医保“双目录”时代启幕：114种新药入基本盘，19种高价创新药首获商保

Core Insights - The release of the new drug directories marks a significant advancement in China's innovative drug security system, transitioning to a "basic medical insurance + commercial insurance" complementary model, which will notably reduce the medication burden for insured patients, especially those with cancer and rare diseases [3][13][20] - The total number of drugs in the national medical insurance directory has increased to 3,253, with 114 new drugs added and 29 drugs removed, including 19 high-priced innovative drugs included in the commercial insurance directory [3][20] Summary by Sections National Medical Insurance Directory - The 2025 National Medical Insurance Drug Directory includes 114 new drugs, with 111 being newly launched in the last five years, marking a historical high for innovative drugs [4][14] - The approval-to-coverage timeline for innovative drugs has been significantly shortened, exemplified by the rapid inclusion of the domestic targeted drug for triple-negative breast cancer, which was approved in November 2024 and will be available for clinical use by October 2025 [5][15] Commercial Health Insurance Directory - The first commercial health insurance innovative drug directory aims to address the accessibility of high-priced innovative drugs that exceed the basic medical insurance's affordability [8][17] - This directory includes 19 drugs, featuring advanced therapies such as CAR-T cell therapy and treatments for Alzheimer's and rare diseases, with costs often reaching hundreds of thousands [17][18] Policy Innovations - The "three exclusions" policy allows drugs in the commercial insurance directory to be exempt from basic medical insurance self-payment rate indicators, centralized procurement monitoring, and disease-based payment ranges, encouraging the development of insurance products that cover these high-priced drugs [18][20] - The strict admission standards for the commercial insurance directory ensure that only drugs with high innovation and clinical value are included, with a success rate of 88.19% for negotiations, indicating a rigorous selection process [16][19] Overall Impact - The dual directory adjustment represents a milestone in China's healthcare system, establishing a multi-tiered medical security framework that combines basic insurance, commercial insurance, and medical assistance [10][20] - The adjustments aim to accelerate the inclusion of innovative drugs in basic medical insurance while creating conditions for more innovative drugs to enter the market, ultimately enhancing patient access to life-saving medications [20][21]