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][3]. Group 1: Innovative Drug Directory - The directory includes drugs for critical areas such as tumors, rare diseases, neurodegenerative diseases, and metabolic diseases, filling gaps in the basic medical insurance catalog [1]. - CAR-T therapy is highlighted as a significant treatment option for difficult-to-treat blood cancer patients, with potential survival rates increasing from six months to over five years, although its high cost limits accessibility [1][3]. Group 2: Implementation Challenges - The successful use of these innovative drugs in hospitals remains a challenge, with some hospitals still navigating the application process for these drugs [2][3]. - The "three exclusions" policy allows drugs in the commercial health insurance directory to be excluded from basic medical insurance self-payment rate indicators and centralized procurement monitoring, but does not resolve the challenges of hospital access for these high-value drugs [3][4]. Group 3: Insurance Product Design - Some Huiminbao products have begun to integrate the innovative drug directory, offering increased reimbursement rates for drugs used during hospitalization [4][5]. - The reimbursement for innovative drugs is contingent upon their successful admission into hospitals, and if not, patients may not receive coverage for these drugs [4][5]. Group 4: Regulatory Support - Local medical insurance bureaus are encouraging retail pharmacies to stock drugs from the commercial health insurance innovative drug directory, which may help address the hospital admission challenges [5][6]. - There is ongoing dialogue between innovative drug companies and commercial insurance providers to explore the inclusion of these drugs in special drug directories, potentially bypassing hospital admission requirements [5][6]. Group 5: Coverage Variability - Some Huiminbao products show significant differences in reimbursement rates for pre-existing conditions versus non-pre-existing conditions, with non-pre-existing conditions receiving a higher reimbursement rate [5][6]. - Recent notifications from multiple local medical insurance bureaus support the design of new products by commercial insurance institutions based on the innovative drug directory to better meet patient needs and reduce medical costs [6].
更多高价药有望用商保报销了 患者为何还难以获益
Di Yi Cai Jing·2026-01-07 09:12