Core Insights - The introduction of the commercial health insurance innovative drug directory aims to address the mismatch between high-cost innovative drugs and patient affordability, particularly in the context of rare diseases and cancer treatments [1][2][3] Group 1: Policy Developments - The National Medical Insurance Administration announced the establishment of a commercial health insurance innovative drug directory, which will include 19 drugs, including CAR-T therapies and treatments for rare diseases [1][2] - The directory is designed to complement the basic medical insurance system, allowing for a multi-tiered medical security framework that supports the development of commercial health insurance [2][3] - The commercial health insurance innovative drug directory is expected to serve as a transitional pool for innovative drugs, allowing them to be included in commercial insurance before potentially entering the basic medical insurance system [2][14] Group 2: Drug Inclusion and Pricing - Five CAR-T products have been included in the commercial health insurance innovative drug directory, which has been a focal point in recent negotiations due to their high costs [2][4][5] - The pricing negotiations for these drugs have reportedly been more favorable than those for basic medical insurance, with some products achieving significant price reductions [5][8] - The directory aims to reduce the financial burden on patients, potentially saving them hundreds of thousands of yuan in out-of-pocket expenses for treatments like CAR-T [6][7] Group 3: Challenges and Considerations - The implementation of the commercial health insurance innovative drug directory faces challenges, including the need for coordination among stakeholders, data integration, and collaboration between medical institutions and payment systems [3][10][13] - The effectiveness of the directory in providing access to patients will depend on the efficiency of medical institutions in adopting these drugs, as inclusion in the directory does not guarantee availability in hospitals [13][15] - The sustainability of this new mechanism relies on the risk management capabilities of commercial insurance providers and the effective integration of commercial and basic medical insurance systems [15] Group 4: Market Opportunities - The establishment of the commercial health insurance innovative drug directory opens significant market opportunities for commercial health insurance, particularly in designing specialized insurance products for high-value innovative drugs [3][12] - The directory is expected to enhance the clinical use of innovative drugs and improve the overall return on investment in research and development for pharmaceutical companies [15][16] - The introduction of this directory aligns with the broader goal of expanding the health service industry in China, with projections indicating a total scale of 16 trillion yuan by 2030 [3]
《财经》特稿：创新药商保破冰
3 6 Ke·2025-12-23 10:46