独家｜首版商保创新药目录完成专家评审 5款“天价”CAR-T过评

Group 1 - The National Healthcare Security Administration (NHSA) has completed the expert review process for the 2025 National Basic Medical Insurance Directory and the Commercial Insurance Innovative Drug Directory, marking the 8th adjustment since its establishment and the first inclusion of a commercial insurance directory [2][3] - A total of 644 drugs passed the formal review, with 534 approved for the basic medical insurance directory and 121 for the commercial insurance innovative drug directory, although some drugs applied for both [2][3] - The expert review process revealed that less than half of the drugs submitted passed the evaluation, indicating a low approval rate for both directories [3][4] Group 2 - Certain categories of innovative drugs are prioritized for inclusion in the commercial insurance innovative drug directory, such as those already included in local health insurance and high-innovation drugs with strong patient benefits [4] - Five CAR-T drugs successfully passed the expert review, despite their high costs, which can reach around 1 million yuan per injection, and previous attempts to include them in the basic medical insurance directory have failed [4] - The expert review process for the commercial insurance innovative drug directory involves multiple rounds of evaluation, with an estimated final approval of fewer than 30 drugs from the initial list of 55 [4] Group 3 - The NHSA is considering a future payment model for innovative drugs that may involve using the commercial insurance innovative drug directory as a transitional phase before drugs are included in the basic medical insurance directory, allowing for real-world data collection [4][5]