotiated drugs" through designated hospitals and retail pharmacies with equal insurance reimbursement [6] - The sales of "nationally negotiated drugs" have significantly increased, from less than 4 billion yuan in 2020 to nearly 15 billion yuan in 2024 [6] - Sichuan Province has implemented a "single payment" policy for high-cost, clinically necessary "nationally negotiated drugs," allowing direct settlement by the insurance fund without affecting hospital budget assessments, thus reducing cost control pressures on hospitals [6]