医保商保“双目录”大力支持创新—— 好药新药加速惠及百姓

Core Insights - The new National Basic Medical Insurance, Maternity Insurance, and Work Injury Insurance Drug Catalog (2025) and the first Commercial Health Insurance Innovative Drug Catalog (2025) will be implemented nationwide starting January 1, 2026, adding 114 new drugs to the basic insurance catalog and 19 to the commercial insurance catalog [1][6]. Summary by Sections Drug Inclusion and Coverage Expansion - The basic medical insurance catalog includes 114 new drugs, with 36 for cancer, 12 for chronic diseases like diabetes, 13 for anti-infection, and 10 for rare diseases, while 29 drugs were removed due to better alternatives [1]. - The total number of drugs in the national medical insurance catalog will increase to 3,253, comprising 1,857 Western medicines and 1,396 traditional Chinese medicines [1]. Innovation and Market Impact - The inclusion of 50 first-class innovative drugs reflects a significant increase in the success rate of new drug approvals to 88%, up from 76% in 2024, indicating a shift towards strategic and value-based purchasing in medical insurance [3][4]. - Notable foreign innovative products, such as Novartis' and Johnson & Johnson's drugs, have also been included, highlighting the commitment to enhancing drug accessibility [3]. Policy Measures for Drug Accessibility - To address the issue of newly included drugs not being available in hospitals, the policy mandates that medical institutions must include these drugs in their procurement lists by the end of February 2026 and allows for temporary green channels if necessary [2]. - Negotiated drugs will not be subject to administrative restrictions, ensuring better access for patients [2]. Commercial Health Insurance Innovations - The first commercial health insurance innovative drug catalog includes 19 drugs, focusing on high-innovation, clinically valuable treatments that exceed basic insurance coverage, thus addressing gaps in clinical drug availability [6]. - The drugs listed are primarily from the 2021-2025 period and include advanced therapies for rare diseases, enhancing market appeal and patient access [6]. Industry Response and Future Directions - The policy signals strong government support for independent innovation, encouraging pharmaceutical companies to invest more in original and differentiated research and development [7]. - The National Medical Insurance Bureau plans to refine policies and strengthen management to ensure the effective implementation of the new drug catalogs, ultimately improving public access to necessary medications [7].