国泰海通｜医药：医保战略购买引导医药产业创新发展——新版基本医保药品目录及首个商保创新药目录发布点评

Core Insights - The article discusses the recent adjustments to the National Basic Medical Insurance, Maternity Insurance, and Work Injury Insurance drug catalog, highlighting the government's commitment to supporting innovative and differentiated drug development through strategic purchasing [1][2]. Group 1: Drug Catalog Adjustments - On December 7, the National Healthcare Security Administration (NHSA) released the updated drug catalog for 2025, which includes 114 new drugs, of which 50 are classified as Class 1 innovative drugs [2]. - The overall success rate of drug negotiations for the insurance catalog has improved to 88% in 2025, up from 76% in 2024, indicating a more favorable environment for drug inclusion [2]. - The total number of drugs in the catalog has increased to 3,253, with significant enhancements in coverage for critical areas such as oncology, chronic diseases, mental health, rare diseases, and pediatric medications [2]. Group 2: Financial Implications - Over the "14th Five-Year Plan" period, the cumulative expenditure of the medical insurance fund has exceeded 13 trillion yuan, benefiting nearly 20 billion patient visits [1]. - The NHSA has included 835 new drugs in the insurance payment scope over the past seven years, with 149 of these being innovative drugs, and approximately 80% of innovative drugs are included in the catalog within two years of their market launch [1]. - The NHSA's negotiations have resulted in over 4.6 trillion yuan in expenditures for negotiated drugs, driving sales exceeding 6 trillion yuan [1]. Group 3: Commercial Health Insurance Innovations - The first version of the commercial health insurance innovative drug catalog was introduced, including 19 drugs that are highly innovative and provide significant clinical value, such as CAR-T therapies and treatments for rare diseases [3]. - This new catalog aims to complement the basic medical insurance, clarifying the boundaries of basic insurance coverage and promoting the development of a multi-tiered medical security system [3].