21世纪经济报道记者季媛媛 无论是卫材公司的仑卡奈单抗还是礼来的多奈单抗，患者一年的治疗费用均需超过10万元。高昂的治疗 费用一度让不少阿尔茨海默病（AD）患者家庭在希望与绝望间徘徊，直到首版商保创新药目录为这种 困境带来了转机。 日前，在2025创新药高质量发展大会上，我国首版《商业健康保险创新药品目录》正式发布。两款近年 来最具突破性的阿尔茨海默病对因治疗药物——仑卡奈单抗注射液和多奈单抗注射液双双入选。 复旦大学公共卫生学院副院长、复旦大学医学技术评估研究中心教授陈英耀表示："对于创新药物和疗 法，国家政策是鼓励为有价值的创新买单。多层次医疗保障体系建设的工作持续推进，商业健康保险也 为创新药支付提供了更丰富和多元的支持路径。" 这也映射着我国多层次医疗保障体系在创新药可及性领域迈出的重要一步。自今年起，国家医保部门首 次探索"商业健康保险"联动医保目录机制，聚焦创新程度高、临床价值大、患者获益显著的药物，旨在 通过医保与商业险的协同发力，进一步提高人民群众对重大疾病创新疗法的可负担性和可及性。 有券商医药行业分析师也对21世纪经济报道记者指出，此次多奈单抗（记能达®）、仑卡奈单抗（乐意 保®）纳入首版 ...

Core Viewpoint - The inclusion of innovative Alzheimer's disease (AD) treatments, Lecanemab and Donanemab, in China's first commercial health insurance innovative drug directory marks a significant breakthrough in the payment model for high-cost treatments, transitioning from a single reliance on public insurance to a "public + commercial" layered payment system [2][6][10]. Group 1: Policy and Market Impact - The release of the first commercial health insurance innovative drug directory at the 2025 Innovative Drug High-Quality Development Conference includes two groundbreaking AD treatments, reflecting a critical step in enhancing the accessibility of innovative drugs within China's multi-tiered healthcare system [1][6]. - The new policy aims to alleviate the financial burden on patients by leveraging the flexibility of commercial insurance, which can provide customized coverage and complement public insurance, thereby reducing out-of-pocket expenses for patients [4][6]. - The commercial insurance directory includes 19 drugs, with a focus on high-innovation and high-clinical-value treatments, indicating a shift in the healthcare landscape towards supporting innovative therapies [6][10]. Group 2: Economic and Social Implications - The economic burden of AD in China is substantial, with annual costs for patients reaching approximately 1.1 trillion RMB in 2015, projected to rise to 3.2 trillion RMB by 2030 and 11.9 trillion RMB by 2050, highlighting the urgent need for effective treatment options [9][10]. - The low early diagnosis rate of AD in China, with 95% of patients diagnosed at moderate to severe stages, underscores the necessity for improved screening and treatment protocols to enhance early intervention [8][9]. - The introduction of the commercial insurance directory is expected to stimulate demand for AD treatments, promoting early diagnosis and standardized treatment practices, which are essential for addressing the public health challenges posed by an aging population [4][10]. Group 3: Research and Development Landscape - The development of new AD drugs is a lengthy and costly process, averaging 10.5 years and requiring approximately 2.6 billion USD, with many candidates failing at various stages of clinical trials [12][14]. - Despite the challenges, the competitive landscape for AD treatments is evolving, with domestic companies rapidly advancing their research efforts, while international firms continue to seek market entry in China [15][16]. - The recent failures of major pharmaceutical companies in clinical trials have not deterred investment in AD research; instead, they have accelerated the transformation of the AD treatment ecosystem, shifting focus from mere drug competition to a broader ecological competition [14][15].

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。 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 2025年国家医保药品目录及首版商保创新药目录日前发布。首次发布医保商保"双目录"，标志着多层次 医疗保障体系建设迈出关键一步，民生药箱在保好基本的同时，还向更多元发展。 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 ...

Core Insights - The recent adjustment to the national medical insurance directory emphasizes support for innovative drugs, with 114 new drugs added, 111 of which are newly approved within the last five years, marking a historic high for innovative drugs not previously listed domestically or internationally [1][3] - The introduction of the "Commercial Health Insurance Innovative Drug Directory" includes 19 innovative drugs, primarily targeting high clinical value and significant patient benefits, which will help fill gaps in basic medical insurance coverage [1][4] Group 1: Innovative Drug Support - The adjustment to the basic medical insurance directory focuses on innovative drugs, with over 70% of the newly added drugs being domestically developed, showcasing China's advancements in certain therapeutic areas [1][3] - The percentage of newly listed drugs in the medical insurance directory that were launched within the last five years has increased from 32% in 2019 to 98% in 2024, indicating a strong shift towards supporting innovation [3] Group 2: Commercial Health Insurance Directory - The newly established "Commercial Health Insurance Innovative Drug Directory" serves as a guide for patients and insurers, allowing for better access to high-priced innovative drugs that are not covered by basic medical insurance [4][5] - The directory includes a significant number of cancer treatments, including CAR-T therapies, which are crucial for patients with difficult-to-treat conditions, thus addressing the financial burden on families [5][6] Group 3: Impact on Patients and Healthcare System - The inclusion of innovative drugs in the insurance directory is expected to reduce out-of-pocket expenses for patients, making treatments more accessible and encouraging hospitals to prescribe these high-cost medications without hesitation [6][7] - The dual-directory system aims to create a multi-tiered medical insurance framework, where basic insurance covers essential needs while commercial insurance supplements coverage for innovative treatments, ultimately reducing the financial burden on patients [7]

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] Group 1: National Basic Medical Insurance Drug Catalog - The updated National Medical Insurance Drug Catalog adds 114 new drugs, including 50 first-class innovative drugs, while removing 29 drugs that are either not clinically available or can be better replaced by other medications [1] - After the adjustments, the total number of drugs in the catalog increases to 3,253, comprising 1,857 Western medicines and 1,396 traditional Chinese medicines, significantly enhancing 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 complements the basic medical insurance, laying a foundation for the differentiated development of commercial insurance and basic medical insurance, and establishing a multi-tiered medical security system [1]

（文章来源：人民日报） 首版商保创新药目录共纳入19种药品，与基本医保形成较好的互补衔接，也为推动商保与基本医保错位 发展、建立多层次医疗保障体系奠定基础。 本报北京12月8日电 （记者孙秀艳）7日，国家医保局、人力资源社会保障部公布《国家基本医疗保 险、生育保险和工伤保险药品目录（2025年）》和《商业健康保险创新药品目录（2025年）》，将于 2026年1月1日起在全国范围内正式实施。 新版国家医保药品目录新增114种药品，其中50种1类创新药，调出了29种临床没有供应或可被其他药物 更好替代的药品。调整后，目录内药品总数增至3253种，其中西药1857种、中成药1396种，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。 ...

新版药品目录将于2026年1月1日在全国范围内正式实施。国家医保局有关负责人表示，随着更多新药进 入目录，临床用药水平将得到稳步提升，同时有效提振医药行业加大研发创新的信心。下一步，国家医 保局、人力资源和社会保障部将进一步细化政策、加强管理，切实做好目录落地，更好保障参保人合理 的临床用药需求，不断提升人民群众的获得感、幸福感、安全感。 新版药品目录是国家医保局成立以来的第八次调整，已形成常态化、规范化、科学化的调整机制。 备受关注的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，也为进一步厘清基本医保保障边界，推动商业健康保险与基本医保错位发展，建立多层次医疗保障 体系奠定基础。 本报北京12月7日电(记者孙秀艳)国家医保局、人力资源和社会保障部近期会同有关部门组织开展了 2025年国家基本医疗保险、生育保险和工伤保险药品目录调整和商业健康保险创新药品目录制定工作， 现已顺利完成。7日，两部门公布了《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 ...

日前，《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"基本医保目录")及 《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")公布。其中，商保创新药目录是 国内首次发布，受到业内广泛关注。 公开资料显示，商保创新药目录由国家医保局主导制定，聚焦创新程度高、临床价值显著但超出基本医 保"保基本"定位的药品，包括高价肿瘤创新药、基因治疗药物、部分罕见病特效药等。上海市卫生和健 康发展研究中心主任金春林表示，部分疗效确切、创新度高的高价药由此获得纳入保障的新路径。"商 保创新药目录和基本医保目录是互补关系，商保的良性发展既能更好满足患者用药需求，支持创新药产 业发展，也有利于健全多层次医疗保障体系，减轻基本医保负担。" 据国家医保局披露，今年共有121个药品通用名通过商保创新药目录的形式审查，最终18家创新药企业 的19种药品成功纳入，涉及和黄医药(中国)有限公司、绿叶制药集团有限公司、北海康成制药有限公司 (以下简称"北海康成")等上市公司。据此推算，首版商保创新药目录的"海选"入选率仅约15.7%。 国家医保局表示，此次商保创新药目录的"选品"，既体现了支持创新的导 ...

医保"双目录" 自2026年1月1日起实施 ① 首版商保创新药目录：19个药品 14个肿瘤治疗药、2个阿尔茨海默 ② 纳入商保创新药目录 需价格协商，预计降20%-40% 百万元的抗癌药，5款CAR-T在内 ③不受DRG/DIP限制 有望推进"医保+商保"一站式结算 1 医保"双目录"：自2026年实施 基本医保目录+商保创新药目录 | 分类 | | 2024年 | 2025年 | 变化 | | --- | --- | --- | --- | --- | | 3. 基本 | 田茶 | 639~脂 | ୧3d | 0 | | 医保自录 | 乙类 | 2520 | 2614 | dd (新增114种) | | 商保创新药品目录 | | | 19 | 19 | 一直以来，基本医疗保险（医保），可以报销50%至8 0%的医疗费用，一定程度上，解 决了大众 "看病贵" 的问题，也减轻了大家的医疗费用支出压力。 不过，只有纳入医保目录的药品，医保基金才能按规定予以支付。因此，哪些药品能够 纳入医保进行报销，就成为大家关注的焦点。 2 0 25 年 1 2 月 7 日 ， 医 保 局 正 式 印 发 《 国 家 基 本 医 ...

Core Insights - The article discusses the recent adjustments to the National Basic Medical Insurance, Maternity Insurance, and Work Injury Insurance drug catalog, highlighting the government's commitment to supporting innovative and differentiated drug development through strategic purchasing [1][2]. Group 1: Drug Catalog Adjustments - On December 7, the National Healthcare Security Administration (NHSA) released the updated drug catalog for 2025, which includes 114 new drugs, of which 50 are classified as Class 1 innovative drugs [2]. - The overall success rate of drug negotiations for the insurance catalog has improved to 88% in 2025, up from 76% in 2024, indicating a more favorable environment for drug inclusion [2]. - The total number of drugs in the catalog has increased to 3,253, with significant enhancements in coverage for critical areas such as oncology, chronic diseases, mental health, rare diseases, and pediatric medications [2]. Group 2: Financial Implications - Over the "14th Five-Year Plan" period, the cumulative expenditure of the medical insurance fund has exceeded 13 trillion yuan, benefiting nearly 20 billion patient visits [1]. - The NHSA has included 835 new drugs in the insurance payment scope over the past seven years, with 149 of these being innovative drugs, and approximately 80% of innovative drugs are included in the catalog within two years of their market launch [1]. - The NHSA's negotiations have resulted in over 4.6 trillion yuan in expenditures for negotiated drugs, driving sales exceeding 6 trillion yuan [1]. Group 3: Commercial Health Insurance Innovations - The first version of the commercial health insurance innovative drug catalog was introduced, including 19 drugs that are highly innovative and provide significant clinical value, such as CAR-T therapies and treatments for rare diseases [3]. - This new catalog aims to complement the basic medical insurance, clarifying the boundaries of basic insurance coverage and promoting the development of a multi-tiered medical security system [3].