2025年医保药品目录变更情况汇总！国家医保局发布药品“清单”

Core Insights - The latest medical insurance drug list has been officially implemented as of January 1, 2026, featuring significant updates that enhance accessibility and affordability for insured individuals [1]. Group 1: New Drug Additions - A total of 114 new drugs have been added to the list, with 50 classified as new category 1 drugs, marking a record high in both quantity and proportion [2][3]. - Notable new drugs include treatments for triple-negative breast cancer, pancreatic cancer, and various chronic conditions, such as long-acting growth hormone injections and diabetes medications [3]. Group 2: Expanded Payment Scope - The payment scope has been broadened to include 65 drugs with new indications, allowing for better access to treatments for conditions like non-small cell lung cancer and rare diseases [4]. - Adjustments have been made to align payment criteria more closely with clinical practices, such as changing the payment criteria for certain drugs to reflect actual treatment scenarios [4]. Group 3: Restrictions and Conditions - New restrictions have been introduced for certain drugs to prevent misuse, ensuring that insurance funds are utilized effectively [5]. - Some drugs have had non-core restrictions removed, but the fundamental usage requirements remain unchanged, emphasizing the need for clinical discretion [5]. Group 4: Structural Adjustments - A total of 29 drugs have been removed from the list, primarily those that have been clinically obsolete or are no longer in production [6]. - A transition period of six months has been established for drugs that were removed but were under negotiation, allowing insured individuals to continue purchasing them at previous reimbursement rates until June 2026 [6]. Group 5: User Accessibility - The National Medical Insurance Bureau has launched a new feature on its WeChat account for users to query the updated basic medical insurance drug list easily [6].