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 Catalog Adjustments - 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 has increased to 3,253, comprising 1,857 Western medicines and 1,396 traditional Chinese medicines [2]. - The adjustment aims to address clinical treatment gaps and enhance drug accessibility for patients, particularly for previously hard-to-treat conditions like triple-negative breast cancer and pancreatic cancer [2][4]. Group 2: Policy Implementation - A combination of policies will ensure that newly added drugs are available in hospitals by February 2026, including the establishment of temporary green channels for procurement [3]. - Negotiated drugs will not be subject to administrative restrictions such as "one product, two regulations" or overall medical insurance caps, allowing for more flexible access [3]. Group 3: Support for Innovation - Among the new 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 [4]. - The inclusion of both domestic and foreign innovative products in the catalog reflects a commitment to enhancing drug accessibility and supporting pharmaceutical innovation [4]. Group 4: Commercial Health Insurance - The newly established commercial health insurance innovative drug catalog includes 19 drugs, focusing on high-innovation, clinically valuable treatments that complement the basic medical insurance offerings [7]. - The catalog features advanced therapies such as CAR-T cell treatments and drugs for rare diseases, which are expected to reduce patient financial burdens and enhance market attractiveness for pharmaceutical companies [7][8]. Group 5: Future Directions - The policy signals strong government support for independent innovation and aims to encourage pharmaceutical companies to invest more in original and differentiated research and development [8]. - The National Medical Insurance Administration plans to refine policies and strengthen management to ensure the effective implementation of the drug catalogs, enhancing public access to necessary medications [8].