热潮之下，一系列关乎其"生命力"的根本性问题也逐渐浮出水面：在政府"指导"与保险公司"承办"的混合模式下，如何确保项目的长期稳健运行？当最初的 投保热情褪去，如何应对可能出现的参保率"瓶颈"与"死亡螺旋"风险？这块旨在补齐多层次医疗保障体系短板的"关键拼图"，能否从一时的"爆红"走向持续 的"长红"，真正打磨成一件经得起时间与风险考验的公共产品？ 全国开花 惠民保最早的雏形可追溯至2015年深圳率先推出的重特大疾病补充医疗险。2020年开始，兼具普惠性与地域特色的"城市定制型商业医疗保险"如雨后春笋般 在全国各地涌现。短短几年时间，这项普惠保险惠及上亿人次。 "一年最低几十元，可享受百万元保障。"这一宣传语早已传遍大街小巷。自2020年以来，惠民保已从深圳蔓延至全国上百个城市，并迅速成为普惠金融与健 康中国交汇点上的现象级产品。惠民保可以对动辄数十万元的特药费用、高额自付医疗费用进行补充报销，承载了无数家庭对"看病贵"难题纾解的期望。 在业内人士看来，为了最大限度地实现普惠，惠民保普遍放宽甚至取消了健康告知，吸引了更多已患病或健康风险较高的人群集中投保。如果产品定价时未 能充分预见这一风险，或者风险准备金计提 ...

2025年12月7日，国家医保局、人力资源社会保障部正式发布《国家基本医疗保险、生育保险和工伤保险药品目录（2025年）》及首版《商业健康保险创 新药品目录（2025年）》。 随着"双目录"制度正式落地，创新药板块再度成为市场关注的焦点。 "双目录"会给创新药板块带来怎样的机会？当前创新药行情处于哪个阶段？经过数月调整后，板块是否已具备投资性价比？ 为此，中国基金报记者采访了： 【导读】四大基金经理解读创新药布局机会 中国基金报记者 方丽 孙晓辉 创新药在前三季度经历了一轮波澜壮阔的行情，累计涨幅巨大，然而，四季度迎来持续调整。 中银基金大健康股票基金经理 王方舟 平安医疗健康混合基金经理 周思聪 长城医药产业精选基金经理 梁福睿 创金合信全球医药生物（QDII）基金经理 毛丁丁 受访基金经理认为，"双目录"落地，首次确立"基本医保+商业保险"双轮驱动的支付体系，"保基本"与"促创新"的边界更加清晰。 这些基金经理认为，第一阶段行业性估值修复基本完成，接下来创新药的叙事将从广泛的估值重估转向进一步基本面落地。多数基金经理认为，当下或是 中长期资金配置的黄金窗口，但也有基金经理认为，板块再次出现较大幅度的Bet ...

Core Viewpoint - The article discusses the opportunities and challenges in the innovative drug sector following the implementation of the "dual directory" system, which establishes a dual payment mechanism of basic medical insurance and commercial insurance, enhancing the clarity between "basic protection" and "promoting innovation" [3][15]. Group 1: Impact of the "Dual Directory" System - The "dual directory" system is expected to accelerate the commercialization of innovative drugs by providing a mechanism for high-value drugs to enter the commercial insurance directory without significant price reductions [21][22]. - The new medical insurance directory includes a record number of 50 class 1 innovative drugs with a negotiation success rate of 88%, indicating a shift towards valuing clinical efficacy over price [17][19]. - The introduction of the commercial insurance directory marks a milestone by including 19 high-value drugs, addressing patient payment challenges and providing a secondary payment tier for pharmaceutical companies [17][19]. Group 2: Current Market Stage and Valuation - The innovative drug sector is currently in a phase of valuation recovery, with a focus shifting from broad valuation reassessment to concrete fundamental performance [15][26]. - The market is expected to see significant growth in 2026, driven by the successful commercialization of innovative drugs and the release of important clinical data [29][30]. - The current valuation of innovative drug companies is considered attractive, especially after recent adjustments, with many companies positioned for potential growth in the coming years [30][31]. Group 3: Investment Strategies and Focus Areas - Investment strategies should focus on companies with sustainable growth potential, particularly those demonstrating strong research and development capabilities and commercial viability [35][36]. - Key areas of interest include advanced medical devices, innovative drug development, and sectors related to the pharmaceutical supply chain, which are expected to benefit from macroeconomic trends [37][38]. - The emphasis should be on selecting individual stocks with strong fundamentals rather than investing broadly in the sector, as the market becomes more discerning [35][36].

行 行业周报 业 研 究 证 券 研 究 报 告 医保商保"双目录"发布，错位发展支持创新 ——医药生物行业周报 分析师： 侯雅楠 SAC NO： S1150524120001 2025 年 12 月 12 日 医药生物 证券分析师 侯雅楠 houyn@bhzq.com 022-23839211 研子究行助业理评级 中药Ⅱ 看好 重点品种推荐 恒瑞医药 买入 近三月行业指数走势图 相关研究报告 中国药品价格登记系统正式 上线——医药生物行业周报 2025.12.05 关注医保目录及商保创新药 投资要点： 行业要闻 （1）新版基本医保药品目录及首个《商业健康保险创新药品目录》发布； （2）中国生物制药首创 CDK2/4/6 抑制剂获批上市。 公司公告 （1）石药集团：①司美格鲁肽注射液的第二项上市许可申请获 NMPA 受理； ②GLP-1/GIP 受体双偏向性激动多肽注射液（SYH2069 注射液）在美国获临 床试验批准；③重组全人源抗 ACTRIIA/IIB 单克隆抗体（JMT206）在美国获 临床试验批准； （2）复星医药：控股子公司签订许可协议； （3）恒瑞医药：公司药品纳入国家医保目录； （4）君实生物 ...

在市场翘首企盼下，《商业健康保险创新药品目录（2025年）》（下称"商保创新药目录"）于日前出 炉，这是我国首版商保创新药目录，将于2026年1月1日在全国范围内正式实施。 记者了解到，首版商保创新药目录共纳入19种药品，既有CAR-T等肿瘤治疗药品，也有神经母细胞瘤、 戈谢病等罕见病治疗药品，还有社会关注度较高的阿尔茨海默病治疗药品，与基本医保形成较好的互补 衔接。 三是体现了基本医保与商业保险的保障边界，基本医保坚持"保基本"定位，主要考虑安全可靠、疗效确 切、靶点机理比较成熟的药品，商保则更偏重创新、前沿的药物。 国家医保局要求，积极推动商保创新药目录纳入商业健康保险保障范围。各地医保部门要会同有关部门 推动多层次医疗保障体系建设，积极支持普惠型商业健康保险发展，商保创新药目录推荐商业健康保 险、医疗互助等多层次医疗保障体系参考使用。 这无疑为商业健康险市场开拓了新的增长空间。国家金融监督管理总局数据显示，2025年前10个月，人 身险和财产险公司合计实现健康险保费收入8943亿元，同比增长2.3%。 对于保险业而言，业内人士指出，商保创新药目录的落地有助于推动健康险从同质化的医疗费用补偿向 对创新药的 ...

Core Insights - The National Healthcare Security Administration and the Ministry of Human Resources and Social Security announced the new National Basic Medical Insurance, Maternity Insurance, and Work Injury Insurance Drug Catalog (2025) and the Commercial Health Insurance Innovative Drug Catalog (2025), which will be implemented nationwide starting January 1, 2026 [1][2] Group 1: National Basic Medical Insurance Drug Catalog - The updated National Medical Insurance Drug Catalog includes 114 new drugs, of which 50 are first-class innovative drugs [1] - A total of 29 drugs that are either not clinically available or can be better replaced by other medications have been removed from the catalog [1] - The total number of drugs in the catalog has increased to 3,253, comprising 1,857 Western medicines and 1,396 traditional Chinese medicines, with significant improvements in coverage for key areas such as oncology, chronic diseases, mental illnesses, rare diseases, and pediatric medications [1] Group 2: Commercial Health Insurance Innovative Drug Catalog - The inaugural Commercial Health Insurance Innovative Drug Catalog includes 19 drugs, which complement the basic medical insurance effectively [2] - This initiative lays the groundwork for the complementary development of commercial insurance and basic medical insurance, contributing to the establishment of a multi-tiered medical security system [2]

Core Viewpoint - The release of the first edition of the "Commercial Health Insurance Innovative Drug Directory" in China, which includes 19 drugs, is expected to drive innovation in commercial health insurance products and open up growth opportunities in the health insurance sector [1][2]. Group 1: Innovative Drug Directory - The directory will officially implement on January 1, featuring 19 drugs, including CAR-T for cancer treatment and drugs for rare diseases like neuroblastoma and Gaucher disease, as well as Alzheimer's disease [1]. - The directory emphasizes three characteristics: support for innovation, focus on key areas, and delineation of the boundary between basic medical insurance and commercial insurance [1][2]. Group 2: Growth Opportunities in Health Insurance - Despite a general increase in commercial health insurance premium income, growth has slowed, with premiums not exceeding 1 trillion yuan in the past three years. The innovative drug directory is seen as a means to unlock growth potential [2]. - Data from the Financial Regulatory Authority indicates that health insurance premium income reached 894.3 billion yuan in the first ten months of 2025, a year-on-year increase of 2.3% [2]. Group 3: Industry Transformation - The directory is expected to shift health insurance from homogeneous competition to differentiated innovation, allowing for more precise product design tailored to specific diseases and populations [2][3]. - The establishment of the directory is anticipated to encourage insurance companies to develop specialized insurance products and deepen the "insurance + specialty drug services + health management" ecosystem [2][3]. Group 4: Challenges and Recommendations - Challenges in product pricing, underwriting, and claims processing remain for commercial health insurance, necessitating improvements in data sharing mechanisms between basic medical insurance and commercial insurance [3]. - Industry experts suggest creating a multi-party data sharing platform to support precise pricing and exploring mechanisms like reinsurance and government risk-sharing to mitigate risks [3].

"一年最低几十元，可享受百万元保障。"这一宣传语早已传遍大街小巷。自2020年以来，惠民保已从深 圳蔓延至全国上百个城市，并迅速成为普惠金融与健康中国交汇点上的现象级产品。惠民保可以对动辄 数十万元的特药费用、高额自付医疗费用进行补充报销，承载了无数家庭对"看病贵"难题纾解的期望。 热潮之下，一系列关乎其"生命力"的根本性问题也逐渐浮出水面：在政府"指导"与保险公司"承办"的混 合模式下，如何确保项目的长期稳健运行？当最初的投保热情褪去，如何应对可能出现的参保率"瓶 颈"与"死亡螺旋"风险？这块旨在补齐多层次医疗保障体系短板的"关键拼图"，能否从一时的"爆红"走 向持续的"长红"，真正打磨成一件经得起时间与风险考验的公共产品？ 全国开花 惠民保最早的雏形可追溯至2015年深圳率先推出的重特大疾病补充医疗险。2020年开始，兼具普惠性与 地域特色的"城市定制型商业医疗保险"如雨后春笋般在全国各地涌现。短短几年时间，这项普惠保险惠 及上亿人次。 这种模式的"普惠"特质体现在多核心维度。极低的投保门槛，通常不设年龄、职业、健康状况限制，尤 其惠及了传统商业保险难以覆盖的老年群体及带病体；亲民的保费水平，各地年缴费标 ...

Core Viewpoint - The release of the commercial health insurance innovative drug directory addresses the issue of "can it be used" at the hospital level, but the "last mile" between high-priced innovative drugs and patients remains unconnected. To achieve seamless transformation from "policy text" to "patient benefit," three key barriers must be crossed [1][3]. Group 1: Release of the Directory - On December 7, 2025, the National Healthcare Security Administration officially released the first version of the "Commercial Health Insurance Innovative Drug Directory," incorporating 19 high-clinical-value, high-cost innovative drugs into the commercial health insurance payment framework for the first time at the national level [2]. - The directory includes 14 anti-tumor drugs (including all 5 CAR-T therapies available in China), 2 rare disease drugs, and 2 Alzheimer's disease new drugs, aligning with the current claims data of commercial health insurance, where malignant tumors are the most prevalent and costly disease area [2]. Group 2: Policy Support and Challenges - The commercial health insurance innovative drug directory is supported by policies that exempt the listed drugs from self-payment rate assessments, collection of alternative monitored varieties, and DRG payment scope, addressing the challenges hospitals face in using innovative drugs under cost control pressures [3]. - Despite the directory solving the "can it be used" issue, the connection between high-priced innovative drugs and patients still needs to be established, requiring standardization and universalization of the directory [3][4]. Group 3: Standardization and Payment Collaboration - The current directory serves as a guiding list rather than a mandatory coverage requirement for commercial insurance products, necessitating the promotion of core drugs in the directory as standard configurations in commercial health insurance, especially in inclusive "benefit insurance" products [4]. - The basic medical insurance market can leverage its large insured population to negotiate lower drug prices, but the fragmented nature of the commercial health insurance market poses challenges in forming a cohesive payment force to negotiate with pharmaceutical companies [4]. Group 4: Service Integration and Patient Experience - An ideal multi-tiered payment system should achieve seamless integration and instant settlement among basic medical insurance, commercial insurance, and patient out-of-pocket expenses, which currently requires patients to prepay and navigate complex claims processes [5]. - Commercial insurance accounts for only 7.7% of the overall payment for innovative drugs, indicating significant growth potential. Bridging the "last mile" between the 19 innovative drugs in the directory and patients requires coordinated efforts from government and market forces [5].

Core Insights - The National Healthcare Security Administration (NHSA) has officially released the first version of the "Commercial Health Insurance Innovative Drug Directory," incorporating 19 high-value, expensive innovative drugs into the commercial health insurance payment framework for the first time [1][2] - The introduction of this directory marks a significant step in improving China's multi-tiered medical security system and transforming the role of commercial insurance [1] Group 1: Directory Overview - The directory includes 19 drugs, of which 14 are anti-tumor drugs (including all 5 CAR-T therapies available in China), 2 are rare disease medications, and 2 are new drugs for Alzheimer's disease [1] - The structure of the directory aligns closely with current claims data from commercial health insurance, as malignant tumors are the most prevalent and costly disease area in China [1] Group 2: Policy Support - The drugs listed in the commercial health insurance innovative drug directory are exempt from self-payment rate assessments, do not fall under centralized procurement monitoring, and are not included in the Diagnosis-Related Group (DRG) payment scope, referred to as the "three exclusions" policy [2] - This policy alleviates the challenges hospitals face in using innovative drugs amid pressures from centralized procurement and DRG payment reforms [2] Group 3: Implementation Challenges - The transition from policy text to patient benefits requires overcoming three key barriers: standardization and inclusivity of the directory, payment coordination and bargaining power, and service fluidity and one-stop experience [2][3][4] - The current directory serves as a guiding list rather than a mandatory coverage requirement for commercial insurance products, necessitating efforts to make core drugs standard features in commercial health insurance, especially in inclusive "benefit insurance" products [3] Group 4: Payment and Service Integration - The commercial health insurance market is fragmented, with varying funding levels and coverage across different regions, which raises uncertainties about its ability to negotiate effectively with pharmaceutical companies [3] - Establishing a regional or national commercial insurance procurement coordination mechanism is essential for negotiating better drug prices and conditions, ensuring financial sustainability of coverage plans [3][4] - The ideal multi-tiered payment system should enable seamless integration and immediate settlement among basic medical insurance, commercial insurance, and out-of-pocket expenses, which currently requires patients to prepay and navigate complex claims processes [4]