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独家|重磅!2025年医保目录调整新进展,首度纳入商保创新药目录
券商中国·2025-06-26 07:10

Core Viewpoint - The recent issuance of the "2025 Basic Medical Insurance Directory and Commercial Health Insurance Innovative Drug Directory Adjustment Application Guidelines" by the National Medical Insurance Administration marks a significant step in integrating commercial health insurance into China's multi-tiered medical security system, enhancing the role of commercial health insurance in the market for innovative drugs [1][2]. Group 1: Policy Changes - The adjustment includes the first-time incorporation of the commercial health insurance innovative drug directory into the adjustment scheme, representing a major transformation in the healthcare insurance landscape [3]. - The guidelines require applicants to register and obtain a unique account for the directory adjustment process, indicating a structured approach to the application [3]. - The government work report emphasizes the need to deepen medical insurance payment reform and support the development of innovative drug directories to better meet the public's multi-tiered medication needs [4]. Group 2: Market Opportunities - The payment reform initiated by the National Medical Insurance Administration since 2019 has aimed to control unreasonable expenditures and improve the efficiency of medical insurance fund usage, creating a favorable environment for the growth of commercial health insurance [5]. - The aging population and the slowdown in medical insurance revenue growth have increased the necessity for payment reform, leading to a diverse demand for medical services and providing broader space for the development of commercial health insurance [5]. - Industry experts believe that as healthcare demands rise, commercial insurance will play a more significant role in enhancing the multi-tiered medical security system and supporting the health of the nation [5]. Group 3: Future Prospects - The current landscape of chronic diseases and non-standard patient populations presents a substantial market for commercial health insurance, especially in light of the ongoing payment reform [6]. - The potential for steady long-term development of commercial health insurance is highlighted, with an emphasis on expanding outpatient coverage and catering to non-standard patient groups [7]. - High-end medical insurance is positioned as a core vehicle for meeting quality healthcare demands due to its broad coverage and high service integration [7].