2024年抗肿瘤药物医保目录准入回顾

Group 1 - The core viewpoint of the report highlights the accelerated inclusion of anti-tumor drugs in the medical insurance directory, with significant effects from target coverage and volume expansion [2][10] - In 2024, 91 new drugs were added to the medical insurance directory, of which 29 were anti-tumor and immune modulators, accounting for 32% of the total [10][11] - The hospital sales revenue for anti-tumor and immune modulators reached 57.9 billion yuan, representing over half of the total sales for negotiated varieties [10][11] Group 2 - The report notes that the new anti-tumor drugs are predominantly focused on lung cancer, with 11 new drugs added for this indication, while no new drugs were included for liver, stomach, or esophageal cancers [4][23] - The current directory adjustments do not align with the cancer spectrum in China, where lung cancer accounts for 27.7% of cancer deaths, indicating unmet needs in other cancer types [4][23] Group 3 - High-priced therapies face dual challenges regarding medical insurance funds and efficacy value, particularly CAR-T therapies, which are priced significantly above the implicit payment threshold [5][27] - The report emphasizes the need for innovative payment ecosystems to support high-value therapies, as the current pricing and reimbursement models are unsustainable [28][27]