专题：新浪健康保险研究院 来源：华夏时报 12月9日，国家医保局召开有关会议，针对医保目录调整工作及首版商业健康保险创新药品目录进行深 度解读。此前12月7日，2025创新药高质量发展大会在广州召开。会议发布2025年《国家基本医疗保 险、生育保险和工伤保险药品目录》以及备受瞩目的首版《商业健康保险创新药品目录》（下称"商保 目录"）。据悉，新版药品目录自2026年1月1日起正式执行。 对此，国家医保局医药服务管理司司长黄心宇表示，双目录的发布标志着我国创新药保障体系迈向"基 本医保+商保"互补的新阶段，参保患者特别是肿瘤、罕见病等患者用药负担将明显减轻。此次调整后 目录内药品总数增至3253种，在"有进有出"的动态调整中，新增114种新药品，29种药品被调出，19种 高价创新药纳入商保目录。 和君咨询高级咨询师史天一接受《华夏时报》记者采访时指出，"这是我国自2018年国家医保局成立以 来进行的8次医保目录调整中最具突破性的创新，首次引入'商保创新药目录'旨在通过制度创新，构建 多赢格局。这一创举打破了我国药品保障体系过去的单一模式，构建了多层次用药保障新格局。那些曾 因价格高昂被挡在医保门外的创新药，如今 ...

Core Insights - The National Healthcare Security Administration (NHSA) has released the 2025 National Medical Insurance Drug List, adding 114 new drugs, including 50 innovative drugs of Class A, and 19 drugs included in the first commercial insurance innovative drug list [1][4] Summary by Sections New Drug Additions - The 2025 National Medical Insurance Drug List primarily adds chemical drugs, with a rapid increase in biological products and some traditional Chinese medicine [1] - Out of the 114 new drugs, 112 were included through negotiation and bidding, while 2 were directly included from national procurement [1] - A total of 111 new drugs were approved in the last five years, with the number of Class A innovative drugs reaching a historical high of 50 [1] Financial Impact - As of October 2023, the NHSA has paid over 460 billion yuan for drugs under agreement, benefiting over 1 billion patients and driving related sales exceeding 670 billion yuan [2] - Basic medical insurance covers approximately 44% of the costs for innovative drugs, while commercial insurance covers about 7% [2] Evaluation and Selection Criteria - The selection process for new drugs has seen a low pass rate during expert reviews, with only 127 out of 311 drugs passing to the negotiation table this year [2] - Some drugs were not favored due to "involutionary innovation," where the clinical value does not significantly improve compared to existing drugs [3][4] - To be included in the list, drugs must meet at least one of three criteria: filling clinical gaps, superior efficacy, or better cost-effectiveness [4] Commercial Insurance Innovations - The newly introduced commercial health insurance innovative drug list emphasizes drug innovation and clinical value, with 19 out of 141 submitted drugs successfully negotiated for inclusion [5] - The drugs in the commercial insurance list include 9 Class A new drugs, addressing gaps in basic medical insurance coverage [5] Future Directions - The NHSA plans to continue annual adjustments to the drug list to meet evolving clinical needs and incorporate advancements in medical technology [6] - The focus will be on supporting domestic and innovative drugs, enhancing collaboration between commercial insurance and innovative pharmaceutical companies [6]

12月7日，在2025年创新药高质量发展大会上，首版《商业健康保险创新药品目录》（以下简称"商 保创新药目录"）正式发布。商保创新药目录共纳入19种药品，涵盖CAR-T等肿瘤治疗药物、神经母细 胞瘤和戈谢病等罕见病治疗药物，以及阿尔茨海默病治疗药物。 商保创新药目录发布的意义，远不止一份药品清单本身。 长期以来，"救命药买不起、报不了""创新药看得见、用不上"是困扰许多患者的痛点，也是我国多 层次医疗保障体系建设的堵点。基本医保作为"保基本"的民生底线，虽然通过每年动态调整将更多药品 纳入了基本医保目录，但受医保基金承受能力限制，仍需在保障范围与可持续性之间寻求平衡，众多临 床价值高、价格昂贵的创新药难以纳入。作为基本医保的重要补充，商业健康保险能够填补这一保障空 白，满足人民群众多样化、多层次的健康需求。商保创新药目录的出台，正是瞄准了这些"医保之外、 生命所需"的领域，与基本医保目录共同为人民群众健康筑起"双保险"。 对于商业健康险市场而言，商保创新药目录的发布堪称其转型发展的"导航图"。长期以来，商业健 康险产品同质化严重，保障责任趋同，差异化不足。商保创新药目录将有助于保险公司依据目录内药品 特性、适 ...

Core Insights - The release of the 2025 National Basic Medical Insurance, Maternity Insurance, and Work Injury Insurance Drug Catalog, along with the first edition of the Commercial Health Insurance Innovative Drug Catalog, marks a significant step in building a multi-tiered medical security system and supporting the development of the innovative drug industry in China [1] Group 1: Medical Insurance Coverage Expansion - The adjusted National Medical Insurance Drug Catalog now includes a total of 3,253 drugs, comprising 1,857 Western medicines and 1,396 traditional Chinese medicines [2] - The 2025 National Medical Insurance Drug Catalog includes drugs that fill gaps in basic medical insurance coverage for major diseases such as triple-negative breast cancer, pancreatic cancer, and lung cancer, as well as rare diseases and chronic conditions [2] - Notable companies like Innovent Biologics and Jiangsu Hengrui Medicine have multiple innovative products included in the 2025 catalog, covering various fields such as oncology and metabolic diseases [2] Group 2: Commercial Health Insurance Innovative Drug Catalog - The first edition of the Commercial Health Insurance Innovative Drug Catalog includes 19 drugs, focusing on high-innovation treatments for conditions like cancer, rare diseases, and Alzheimer's disease [3] - The introduction of this catalog aims to provide a transitional solution for high-priced innovative drugs that cannot be included in the basic medical insurance catalog, ensuring patient access to necessary treatments [3] Group 3: Policy and Capital Resonance - Recent policies have increasingly supported innovative drugs and medical devices, with 835 new drugs added to the medical insurance payment scope over the past seven years, including 149 innovative drugs [4] - The introduction of the Commercial Health Insurance Innovative Drug Catalog is seen as a crucial measure to address payment challenges and promote a diversified payment system [4] - Companies are encouraged to focus on developing clinically valuable drugs, leveraging their strengths in innovation and manufacturing [4] Group 4: Industry Outlook - The pharmaceutical industry is expected to enter a new phase of policy stabilization, industrial upgrading, and internationalization over the next five years, with the potential for high industry prosperity [6]

Core Insights - The newly released "Commercial Health Insurance Innovative Drug Directory (2025)" marks the first of its kind in China, focusing on high-innovation drugs that exceed the basic medical insurance's scope [1][2] Group 1: Overview of the Commercial Health Insurance Innovative Drug Directory - The directory was developed by the National Healthcare Security Administration and includes high-priced innovative drugs, gene therapies, and specific rare disease treatments [1] - A total of 121 drug names were reviewed, with 19 drugs from 18 innovative pharmaceutical companies successfully included, resulting in an acceptance rate of approximately 15.7% [1] Group 2: Focus on Rare Diseases and Cancer Treatments - The directory includes drugs for Alzheimer's disease and rare diseases prevalent in children, such as Gaucher disease and neuroblastoma [2] - North Sea Kangcheng's Gaucher drug, the first domestically developed enzyme replacement therapy, was approved for use in patients aged 12 and older [2] Group 3: Impact on CAR-T Therapy - Five domestic CAR-T products were included in the directory, which is expected to significantly reduce patient out-of-pocket expenses and improve accessibility [3] - The inclusion of CAR-T products is seen as a milestone that will positively impact the entire industry chain, with companies planning to expand domestic supplier partnerships to enhance supply chain efficiency [3]

受访专家表示，商保创新药目录的发布有利于促进商业健康险市场产品优化和创新，增强产品吸引力， 并助力推动多层次医疗保障体系建设。 提供创新药给付依据 今年6月份，国家医保局、国家卫生健康委发布《支持创新药高质量发展的若干措施》，提出"增设商业 健康保险创新药品目录"，要求适应多层次医疗保障体系发展需要，增设商保创新药目录，重点纳入创 新程度高、临床价值大、患者获益显著且超出基本医保保障范围的创新药，推荐商业健康保险和医疗互 助等多层次医疗保障体系参考使用。 具体来看，此次共有18家创新药企业的19个药品成功纳入首版商保创新药目录，包括消化道和代谢方面 的药物、抗肿瘤药及免疫调节剂、神经系统药物等。 对外经济贸易大学创新与风险管理研究中心副主任龙格对《证券日报》记者表示，商保创新药目录的发 布将为商业健康险市场提供明确、权威的创新药给付依据，有助于险企精准设计产品、控制理赔风险， 并推动开发覆盖前沿疗法的特色健康险。 而对于多层次医疗保障体系建设，商保创新药目录的推出也具有积极意义。北京大学应用经济学博士后 朱俊生对《证券日报》记者分析称，商保创新药目录的发布为医保体系提供了补充，通过引入部分高端 创新药品弥补了 ...

近日，国家医保局、人力资源社会保障部印发《国家基本医疗保险、生育保险和工伤保险药品目录（2025年）》（以下简 称"药品目录"）和《商业健康保险创新药品目录（2025年）》（以下简称"商保创新药目录"），上述两项目录将于2026年1月1 日起在全国范围内正式实施。其中，后者也是我国发布的首版商保创新药目录。 本报记者 杨笑寒 受访专家表示，商保创新药目录的发布有利于促进商业健康险市场产品优化和创新，增强产品吸引力，并助力推动多层次 医疗保障体系建设。 提供创新药给付依据 今年6月份，国家医保局、国家卫生健康委发布《支持创新药高质量发展的若干措施》，提出"增设商业健康保险创新药品 目录"，要求适应多层次医疗保障体系发展需要，增设商保创新药目录，重点纳入创新程度高、临床价值大、患者获益显著且 超出基本医保保障范围的创新药，推荐商业健康保险和医疗互助等多层次医疗保障体系参考使用。 具体来看，此次共有18家创新药企业的19个药品成功纳入首版商保创新药目录，包括消化道和代谢方面的药物、抗肿瘤药 及免疫调节剂、神经系统药物等。 对此，龙格认为，财险公司近年来的健康险保费收入增速较快，主要有三方面原因：一是凭借车险等强大线 ...

新华社北京12月9日电 题：民生药箱"保基本"还要更多元 新华社记者徐鹏航、彭韵佳 新版国家医保药品目录新增114种药品，肿瘤、慢性病、精神疾病、罕见病、儿童用药等重点领域的保 障水平得到明显提升。首版商保创新药目录纳入19种药品，多为创新程度高、临床价值大的药品。医保 托底、商保扩容的思路，既体现国家对于群众用药可及性的高度重视，也精准回应了百姓多元化用药需 求。 如何平衡普惠公平与多元选择、兼顾用药可及性与产业创新动力，是医保领域的一道难题。此次商保创 新药目录的发布，正是对这一难题的一次有效破题。 "双目录"双轨协同，既坚守了基本医保"保基本"的原则，避免高价药对基金池造成冲击，也为高值创新 药开辟新通道，保护企业研发创新药的积极性。 "双目录"的落地，将带来多方共赢的局面。患者可以通过购买相应的商业保险产品，报销部分医药费 用，减轻经济负担；进入商保创新药目录的药品，可以享受医保等部门支持入院的政策；商业保险可以 通过纳入商保创新药目录药品，提高参保率。 未来，如何打破基本医保与商业保险的数据壁垒，建立"医保+商保"一站式结算等，还需相关部门进行 更多探索，以更好发挥医保托底、商保扩容的作用。在实践中 ...

Core Insights - The release of the 2025 National Medical Insurance Drug List and the first version of the Commercial Insurance Innovative Drug List marks a significant step in the construction of a multi-tiered medical security system, enhancing the accessibility of essential medications while diversifying options for patients [1] Group 1: National Medical Insurance Drug List - The updated National Medical Insurance Drug List includes 114 new drugs, significantly improving coverage for key areas such as cancer, chronic diseases, mental health, rare diseases, and pediatric medications [1] - The approach of combining basic medical insurance with commercial insurance reflects the government's commitment to improving drug accessibility for the public and addressing diverse medication needs [1] Group 2: Commercial Insurance Innovative Drug List - The first version of the Commercial Insurance Innovative Drug List includes 19 drugs, primarily those with high innovation and clinical value [1] - The dual-list system aims to balance the principles of basic insurance coverage while providing a pathway for high-value innovative drugs, thus encouraging pharmaceutical companies to invest in research and development [1] Group 3: Benefits of the Dual-List System - The implementation of the dual-list system is expected to create a win-win situation for multiple stakeholders, allowing patients to reduce their economic burden through commercial insurance reimbursement for certain medical expenses [1] - Drugs included in the Commercial Insurance Innovative Drug List can benefit from support policies for hospitalization, while commercial insurance can increase enrollment rates by including these innovative drugs [1] Group 4: Future Considerations - Future efforts are needed to break down data barriers between basic medical insurance and commercial insurance, establishing a one-stop settlement system to better leverage the roles of basic insurance and commercial insurance [2]

Core Insights - The National Healthcare Security Administration (NHSA) has released the updated National Basic Medical Insurance, Maternity Insurance, and Work Injury Insurance drug catalog, adding 114 new drugs, significantly enhancing coverage in key areas such as oncology [1][2] - The report highlights a successful establishment of a clear direction for supporting genuine and differentiated innovation through strategic purchasing [1] - The commercial health insurance drug catalog has been introduced, complementing the basic medical insurance and laying the foundation for a multi-tiered medical security system [3] Group 1: Drug Catalog Adjustments - The recent adjustment added 114 new drugs, including 50 class 1 innovative drugs, with an overall negotiation success rate of 88%, up from 76% in 2024 [2] - The total number of drugs in the catalog has increased to 3,253, with significant improvements in coverage for oncology, chronic diseases, mental illnesses, rare diseases, and pediatric medications [2] Group 2: Financial Implications - During the 14th Five-Year Plan period, the cumulative expenditure of the medical insurance fund exceeded 13 trillion yuan, benefiting nearly 20 billion patient visits [1] - Over the past seven years, 835 new drugs have been included in the medical insurance payment scope, with 149 of them being innovative drugs, and approximately 80% of innovative drugs being included within two years of market launch [1] Group 3: Commercial Health Insurance Developments - The first version of the commercial health insurance innovative drug catalog includes 19 drugs, focusing on high innovation, significant clinical value, and patient benefits beyond basic insurance coverage [3] - The introduction of the commercial health insurance catalog is expected to clarify the boundaries of basic medical insurance and promote the differentiated development of commercial health insurance [3]