28省份明确：商保创新药“进院”参照“国谈药”

Core Viewpoint - The article discusses the implementation of the first commercial insurance innovative drug directory in China, highlighting the challenges and opportunities for innovative drugs to enter hospitals and outpatient settings under the new policies [3][4][6]. Group 1: Policy Implementation and Impact - The "three exclusions" policy allows innovative drugs included in the commercial insurance directory to be billed separately for inpatient cases, not affecting the bundled payment limits [3][6]. - As of January 8, at least 28 provinces have issued notifications regarding the execution of the national drug directory and the commercial insurance innovative drug directory [6]. - The sales data from the National Healthcare Security Administration indicates that from January 1 to 6, over 15 medical institutions recorded sales of commercial insurance innovative drugs, although most had already stocked these drugs prior to the directory's release [6][7]. Group 2: Challenges in Outpatient Use - The outpatient use of commercial insurance innovative drugs remains largely unregulated, with no clear incentives established for outpatient prescriptions [4][10]. - The article notes that while inpatient use may be supported by the "three exclusions" policy, outpatient scenarios face significant barriers, including a lack of payment guarantees from commercial insurance products [10][11]. - The need for clearer guidelines and incentives for outpatient use is emphasized, as many innovative drugs, particularly for cancer and Alzheimer's treatment, are typically administered in outpatient settings [10][11]. Group 3: Market Dynamics and Future Outlook - The article suggests that the success of commercial insurance innovative drugs in hospitals will depend on balancing interests among stakeholders and creating differentiated plans based on local healthcare financing conditions [11][12]. - There is a call for establishing specific standards for exceptional case applications to ensure that patients using commercial insurance innovative drugs are not competing for limited resources with those using nationally negotiated drugs [12][13]. - The potential for hospitals to receive more definitive incentives through "exceptional payments" is highlighted, as this could significantly impact the market volume of commercial insurance innovative drugs [13][14]. Group 4: Retail Pharmacy Integration - The National Healthcare Security Administration has proposed supporting retail pharmacies in stocking drugs from the commercial insurance innovative drug directory, which could enhance access to these medications [15][16]. - However, concerns remain regarding how pricing negotiations and reimbursement rules will be implemented, which could affect the willingness of commercial insurance companies to include these drugs in their coverage [15][16]. - The article stresses the importance of aligning the commercial insurance innovative drug directory with existing healthcare policies to build confidence among healthcare providers in prescribing these medications [16].