医保商保双目录支持“真创新”

Core Insights - The new National Medical Insurance Drug List and the first Commercial Insurance Innovative Drug List have been officially released, including over a hundred innovative drugs, set to be implemented on January 1 next year [1] Group 1: New Drugs Included in the Medical Insurance List - 98% of the drugs included in the medical insurance list are new drugs approved within the last five years, with 50 of them being first-class new drugs, marking a historical high [2] - A significant portion of the newly added drugs addresses high-demand conditions such as cancer, chronic diseases, and rare diseases, with 36 cancer drugs included, accounting for approximately 30% of the total [2] - The inclusion of innovative drugs is expected to alleviate clinical pain points, particularly for conditions previously lacking effective treatments, such as triple-negative breast cancer and pancreatic cancer [3] Group 2: Coverage and Clinical Value - The new medical insurance directory covers a wide range of diseases, including metabolic diseases and rare diseases, with drugs like KARS-targeted therapies now included [3] - Chronic disease medications, such as the cholesterol-lowering drug Increlex and the dual-target diabetes drug Tirzepatide, have also been added to the list [4] - The approval rate for drugs entering the expert review stage has decreased to 41.48%, with 331 drugs evaluated and only 129 passing the review [5] Group 3: Criteria for Inclusion - The "Four No Changes" principle restricts the inclusion of drugs that do not alter the main components, indications, administration routes, or clinical value, focusing on "true innovative" drugs that fill existing gaps [6] - Several first-class new drugs did not pass the expert review due to insufficient clinical value, despite being new compounds [7] - Experts emphasize the need to avoid homogenized innovation that wastes resources, advocating for genuine innovation that demonstrates real clinical benefits [8] Group 4: Commercial Insurance Innovative Drug List - The first Commercial Insurance Innovative Drug List includes advanced therapies such as CAR-T cell therapy, monoclonal antibodies, and small molecule targeted drugs, with 19 drugs included [10] - To facilitate the implementation of the commercial insurance innovative drug list, the National Medical Insurance Bureau has provided supportive measures, including exemptions from certain monitoring and payment frameworks [11] - The successful implementation of this new system requires careful consideration of actuarial pricing and the establishment of efficient communication platforms between commercial insurance and medical enterprises [11]