国家医保局详解2025年医保药品目录变化 为何有一类创新药无法通过专家评审？

Core Insights - The National Healthcare Security Administration (NHSA) has released the 2025 National Medical Insurance Drug List, adding 114 new drugs, including 50 innovative drugs of Class A, and 19 drugs included in the first commercial insurance innovative drug list [1][4] Summary by Sections New Drug Additions - The 2025 National Medical Insurance Drug List primarily adds chemical drugs, with a rapid increase in biological products and some traditional Chinese medicine [1] - Out of the 114 new drugs, 112 were included through negotiation and bidding, while 2 were directly included from national procurement [1] - A total of 111 new drugs were approved in the last five years, with the number of Class A innovative drugs reaching a historical high of 50 [1] Financial Impact - As of October 2023, the NHSA has paid over 460 billion yuan for drugs under agreement, benefiting over 1 billion patients and driving related sales exceeding 670 billion yuan [2] - Basic medical insurance covers approximately 44% of the costs for innovative drugs, while commercial insurance covers about 7% [2] Evaluation and Selection Criteria - The selection process for new drugs has seen a low pass rate during expert reviews, with only 127 out of 311 drugs passing to the negotiation table this year [2] - Some drugs were not favored due to "involutionary innovation," where the clinical value does not significantly improve compared to existing drugs [3][4] - To be included in the list, drugs must meet at least one of three criteria: filling clinical gaps, superior efficacy, or better cost-effectiveness [4] Commercial Insurance Innovations - The newly introduced commercial health insurance innovative drug list emphasizes drug innovation and clinical value, with 19 out of 141 submitted drugs successfully negotiated for inclusion [5] - The drugs in the commercial insurance list include 9 Class A new drugs, addressing gaps in basic medical insurance coverage [5] Future Directions - The NHSA plans to continue annual adjustments to the drug list to meet evolving clinical needs and incorporate advancements in medical technology [6] - The focus will be on supporting domestic and innovative drugs, enhancing collaboration between commercial insurance and innovative pharmaceutical companies [6]