商保怎么落地？医保怎么支持创新？权威解读来了

Core Insights - The National Healthcare Security Administration (NHSA) has released an updated National Basic Medical Insurance (BMI) catalog, adding 114 new drugs, and a first version of the commercial insurance innovative drug catalog, which includes 19 drugs. This dual catalog aims to clarify the boundaries of basic insurance coverage and create space for the development of commercial insurance, contributing to a diversified medical security system [1][2]. Group 1: Commercial Insurance Catalog Implementation - NHSA emphasizes three considerations for the implementation of the commercial insurance catalog: enhancing communication with local authorities, maintaining drug market prices while providing discounts to insurance companies, and encouraging the design of commercial health insurance products targeting the innovative drug catalog [2][3]. - The commercial insurance catalog includes 19 drugs, with a strict selection process resulting in a less than 20% approval rate for drugs entering the price negotiation phase, indicating a rigorous expert review [3][4]. Group 2: Characteristics of Included Drugs - The drugs in the commercial insurance catalog exhibit four main characteristics: high innovation level, significant clinical value, non-replaceability by existing BMI catalog drugs, and strong insurability [4][5]. - Most drugs included are for second-line and third-line treatments, highlighting the catalog's focus on providing coverage for high-cost treatments of catastrophic diseases beyond existing BMI coverage [5][6]. Group 3: Stakeholder Benefits and Challenges - The commercial insurance catalog is expected to create a win-win situation for patients, insurance companies, and hospitals, allowing access to innovative drugs while providing discounts to insurers and enhancing hospital capabilities [6][7]. - Challenges identified include the need for better integration between commercial insurance and medical institutions, improving claims efficiency, and ensuring that product designs adequately cover truly innovative drugs [6][8]. Group 4: Future Developments and Considerations - The commercial insurance catalog is anticipated to officially launch on January 1, 2026, with insurance companies expected to quickly develop corresponding products. However, the timeline for public access to these products remains uncertain [8][9]. - The potential for insuring individuals with pre-existing conditions is noted, but concerns about adverse selection in the insurance market are raised, emphasizing the need for careful management of pricing and claims data [9][10]. Group 5: Support for True Innovation - The NHSA has increased support for innovative drugs in the BMI catalog, with 50 out of 114 new drugs being classified as first-class innovative drugs, reflecting a significant commitment to fostering true innovation in the pharmaceutical sector [11][12]. - The approval process for drugs has become more stringent, with a lower approval rate for expert reviews, indicating a focus on supporting differentiated innovations rather than redundant ones [12][13].