【医药生物】医保和商保目录并轨，扩容与提质并重，支持创新药高质量发展——2025年版医保目录调整政策点评（王明瑞/黄素青）

Core Viewpoint - The article discusses the recent updates to the National Medical Insurance and Commercial Health Insurance drug directories, highlighting the successful negotiations and the inclusion of innovative drugs, which aim to enhance the healthcare system in China [4][5]. Group 1: Drug Directory Updates - The total number of drugs in the basic medical insurance directory increased from 3,159 to 3,253, with 1,857 Western medicines and 1,396 traditional Chinese medicines included [5]. - A total of 127 drugs outside the directory participated in negotiations, with 112 successfully negotiated, achieving a success rate of 88%, the highest in seven years [5]. - The newly added drugs primarily target cancer, infections, chronic diseases, and rare diseases, indicating a focus on critical therapeutic areas [5]. Group 2: Commercial Health Insurance Directory - The first version of the commercial health insurance directory included 24 drugs for price negotiations, with 19 successfully included, resulting in a success rate of 79% [5]. - Among the included drugs, 9 are classified as first-class new drugs, addressing significant clinical needs such as Alzheimer's disease and multiple myeloma [5]. - The directory aims to bridge the gap between basic medical insurance and commercial health insurance, focusing on high-value drugs not covered by basic insurance [8]. Group 3: Negotiation and Renewal Rates - The recent adjustments added 114 new drugs while removing 29 drugs that were either replaced or not in production, with 111 being newly listed within five years [6]. - The renewal rate for drugs already in the directory reached 75%, indicating strong support for existing treatments [6]. - The overall approval rate for drugs undergoing formal review was 41.48%, reflecting a stringent evaluation process [6]. Group 4: Policy Support for Innovation - The dual-directory system is designed to support "true innovation" and "differentiated innovation" in the pharmaceutical sector [7]. - Measures introduced in June 2025 aim to enhance support for innovative drug development and encourage their inclusion in both insurance directories [7][8]. - The commercial health insurance directory complements the basic insurance directory by focusing on high-value drugs with significant clinical benefits [8].