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Core Viewpoint - The high cost of innovative drug treatments, such as CAR-T cell therapy, is a growing concern, prompting discussions on how to ensure accessibility without imposing financial burdens on patients and their families [1][2][3] Payment System for Innovative Drugs - The establishment of a sustainable and efficient payment system for innovative drugs is crucial for their widespread application [3] - Recent policies have been introduced to support the inclusion of innovative drugs in basic medical insurance and commercial health insurance directories, aiming to enhance payment capabilities [3][4] - By 2024, commercial health insurance is expected to cover approximately 12.4 billion yuan for innovative drugs, with direct reimbursements amounting to 6.6 billion yuan [4] Market Growth and Challenges - China's pharmaceutical market has become the second largest globally, with an annual growth rate exceeding 3%, driven primarily by innovative drugs [6] - The market size for innovative drugs reached approximately 162 billion yuan in the previous year, reflecting a year-on-year growth of 16% [6] - Basic medical insurance currently covers only 16% to 25% of the innovative drugs applied for, indicating a significant gap in coverage [7] Policy Support and Developments - Various policies have been enacted to support the development of innovative drugs and establish a multi-channel payment system [12][14] - The introduction of the commercial health insurance innovative drug directory is seen as a strategic move to enhance the integration of insurance and pharmaceutical industries [15][16] Collaborative Efforts and Innovations - Insurance companies and pharmaceutical firms are exploring new payment models, including risk-sharing mechanisms based on treatment efficacy [21][22] - Local governments are facilitating the design and underwriting challenges faced by commercial insurance in the innovative drug payment sector [21][24] Future Directions - The successful implementation of the "three exclusions" policy, which allows innovative drugs in the commercial insurance directory to be excluded from certain payment metrics, is critical for compliance and pricing negotiations [23] - There is a need for a collaborative ecosystem involving government, insurance companies, and pharmaceutical firms to transform commercial insurance from a traditional compensator to a health management and payment innovator [24]