从“灵魂砍价”到“价值共赢” 医保与创新药的双向奔赴

Core Insights - The new national medical insurance drug list and the first commercial insurance innovative drug list will be implemented nationwide starting January 1, 2026, marking the largest expansion of innovative drugs in the history of the medical insurance directory [1] - The adjustment of the medical insurance directory represents a dual benefit for the innovative drug industry in China, with significant changes in the inclusion of innovative drugs and the establishment of a commercial insurance innovative drug directory [1][2] Summary by Sections Innovative Drug Inclusion - A total of 114 new drugs have been added to the national medical insurance drug list, including 111 new products launched within the last five years and 50 Class I new drugs, both of which set historical highs in terms of quantity and proportion [1][2] - The newly included drugs generally possess three common characteristics: they either fill a treatment gap, are superior alternatives, or offer better cost-effectiveness [2] Commercial Insurance Innovative Drug Directory - The first commercial insurance innovative drug directory includes 19 drugs, covering treatments for various conditions such as CAR-T therapies for tumors, rare diseases like Gaucher disease, and Alzheimer's disease, complementing the basic medical insurance [2][3] - The selection mechanism for the commercial insurance directory emphasizes high innovation, significant clinical value, strong irreplaceability, and adaptability to a multi-tiered payment system [3] Payment System and Market Impact - The medical insurance fund has paid over 460 billion yuan for negotiated drugs by the end of October 2025, benefiting 1 billion patients and driving related drug sales exceeding 670 billion yuan [4] - The new dual-directory system aims to clarify the boundaries of basic medical insurance coverage while allowing space for commercial insurance development, thus supporting a multi-tiered payment system [3][4] Innovation Ecosystem - The integration of the commercial insurance innovative drug directory with the national medical insurance drug list is crucial for building a multi-layered medical security system, focusing on high-innovation and clinically significant drugs that exceed basic insurance coverage [5] - The successful inclusion of breakthrough therapies like Alpelisib not only provides hope for patients but also signals strong support for genuine innovation within the pharmaceutical industry [5]