商保怎么落地？医保怎么支持创新？权威解读来了

Core Viewpoint - The introduction of the commercial insurance innovative drug directory will create a win-win situation for patients, insurance companies, and hospitals, allowing patients access to innovative drugs, insurance companies to benefit from discounts, and hospitals to enhance their diagnostic capabilities and influence [1][7]. Summary by Sections Commercial Insurance Directory Release - On December 7, the National Medical Insurance Administration released the adjusted national basic medical insurance directory and the first version of the commercial insurance innovative drug directory, adding 114 new drugs to the basic insurance directory and 19 drugs to the commercial insurance directory [2]. Support for Innovation - The National Medical Insurance Administration aims to clarify the boundaries of basic medical insurance coverage and leave room for the development of commercial insurance, focusing on supporting true and differentiated innovations rather than redundant innovations [3][15]. Drug Selection Criteria - The drugs included in the commercial insurance directory are characterized by high innovation, significant clinical value, non-replaceability by existing basic insurance drugs, and strong insurability [6][11]. Market Dynamics - The commercial insurance directory is expected to provide coverage primarily for high-cost treatments after second and third-line therapies, indicating that it is designed to supplement existing basic insurance rather than simply overlap with it [7][10]. Insurance Product Development - Insurance companies are encouraged to design products that align with the commercial insurance directory, focusing on specific populations and innovative drugs [8][10]. Challenges and Considerations - The main challenges for commercial insurance include improving the efficiency of claims processing, ensuring that products cover truly innovative drugs, and addressing the potential issue of adverse selection if sick individuals are more inclined to purchase insurance [12][13]. Future Outlook - The commercial insurance directory is expected to officially launch on January 1, 2026, with insurance companies likely to introduce corresponding products shortly thereafter [10][12]. Regulatory Support - The National Medical Insurance Administration is committed to supporting true innovation and has implemented stricter evaluation criteria for new drugs, resulting in a lower approval rate for submissions [16][18]. Financial Impact - As of October 2025, the medical insurance fund has paid over 460 billion yuan for negotiated drugs, benefiting over 1 billion patients and driving related sales exceeding 670 billion yuan, demonstrating substantial financial support for the development of innovative drugs [18].