首版医保“双目录”开启 高价创新药惠及更多百姓

Core Viewpoint - The implementation of the new National Medical Insurance Drug List and the Commercial Health Insurance Innovative Drug List in 2025 marks a significant step towards addressing the payment challenges for high-value innovative drugs, enhancing the role of commercial health insurance in multi-tiered medical security [1][2][3] Group 1: Policy Implementation - The new drug lists will be executed starting January 1, 2026, with the commercial health insurance list including 19 innovative drugs, notably five CAR-T cancer treatment drugs [1][2] - The introduction of the "dual directory" system aims to bridge the gap between basic medical insurance and commercial health insurance, facilitating access to high-value drugs for more patients [1][5] Group 2: Commercial Health Insurance Role - The commercial health insurance sector is expected to innovate and expand coverage in response to the new drug lists, potentially allowing more patients to access expensive treatments [1][3][6] - The "three exclusions" policy will enable hospitals to prescribe high-priced innovative drugs more freely, thus improving clinical accessibility and allowing for smoother commercial health insurance settlements [4][6] Group 3: Market Dynamics - As of 2024, commercial health insurance premiums reached 977.3 billion yuan, yet only contributed 7.7% to the innovative drug market, indicating untapped potential in this sector [8] - The dual directory system is seen as a crucial step in building a high-quality multi-tiered medical security system, aiming to resolve the issue of high-value drugs being available but not affordable [8][9] Group 4: Future Considerations - Experts emphasize the need for a collaborative platform to enhance negotiation power between insurance companies and pharmaceutical firms, as well as the importance of data management and actuarial pricing for sustainable product offerings [9] - There is a call for establishing dynamic connection mechanisms between the medical insurance and commercial insurance directories to ensure smooth transitions and effective patient support [9]