百万「抗癌针」、长效降脂针，真降价了丨焦点分析

Core Insights - The article discusses the inclusion of multiple "heavyweight new drugs" in this year's medical insurance directory, highlighting significant updates in the national basic medical insurance directory and the first commercial health insurance innovative drug directory [3][4]. Group 1: New Drug Additions - A total of 114 new drugs have been added to the medical insurance directory, covering various fields such as oncology, anti-infection, and chronic diseases [4]. - Notable new drugs include GLP-1 diabetes/weight loss drug Tirzepatide, a semi-annual injection lipid-lowering drug Inclisiran, and gout treatment drug Febuxostat [4]. Group 2: Characteristics of New Drugs - New drugs in the directory are characterized by filling market gaps, offering superior alternatives, and providing better cost-effectiveness [5]. - Examples include the cancer drug Skanosat, diabetes drug Zepatier, and the eczema treatment drug Dupilumab [5]. Group 3: Price Reductions - Although the National Healthcare Security Administration did not disclose average price reductions, it is speculated that the reduction may be similar to previous years' reductions of 50%-60% [6]. - For instance, the long-acting growth hormone injection's price is reported to be around 850 yuan per unit, reflecting a nearly 50% reduction [6]. Group 4: Commercial Health Insurance Directory - The newly introduced commercial health insurance directory aims to address the payment challenges of high-priced innovative drugs and is closely linked to the medical insurance directory [7]. - The commercial directory includes 19 products, with price reductions ranging from 15% to 50%, slightly exceeding the industry’s previous expectations of a 30% reduction [7][10]. Group 5: Inclusion Criteria for Commercial Directory - The inclusion criteria for the commercial directory are stringent, requiring high innovation, significant clinical value, non-replaceability by the basic medical insurance directory, and diversified payment recommendations [9]. - The initial acceptance rate for the commercial directory was only 15% from the 121 products that passed the preliminary review [10]. Group 6: CAR-T Therapy - CAR-T therapies, often referred to as "anti-cancer injections," represent a significant portion of the commercial directory, with five CAR-T products included, marking the first time they have a national reimbursement pathway [13]. - Historically, CAR-T therapies faced challenges in negotiations due to their high costs, but the new directory provides a structured reimbursement approach [13][14]. Group 7: Implications for Pharmaceutical Companies - Inclusion in the commercial directory allows pharmaceutical companies to avoid negotiating with different commercial insurance products on a provincial basis [14]. - The "three exclusions" policy for products in the commercial directory offers advantages, such as not being included in basic medical insurance self-payment rates and not being subject to competitive bidding for alternative drugs [15]. Group 8: Future of Commercial Health Insurance - The article suggests that the commercial directory is just the first step, with the actual implementation being crucial for its success [22]. - There is a consensus that future products will likely be integrated into existing commercial health insurance schemes, such as "Hui Min Bao" and group insurance [22][24]. Group 9: Market Dynamics - The commercial health insurance sector is becoming an increasingly important part of the multi-tiered medical insurance system in China, with significant growth in premium income [24]. - The National Healthcare Security Administration emphasizes a collaborative rather than competitive relationship between basic medical insurance and commercial health insurance [25].