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][2] Group 1: Drug Inclusion and Coverage - The updated basic medical insurance catalog includes 114 new drugs, with significant representation from oncology (36 drugs), chronic diseases (12 drugs), anti-infectives (13 drugs), and rare diseases (10 drugs) [2] - 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 [2] - The inclusion of innovative drugs addresses clinical gaps, such as previously untreatable conditions like triple-negative breast cancer and pancreatic cancer, enhancing patient access to necessary treatments [2][4] Group 2: Policy Implementation and Access - To address the issue of newly included drugs not being available in hospitals, the policy mandates that all designated medical institutions must include new drugs in their procurement catalogs by the end of February 2026, with provisions for temporary green channels if necessary [3] - Negotiated drugs will not be subject to administrative restrictions like "one drug, two regulations" or total medical insurance expenditure limits, facilitating quicker access to high-value innovative drugs [3] Group 3: Innovation and Market Dynamics - Among the newly added drugs, 50 are classified as first-class innovative drugs, with an overall success rate of 88%, up from 76% in 2024, indicating a shift towards strategic purchasing and value-based reimbursement in the healthcare system [4][5] - The 2025 catalog includes both domestic innovative products and foreign original research products, reflecting a commitment to enhancing drug accessibility and supporting innovation [4] Group 4: Commercial Health Insurance Innovations - The first Commercial Health Insurance Innovative Drug Catalog includes 19 drugs, primarily high-innovation treatments for conditions like neuroblastoma and Gaucher disease, which are often prevalent in children [7] - The commercial insurance catalog complements the basic medical insurance, allowing pharmaceutical companies to expand their market presence while reducing patient financial burdens [7][8] Group 5: Future Directions and Industry Impact - The policy signals strong government support for independent innovation and aims to ensure that the value of innovations is recognized and rewarded, encouraging pharmaceutical companies to invest more in original and differentiated research [8] - The National Medical Insurance Bureau plans to refine policies and enhance management to ensure the effective implementation of the drug catalogs, ultimately improving the clinical medication experience for insured individuals [8]