我国将建立医保综合价值评价体系

Core Insights - The National Healthcare Security Administration (NHSA) is seeking public input on trial guidelines for the comprehensive value assessment of medical services and drugs based on real-world data, aiming to establish a unified national evaluation system [1][2] - The traditional pricing and payment methods for medical services have relied on application materials, expert reviews, and historical data, which are inadequate for assessing the efficacy, safety, and cost-effectiveness of innovative technologies like cell therapy and AI-assisted diagnostics [1] - The new evaluation system will focus on real-world data from daily clinical practices, electronic medical records, insurance settlement records, and follow-up results to provide reliable evidence for healthcare decision-making [1] Evaluation Focus - The new system will evaluate various types of drugs, including innovative drugs, generic drugs, and those with insufficient evidence for combination therapies, as well as high-cost drugs that significantly consume healthcare funds [1] - It will also assess drugs with questionable efficacy or safety, off-label use drugs that are clinically necessary, and high-priced drugs that struggle to compete in centralized procurement [1] Implementation Timeline - Pilot programs for the new evaluation system have already been initiated in Beijing and other regions in 2025 [2] - By 2026, pilot areas will establish databases and undertake specific evaluation tasks [2] - The evaluation results will be prioritized as supporting evidence for healthcare decision-making in pilot regions starting in 2027 [2]