更多高价药有望用商保报销了，患者为何还难以获益

Core Viewpoint - The first edition of the "Commercial Health Insurance Innovative Drug Directory" has been implemented, which includes 19 innovative drugs with significant clinical value that exceed the payment capacity of basic medical insurance, potentially benefiting participants of the Huiminbao insurance program [1][2]. Group 1: Innovative Drug Directory - The directory includes drugs for critical areas such as tumors, rare diseases, neurodegenerative diseases, and metabolic diseases, including CAR-T therapy and treatments for Alzheimer's and rare diseases like neuroblastoma and Gaucher disease [1]. - The introduction of the directory aims to alleviate the financial burden on patients, particularly for high-cost treatments like CAR-T, which can significantly extend survival rates for patients with difficult-to-treat blood cancers [1][2]. Group 2: Implementation Challenges - There are obstacles in the actual use of these high-value innovative drugs in hospitals, as the integration into hospital systems remains a challenge [2][3]. - Some hospitals are in the process of applying for the inclusion of these drugs, but the requirements and policies vary by institution, affecting the availability of these treatments [2][3]. Group 3: Policy Support - The National Healthcare Security Administration and the National Health Commission have introduced policies to support the development of innovative drugs, including the "three exclusions" policy, which allows drugs in the directory to be excluded from certain cost monitoring and payment frameworks [2][4]. - Despite these policies, challenges remain regarding the entry of high-value innovative drugs into hospitals due to operational costs and hospital performance metrics [2][4]. Group 4: Insurance Product Design - Some Huiminbao products have begun to connect with the innovative drug directory, offering increased reimbursement rates for drugs listed in the directory when used during hospitalization [2][3]. - The reimbursement structure varies significantly between patients with pre-existing conditions and those without, with some products offering higher reimbursement rates for non-pre-existing conditions [4][5]. Group 5: Future Directions - Local healthcare authorities are encouraging the integration of innovative drugs into retail pharmacies, which could help address the challenges of hospital access [4][5]. - There is ongoing dialogue between pharmaceutical companies and commercial insurance providers to explore the inclusion of these innovative drugs in special insurance directories, potentially bypassing hospital admission requirements [4].