Core Viewpoint - The National Healthcare Security Administration (NHSA) has completed the expert review for the 2025 National Basic Medical Insurance (BMI) catalog and the commercial insurance innovative drug catalog, marking the eighth adjustment since its establishment and the first inclusion of a commercial insurance innovative drug catalog [1][2]. Group 1: CAR-T Products Approval - Five CAR-T products have successfully passed the expert review and will be included in both the basic medical insurance and commercial insurance innovative drug catalogs, laying the groundwork for future negotiations and access [1][2]. - The approval of these CAR-T products is seen as a positive signal, indicating the regulatory body's commitment to improving access to cutting-edge therapies [1][3]. - The review process emphasized the innovation level, efficacy, and the ability to fill treatment gaps, with CAR-T therapies receiving unanimous approval [2][5]. Group 2: Impact on Patients and Companies - The introduction of the commercial insurance innovative drug catalog is expected to significantly reduce out-of-pocket expenses for patients, making high-cost CAR-T treatments more accessible [3][4]. - Companies view the catalog as a "second channel" for innovative drugs, alleviating pricing pressure during negotiations with basic medical insurance and potentially expanding market share [4][5]. - The collaboration between pharmaceutical companies and insurance providers is anticipated to evolve towards deeper cooperation, exploring mechanisms like outcome-based payments and risk-sharing [4][5]. Group 3: Future Outlook - Companies express cautious optimism regarding the inclusion of CAR-T products in the commercial insurance innovative drug catalog, supported by policy direction, clinical value, and practical experience [5][6]. - The ongoing expansion and optimization of the commercial insurance catalog are expected to further benefit patients in need of CAR-T therapies [6].

自2018年国家医保局成立，今年是国家医保谈判（下称"国谈"）常态化开展以来的第八个年头，今年亦 首次增设商业健康保险创新药品目录（下称"商保创新药目录"）。这一举措，为创新程度高、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，增添了新选择。 专家评审结果公布当日，正值2025第十四届中国罕见病高峰论坛在武汉举办。与会者不仅聚焦罕见病立 法、多元支付等话题，亦对商保创新药目录的出台能否进一步解决罕见病支付端的难题进行了诸多探 讨。 武汉大学董辅礽经济社会发展研究院教授，武汉大学全球健康研究中心主任毛宗福指出，全球范围来 讲，罕见病用药治疗更多是政府主导的保障体系，国民健康保障支撑体系也是在多层次保障体系当中去 解决。从目前来看，中国的罕见病用药支付一部分靠基本医保的过渡和衔接，同时在商保创新药目录中 提供特殊的规则，促使商保跟上商保创新药目录的进展和节奏，在管理体系上、运营模式上也在做调整 和迭代。他认为，对于有药可治的，尤其是创新程度高、临床价值大，而且患者的获得感比较强的这一 部分罕见病用药，应该会比较快进展。 一位参与2025年国家基本医保目录及商保创新药目录评审环节的人 ...

Core Insights - The National Healthcare Security Administration (NHSA) announced the completion of expert review for the 2025 National Basic Medical Insurance (BMI) catalog and the commercial insurance innovative drug catalog adjustments, marking the 8th adjustment since the NHSA's establishment and the first inclusion of a commercial insurance innovative drug catalog [1] Group 1: Drug Approval Process - A total of 644 drugs passed the formal review, with 534 approved for the basic BMI catalog and 121 for the commercial insurance innovative drug catalog, noting that some drugs applied for both [1] - The expert review phase saw less than half of the submitted drugs approved, with low approval rates for both the basic BMI and commercial insurance innovative drug catalogs [2] Group 2: Expert Review Insights - The expert review was conducted by a diverse group including NHSA, insurance companies, universities, and third-party technical firms, with a broad coverage of innovative drugs prioritized for inclusion [2] - Five CAR-T drugs received unanimous approval from experts, despite their high costs, which range around 1 million yuan per injection, and previous unsuccessful attempts to enter the basic BMI catalog [2] Group 3: Future Considerations - The expert review process includes a metric for "expert opinion consensus rate," which increases the likelihood of approval for drugs with broader expert support, while rare disease drugs are approached with more caution [3] - Future payment models for innovative drugs may involve using the commercial insurance innovative drug catalog as a transitional phase before potential inclusion in the basic BMI catalog, allowing for real-world data collection [3] - The NHSA plans to hold a face-to-face communication meeting in Beijing with companies involved in negotiations, bidding, and price discussions [3]

Core Insights - The National Healthcare Security Administration (NHSA) announced the completion of expert reviews for the 2025 National Basic Medical Insurance Directory and the Commercial Health Insurance Innovative Drug Directory, marking the 8th adjustment since the NHSA's establishment and the first inclusion of a commercial insurance innovative drug directory [1][2] Group 1: Directory Adjustments - A total of 534 drugs were reviewed for inclusion in the basic medical insurance directory, while 121 drug generic names were reviewed for the commercial health insurance innovative drug directory, including high-priced innovative drugs like CAR-T therapy [1] - The NHSA's announcement indicates that drugs marked for "proposed negotiation," "proposed bidding," and "proposed price consultation" are eligible for negotiation or bidding but do not guarantee inclusion in the directories [1] Group 2: Negotiation and Communication - Following the expert review, the next phase will involve negotiation, bidding, and price consultation, where companies must submit relevant materials for assessment by the NHSA [2] - The NHSA plans to hold a face-to-face communication meeting in Beijing with companies involved in negotiations, bidding, and price consultations to discuss evaluation methods and gather feedback [2] - The timeline for this year's negotiations is tighter compared to previous years, with companies required to submit materials by September 30, 2023, following the announcement on September 20, 2023 [2]

Core Points - The National Healthcare Security Administration (NHSA) announced changes to the drug list for basic medical insurance, with six drugs undergoing form review changes, including two drugs that did not pass the review [1][3] - The two drugs that failed the review are injectable risperidone microspheres and injectable triptorelin, both of which are exclusive products from Zhejiang Shengzhao Pharmaceutical Co., Ltd. and Ipsen, respectively [2][3] - The injectable risperidone microspheres have a global market size of $490 million in 2022, with expectations to reach 920 million yuan in China by 2030 [3] Drug Review Changes - Six drugs had their form review results changed, with injectable risperidone microspheres and injectable triptorelin being excluded from the basic medical insurance directory [3][4] - Injectable risperidone microspheres, approved in February 2023, is the first generic version in China for treating mental disorders, while injectable triptorelin was approved in 2023 for treating precocious puberty and prostate cancer [3][4] Commercial Health Insurance Innovations - The newly established commercial health insurance innovative drug directory has gained attention, with 121 drugs passing the form review, including CAR-T and nuclear medicine therapies [5] - CAR-T therapy has faced challenges in entering the insurance directory due to high costs, but five CAR-T products have now passed the form review for the commercial health insurance directory [5] - Nuclear medicine, known for its precision in targeting cancer cells, has also seen several products approved, including technetium-99m and fluorine-18 labeled drugs [6] Future Developments - Negotiations and price discussions for the drug directory adjustments will take place from September to October, with results expected to be announced in November [7]

智通财经APP获悉，港股恒生指数涨0.63%，涨158点，报25156点；恒生科技指数涨0.56%。港股早盘成 交1841亿港元。 中信证券近期研报指出，国家医保局启动商保创新药目录调整工作，标志着商保创新药目录进入实质性 落地阶段。医疗健康产业有望迎来戴维斯双击，估值体系有望重塑。恒生生物科技指数涨3.73%。成份 股中，微创机器人-B（02252）涨8%；信达生物（01801）涨超7%；药明生物（02269）涨6.7%；石药 股份（01093）涨超6%。 黄金股集体走高，近期金价迎来多重催化，多家黄金矿企中报亮眼。中国黄金国际(02099)涨10%；赤峰 黄金(06693)涨6.97%；招金矿业(01818)涨5.98%。 国泰君安国际(01788)涨超15%，公司正式在香港地区推出加密货币交易服务。 荣昌生物(09995)再涨超13%，核心产品放量带动营收高增，上半年亏损同比显著收窄。 阜博集团(03738)涨8.65%，上半年盈利同比翻倍增长，公司强化订阅与增值双引擎。 瑞浦兰钧(00666)涨6%，公司携手阪和兴业株式会社，正式布局日本储能市场。 科笛-B(02487)涨超21%，战略调整拖累上半年 ...

Core Insights - The high cost of innovative drug treatments, such as CAR-T cell therapy, is a growing concern for patients and their families, with single treatment costs exceeding one million yuan [1][2] - There is an increasing societal focus on ensuring that expensive innovative drug treatments do not hinder patient access to necessary care [2][3] Payment System Development - The establishment of a sustainable and efficient payment system is crucial for the widespread application of innovative drugs [2][3] - Recent government policies aim to support the inclusion of innovative drugs in basic medical insurance and commercial health insurance directories, enhancing payment capabilities [2][12] - The multi-payment system for innovative drugs includes commercial health insurance, charity funds, and high-end medical insurance, which helps reduce the financial burden on patients [2][3] Market Growth and Trends - China's innovative drug market reached approximately 162 billion yuan in 2022, with a year-on-year growth of 16% [4] - The trend of new drugs being launched in China has increased significantly, with 29% of new drugs debuting in China in 2023, up from 9% in 2017 [4] Challenges in Coverage - Basic medical insurance currently covers only 16% to 25% of the innovative drugs applied for, indicating a gap in coverage [5][6] - Despite the establishment of a universal healthcare system, basic insurance is insufficient to cover high-priced innovative drugs, necessitating the exploration of new payment models [6][9] Insurance and Policy Initiatives - The commercial health insurance sector is expected to provide approximately 12.4 billion yuan in compensation for innovative drugs in 2024, with direct reimbursements amounting to 6.6 billion yuan [3][7] - The introduction of the commercial insurance innovative drug directory is seen as a significant step towards integrating commercial insurance with the pharmaceutical industry [13][14] Collaborative Efforts - Various stakeholders, including insurance companies, pharmaceutical firms, and local governments, are working together to address challenges in the innovative drug payment system [17][20] - New models of risk-sharing and payment mechanisms are being explored to enhance the accessibility of innovative drugs [18][19] Regulatory Framework - The establishment of clear regulatory frameworks and operational guidelines is essential for the effective implementation of the multi-payment system for innovative drugs [9][19] - The "three exclusions" policy aims to facilitate the integration of commercial insurance with innovative drug coverage, impacting pricing negotiations and compliance [19][20]

Group 1 - The core viewpoint of the article highlights the introduction of several high-value "star drugs" in the commercial health insurance innovative drug directory, which is expected to create new payment channels and benefit a broader patient population [1][2] - The National Healthcare Security Administration (NHSA) has initiated the adjustment of the commercial health insurance innovative drug directory, marking a significant step towards a multi-layered and balanced payment structure in the healthcare industry [1][2] - According to Frost & Sullivan, the share of commercial health insurance payments is projected to reach 16.3% by 2030, more than doubling from 2024, indicating a growing trend in the market [2] Group 2 - The construction of a diversified medical payment system faces challenges, including fragmented reimbursement rules and payment proportions across different payment methods, which complicates the payment process [2][3] - The "Yima Direct Payment" platform by Meixin Health exemplifies how platform companies are effectively addressing these challenges by integrating various payment solutions and streamlining complex claims processes [3] - The importance of ensuring that innovative drugs are accessible post-launch, including prescription transmission and direct payment capabilities, is emphasized as a critical factor for commercial insurance [2][3]

Core Viewpoint - The high cost of innovative drug treatments, such as CAR-T cell therapy, is a growing concern, prompting discussions on how to ensure accessibility without imposing financial burdens on patients and their families [1][2][3] Payment System for Innovative Drugs - The establishment of a sustainable and efficient payment system for innovative drugs is crucial for their widespread application [3] - Recent policies have been introduced to support the inclusion of innovative drugs in basic medical insurance and commercial health insurance directories, aiming to enhance payment capabilities [3][4] - By 2024, commercial health insurance is expected to cover approximately 12.4 billion yuan for innovative drugs, with direct reimbursements amounting to 6.6 billion yuan [4] Market Growth and Challenges - China's pharmaceutical market has become the second largest globally, with an annual growth rate exceeding 3%, driven primarily by innovative drugs [6] - The market size for innovative drugs reached approximately 162 billion yuan in the previous year, reflecting a year-on-year growth of 16% [6] - Basic medical insurance currently covers only 16% to 25% of the innovative drugs applied for, indicating a significant gap in coverage [7] Policy Support and Developments - Various policies have been enacted to support the development of innovative drugs and establish a multi-channel payment system [12][14] - The introduction of the commercial health insurance innovative drug directory is seen as a strategic move to enhance the integration of insurance and pharmaceutical industries [15][16] Collaborative Efforts and Innovations - Insurance companies and pharmaceutical firms are exploring new payment models, including risk-sharing mechanisms based on treatment efficacy [21][22] - Local governments are facilitating the design and underwriting challenges faced by commercial insurance in the innovative drug payment sector [21][24] Future Directions - The successful implementation of the "three exclusions" policy, which allows innovative drugs in the commercial insurance directory to be excluded from certain payment metrics, is critical for compliance and pricing negotiations [23] - There is a need for a collaborative ecosystem involving government, insurance companies, and pharmaceutical firms to transform commercial insurance from a traditional compensator to a health management and payment innovator [24]

Core Insights - The high cost of CAR-T cell therapy is a significant concern for patients, with single treatment costs exceeding one million yuan, leading to financial strain on families [2] - The establishment of a sustainable and efficient payment system for innovative drugs is increasingly recognized as essential for improving patient access [2][3] - Recent government policies aim to support the development of innovative drugs and enhance their accessibility through various payment mechanisms [2][9][11] Payment System Development - The multi-payment system for innovative drugs includes commercial health insurance, charity funds, and high-end medical insurance, which are crucial for reducing the financial burden on patients [2][3] - In 2024, commercial health insurance is expected to cover approximately 12.4 billion yuan for innovative drugs, with direct reimbursements amounting to 6.6 billion yuan [3] - The current multi-payment system faces challenges such as policy uncertainty, pricing negotiations, and compliance issues [3][8] Market Growth and Trends - China's innovative drug market reached approximately 162 billion yuan in 2022, with a year-on-year growth of 16% [5] - The percentage of new drugs launched in China has increased from 9% in 2017 to 29% in 2023, indicating a growing trend of global innovative drugs entering the Chinese market [5] - The aging population and increasing healthcare demands are driving China's position as the second-largest pharmaceutical market globally, with an annual growth rate exceeding 3% [4] Insurance and Policy Initiatives - The basic medical insurance system currently covers only 16% to 25% of innovative drugs, highlighting the need for commercial insurance to play a more significant role [6] - The introduction of the commercial insurance innovative drug directory is seen as a strategic move to enhance the integration of insurance and pharmaceutical industries [13][14] - Recent policies aim to clarify the operational guidelines for commercial insurance in relation to innovative drugs, addressing compliance and pricing negotiation challenges [8][19] Collaborative Efforts - Various stakeholders, including insurance companies, pharmaceutical firms, and local governments, are exploring new collaborative models to enhance the payment system for innovative drugs [17][20] - Risk-sharing mechanisms based on financial and efficacy outcomes are being tested to improve the affordability and accessibility of innovative therapies [18][20] - The "three exclusions" policy aims to facilitate the integration of commercial insurance with innovative drug coverage, impacting pricing negotiations and compliance operations [19][20]