健康险寻“药”匙：首版创新药目录能否打开万亿元风口

Core Viewpoint - The release of the first edition of the "Commercial Health Insurance Innovative Drug Directory" in China, which includes 19 drugs, is expected to drive innovation in commercial health insurance products and open up growth opportunities in the health insurance sector [1][2]. Group 1: Innovative Drug Directory - The directory will officially implement on January 1, featuring 19 drugs, including CAR-T for cancer treatment and drugs for rare diseases like neuroblastoma and Gaucher disease, as well as Alzheimer's disease [1]. - The directory emphasizes three characteristics: support for innovation, focus on key areas, and delineation of the boundary between basic medical insurance and commercial insurance [1][2]. Group 2: Growth Opportunities in Health Insurance - Despite a general increase in commercial health insurance premium income, growth has slowed, with premiums not exceeding 1 trillion yuan in the past three years. The innovative drug directory is seen as a means to unlock growth potential [2]. - Data from the Financial Regulatory Authority indicates that health insurance premium income reached 894.3 billion yuan in the first ten months of 2025, a year-on-year increase of 2.3% [2]. Group 3: Industry Transformation - The directory is expected to shift health insurance from homogeneous competition to differentiated innovation, allowing for more precise product design tailored to specific diseases and populations [2][3]. - The establishment of the directory is anticipated to encourage insurance companies to develop specialized insurance products and deepen the "insurance + specialty drug services + health management" ecosystem [2][3]. Group 4: Challenges and Recommendations - Challenges in product pricing, underwriting, and claims processing remain for commercial health insurance, necessitating improvements in data sharing mechanisms between basic medical insurance and commercial insurance [3]. - Industry experts suggest creating a multi-party data sharing platform to support precise pricing and exploring mechanisms like reinsurance and government risk-sharing to mitigate risks [3].