出品 | 虎嗅科技医疗组 作者 | 陈广晶 商保创新药目录又进一步。 7月10日，国家医保局发布了一系列关于2025年基本医保目录和第一版商保创新药目录调整的文件。 其中显示：7月为创新药申报商保目录阶段；8月到9月为专家评审阶段；9月到10月为谈判、竞价、 价格协商阶段；预计10月到11月，两个目录都将正式公布并进入落地阶段。 这意味着业界期盼已久的"医保丙类目录"——商业健康保险创新药目录（ 简称：商保创新药目录 ），这回真的要来了。 在6月30日召开的新闻发布会上，国家医保局医药服务管理司司长黄心宇曾指出， 这有利于进一步明 确基本医保保障边界，也给商业健康保险留出更多的发展空间。 商保创新药目录调整过程中，医保部门将充分尊重商业健康保险的市场主体地位，在价格协商等方 面，保险公司、行业专家等都将充分参与其中，商保专家有重要决策权。 "这个目录本质就是通过医保在资源、能力、专业等方面的优势，帮助商保、患者、医疗等各方来遴 选优质创新药。"医保研究专家仲崇明向虎嗅分析指出，这些产品虽然并不强制商保产品必须配套， 但是结合市场需求来看， "谁早干、多干、干好，就取得新领先" 。 可以说，商保创新药目录对医药 ...

Core Points - The adjustment of the national basic medical insurance drug catalog for 2025 has officially started, with a notable addition of a commercial health insurance innovative drug catalog [1][4] - The focus of the 2025 adjustment will be on areas where basic catalog coverage is insufficient, such as encouraging the development of pediatric and rare disease medications [3][4] - Over the past seven years, the national basic medical insurance catalog has undergone regular and dynamic adjustments, successfully negotiating and including a large number of life-saving drugs at reasonable prices [3][4] Group 1 - The 2025 adjustment aims to fill clinical medication gaps and provide better support for patients [3][4] - A total of 835 new drugs have been added to the national basic medical insurance catalog, covering various fields including cancer, chronic diseases, and rare diseases [3][4] - 438 drugs that are ineffective, prone to abuse, or have been eliminated from clinical use have been removed from the catalog, resulting in a more rational structure [3][4] Group 2 - The newly introduced commercial health insurance innovative drug catalog serves as a supplement to the basic catalog, allowing for the inclusion of innovative drugs that cannot yet be reimbursed by the basic insurance [4][5] - Drugs approved for marketing within the last five years or exclusive drugs for rare diseases can be submitted for the commercial health insurance innovative drug catalog [5][6] - The process for a drug to enter the commercial health insurance innovative drug catalog involves expert review and price negotiations among the national medical insurance bureau, commercial insurance companies, and pharmaceutical enterprises [6]

Group 1 - The National Medical Insurance Administration has officially launched the adjustment of the national basic medical insurance, maternity insurance, and work-related injury insurance drug catalog, as well as the commercial health insurance innovative drug catalog, starting from July 11, 2023 [1] - The newly added commercial health insurance innovative drug catalog focuses on high innovation, significant clinical value, and substantial patient benefits, which cannot be included in the basic catalog due to exceeding the "basic insurance" scope [1][4] - The adjustment aims to enhance the multi-tiered medication security system, better meet the diverse medication needs of the public, and provide stronger economic support for the development of innovative drugs [1][4] Group 2 - The adjustment criteria for traditional Chinese medicine (TCM) have been clarified, allowing eligible TCM decoction pieces to be included in the adjustment scope [2] - Specific conditions for TCM drugs to be included in the basic catalog include those approved by the National Medical Products Administration between January 1, 2020, and June 30, 2025, and those with significant changes in indications or functions [2][3] - The adjustment will also consider removing TCM drugs from the basic catalog if they have not supplied the market as agreed or have no transaction volume on the national medical insurance information platform [3] Group 3 - The commercial health insurance innovative drug catalog will be submitted and adjusted simultaneously with the medical insurance catalog, reducing the administrative burden on pharmaceutical companies [4][5] - The establishment of the commercial health insurance innovative drug catalog is intended to clarify the boundaries of basic medical insurance coverage and provide more development space for commercial health insurance [4] - The National Medical Insurance Administration will ensure the connection between the medical insurance drug catalog and the commercial health insurance innovative drug catalog, providing stable outlets for innovative drugs [5]

新增商保创新药目录 2025年医保目录调整正式启动 2025年国家基本医疗保险、生育保险和工伤保险药品目录及商业健康保险创新药品目录调整正式启动， 符合条件的申报主体可在7月11日至20日期间，通过国家医保服务平台进行网上申报。今年首次新增的 商保创新药目录，主要聚焦创新程度高、临床价值大、患者获益显著，但因超出"保基本"定位暂时无法 纳入基本目录的药品，助力健全多层次用药保障体系，更好满足人民群众多元化的用药需求，为创新药 发展提供更充足的经济支撑。 ...

医保目录调整工作流程图片来源：国家医保局 纳入商保有利于创新药入院使用 按照本次出台的《工作方案》，从7月11日到7月20日，符合条件的企业可以在国家医保局的国家医保服 务平台自主申报纳入药品目录。 纳入商保创新药目录，对创新药有哪些利好？ 7月10日，国家医保局发布《2025年国家基本医疗保险、生育保险和工伤保险药品目录及商业健康保险 创新药品目录调整工作方案》（以下简称《工作方案》）等多份文件。相关目录从今日（7月11日）起 开始接受申报。 按照本次出台的《工作方案》，在5年内批准上市的新通用名或治疗罕见病的独家药品，可以申报商业 健康保险创新药品目录（以下简称商保创新药目录）。 一位医疗产业分析师在接受《每日经济新闻》记者（以下简称每经记者）微信采访时表示，此次发布的 文件与7月1日发布的征求意见稿在内容上基本一致，主要差异在于明确了申报时间，后续应重点关注该 文件的实施结果。 | 工作流程 | 主要内容 | | --- | --- | | 准备 | 成立工作专班,健全工作机制,制订工作规则和廉政保密等规定; | | (6-7月) | 制定工作方案,确定目录调整制定的原则、范围、程序; . | | | ...

Core Points - The National Healthcare Security Administration (NHSA) has announced a series of adjustments to the basic medical insurance directory and the first version of the commercial health insurance innovative drug directory, with the new directories expected to be officially published between October and November 2023 [1][2][6] Group 1: Policy Changes and Implications - The introduction of the commercial health insurance innovative drug directory is seen as a long-awaited opportunity for the industry, allowing for more market opportunities for high-priced drugs [2][4] - The NHSA emphasizes the importance of respecting the market position of commercial health insurance during the directory adjustment process, allowing insurance companies and industry experts to participate in price negotiations [5][10] - The new directory will include innovative drugs that exceed the basic medical insurance scope but have significant clinical value, with a focus on unique drugs approved between January 1, 2020, and June 30, 2025 [10][11] Group 2: Market Response and Growth Potential - The investment market has reacted positively, with innovative drug concept stocks rising by 7.76% within a week, indicating strong investor interest [7] - The self-funded market for innovative drugs in China is projected to grow from 320 billion yuan in 2024 to 1 trillion yuan by 2030, highlighting significant growth potential [6] - The introduction of the commercial health insurance directory is expected to provide more payment opportunities for high-priced "life-saving" drugs, particularly in the cell therapy and rare disease sectors [9][12][14] Group 3: Challenges and Industry Dynamics - Despite the positive outlook, not all players in the market will benefit equally, and the industry may face a significant shake-up akin to the centralized procurement process [8][25] - The NHSA's new policies aim to address issues of drug homogeneity and competition, with a focus on data openness to enhance the efficiency of innovative drug development [26][30] - The competitive landscape is expected to intensify, particularly for PD-1 drugs, as clinical performance will be linked to insurance renewals, increasing the pressure on companies to demonstrate efficacy [33]

Core Viewpoint - The new healthcare policy aims to enhance the accessibility of innovative drugs through the establishment of a commercial insurance innovation drug directory, which is expected to include around 20 to 30 new drugs, thereby improving the overall insurance coverage for patients [6][9]. Group 1: Policy Changes - The National Healthcare Security Administration (NHSA) has released a series of documents outlining the adjustments to the 2025 National Basic Medical Insurance, Maternity Insurance, and Work Injury Insurance drug directories, as well as the commercial health insurance innovation drug directory [2][4]. - The new policy emphasizes a collaborative negotiation mechanism for the commercial insurance innovation drug directory, differing from the basic insurance directory's negotiation process [6][8]. Group 2: Market Impact - The introduction of the commercial insurance innovation drug directory is expected to allow insurance companies to negotiate prices with pharmaceutical companies, leading to lower prices compared to existing market rates [6][8]. - This policy is anticipated to expand the coverage of commercial insurance and reduce operational costs for insurance companies, ultimately benefiting patients by increasing their access to innovative drugs [6][9]. Group 3: Implementation and Future Outlook - The NHSA will begin accepting applications from eligible companies for the new drug directory starting from July 20, 2023, indicating that the preparation for the 2025 adjustments is nearly complete [9]. - The dynamic nature of the directory, which will be updated annually, suggests that more innovative drugs may be included in short-term health insurance plans in the future, providing more options for the public [8][9].

南方财经.21世纪经济报道记者围绕今年医保目录新政，深入分析政策设计思路，解读此次释放的政策 信号对市场的影响。商保创新药侧重协商定价 相关文件甫一发布，最受市场关注的当数新增商保创新药目录。对此，一位医保业内核心专家对记者分 析，医保部门相当于首次给了市场一份创新药支持清单，可能会有二三十种药。将弥补基本医保目录的 空白，整体提高现有保障水平。 21世纪经济报道记者贺佳雯北京报道 7月10日晚，国家医保局正式发布《2025年国家基本医疗保险、生育保险和工伤保险药品目录及商业健 康保险创新药品目录调整工作方案》《2025年国家基本医疗保险、生育保险和工伤保险药品目录及商业 健康保险创新药品目录调整申报指南》《谈判药品续约规则》以及《非独家药品竞价规则》。 有别于基本医保目录谈判机制，值得注意的是，商保创新药目录更侧重协商机制。从政策设计层面考 虑，体现了强度上的差异。 事实上，此前商保公司鲜少有机会和能力，与医药企业"砍价"。"此次医保搭台，以商保公司为主。"该 专家说，具体价格怎么谈，还是看商保公司和药企协商。通过医保、保险公司和医药企业三方协商，对 创新药评估一个价格，这个价格肯定比原有市场价低。这对商保 ...

那么，医保保障不了的药，如何让有需求的老百姓能用上？对此，国家提出"商业健康保险创新药目 录"这一项改革举措。 黄心宇表示，建立商保创新药目录将有利于进一步明确基本医保保障边界，给商业健康保险留出更多的 发展空间；有利于发挥医保在数据、专家、管理、政策等方面的优势，为商业健康保险提供公共服务； 有利于整合医保和商业健康保险资金，形成保障人民群众健康的合力，也为创新药发展提供更充足的经 济支撑。 近日，国家医保局会同国家卫健委印发《支持创新药高质量发展的若干措施》，提出包括支持创新药进 入医保目录和商业健康保险创新药品目录等在内的5方面16条举措。 商业健康保险创新药品目录是《若干措施》的一大亮点。这对于创新药的生产和老百姓的用药会带来什 么变化？ 建立商保创新药目录，形成保障人民群众健康的合力 近年来，创新药进入医保，给老百姓就医用药带来了显著变化。据介绍，国家医保局近年来采取有效措 施积极支持创新药发展，2018-2024年，我国1类创新药获批上市数量呈现明显上升趋势，2024年获批数 量达48种，是2018年的5倍以上，今年上半年已近40种，井喷效应明显。 同时，随着更多的创新药进入医保目录，推动了我国临 ...

行业周报 行业评级： | 报告期：2025.6.23-2025.7.6 | | | --- | --- | | 投资评级 | 看好 | | 评级变动 | 维持评级 | 本报告期医药生物行业指数涨幅为 5.30%，在申万 31 个一级行业中 位居第 14，跑赢沪深 300 指数（3.52%）。从子行业来看，其他生物 制品、医疗研发外包涨幅居前，涨幅分别为 11.20%、9.37%；医疗设 备、血液制品涨幅居后，涨幅均为 0.98%。 行业走势： 估值方面，截至 2025 年 7 月 4 日，医药生物行业 PE（TTM 整体法， 剔除负值）为 28.52x（上期末为 27.28x），估值上行，低于均值。医 药生物申万三级行业 PE（TTM 整体法，剔除负值）前三的行业分别 为疫苗（54.13x）、医院（36.88x）、其他生物制品（34.72x），中 位数为 29.22x，医药流通（15.20x）估值最低。 XXXX@gwgsc.com 本报告期，两市医药生物行业共有 34 家上市公司的股东净减持 4.92 亿元。其中，7 家增持 5.09 亿元，27 家减持 10.01 亿元。 2025 年 7 月 7 日 证 ...