Core Viewpoint - The article discusses the introduction of a "Commercial Insurance Innovative Drug Directory" as part of the 2025 medical insurance directory adjustment, marking the beginning of a dual-directory era for medical insurance and commercial health insurance in China [1][10][11]. Group 1: Introduction of the Dual-Directory System - The 2025 medical insurance directory will for the first time include a "Commercial Insurance Innovative Drug Directory," allowing innovative drugs that are not covered by medical insurance to be reimbursed by commercial insurance [2][10]. - This adjustment aims to clarify the boundaries of basic medical insurance coverage and enhance the collaboration between commercial health insurance and basic medical insurance [21][24]. Group 2: Features of the Commercial Insurance Innovative Drug Directory - The "Commercial Insurance Innovative Drug Directory" will focus on innovative drugs that have high innovation levels, significant clinical value, and substantial patient benefits, which exceed the coverage of basic medical insurance [24]. - The directory will allow companies to apply for inclusion in either the medical insurance directory or the commercial insurance directory, or both simultaneously [27][28]. Group 3: Payment and Collaboration Mechanisms - The article highlights the importance of synchronizing settlements and data collaboration between medical insurance and commercial health insurance, facilitating a smoother reimbursement process for patients [4][39]. - The introduction of the "three exclusions" support for the commercial insurance innovative drug directory will ensure that these drugs are not subject to certain basic medical insurance metrics, allowing for more flexible pricing negotiations [31][32]. Group 4: Growth of Commercial Health Insurance - Since 2014, the commercial health insurance sector has experienced rapid growth, with premium income reaching 97.73 billion by the end of 2024, more than six times the amount from a decade ago, reflecting a compound annual growth rate of approximately 20% [41]. - The article notes that the claims for medical insurance have also seen significant increases, with medical claims accounting for 44% and critical illness claims for 36% of total payouts in 2024 [43].

Group 1 - The establishment of a "Commercial Health Insurance Innovative Drug Directory" aims to address the payment challenges for high-priced innovative drugs outside of basic medical insurance [1][2][3] - The new policy signals a shift in the role of commercial insurance in supporting innovative drug payments, creating a multi-tiered medical security system [2][4] - The commercial health insurance sector is expected to develop specialized insurance products to support innovative drug payments, leveraging standardized drug lists and pricing mechanisms [3][4] Group 2 - The current basic medical insurance system has limitations in funding, particularly for high-cost treatments like CAR-T therapy, which can exceed one million yuan [4][5] - Commercial health insurance has a small market share in innovative drug payments, with only 7.7% of the innovative drug market being covered by commercial health insurance expenditures [5][6] - The "Hui Min Bao" program has made significant contributions to innovative drug payments, but its compensation for innovative drugs remains low compared to the overall market size [6][5] Group 3 - The implementation of the new policy presents challenges for insurance companies, including directory management, payment negotiations, cost impacts, risk control, and market education [7][8] - A robust evaluation system is necessary for assessing the clinical value and cost-effectiveness of innovative drugs, which poses a significant challenge for insurers [7][8] - The lack of historical data and the need for effective risk management strategies complicate the pricing and compensation models for innovative drugs [9][10] Group 4 - Data sharing between basic medical insurance and commercial health insurance is crucial for enhancing the effectiveness of innovative drug payment systems [11][13] - The development of specialized data interfaces and standardized coding for diseases and drugs is recommended to facilitate better collaboration between insurance sectors [14][13] - The focus on improving data collaboration can lead to more precise product development and risk management in the commercial health insurance market [13][14]

Group 1 - The core viewpoint of the article is the introduction of measures to support the high-quality development of innovative drugs in China, focusing on issues such as accessibility and reimbursement [1] - The National Healthcare Security Administration and the National Health Commission released a document titled "Several Measures to Support the High-Quality Development of Innovative Drugs," which includes 16 measures across five areas to support the entire chain of innovative drug development, access, hospital use, and multi-payment systems [1] Group 2 - The National Healthcare Security Administration is accelerating the establishment of a multi-tiered medical security system, which includes a unified medical insurance information platform and a three-tiered basic medical security system [2] - The "1+3+N" multi-tiered medical security system aims to enhance the effectiveness of basic medical insurance, critical illness insurance, and medical assistance while promoting the role of commercial health insurance and other supplementary protections [2] - Collaboration between basic medical insurance and commercial health insurance will focus on areas such as coverage scope, data sharing, settlement processes, and regulatory oversight to support the development of innovative drugs [3]

Core Insights - The National Healthcare Security Administration and the National Health Commission issued measures to support the high-quality development of innovative drugs, focusing on the entire chain from research and development to payment systems [1] - The inclusion of innovative drug directories in commercial health insurance is expected to enhance the multi-tiered medical security system and provide economic support for the development of innovative drugs [1][2] - The stock market reacted positively, with significant gains in innovative drug concept stocks and ETFs, indicating strong investor interest and liquidity in this sector [1][2] Industry Developments - The establishment of a commercial insurance innovative drug directory marks a significant step in enhancing the role of commercial insurance in the multi-tiered medical security system, providing payment support for high-priced innovative drugs and medical devices [2] - The "18A" policy has catalyzed a wave of medical companies listing in Hong Kong, focusing on cutting-edge medical industry directions, which has attracted market attention and investment [2] Market Performance - The Hong Kong innovative drug ETF (513120) saw a rise of over 2%, with a trading volume of 4.1 billion yuan, leading the market in the pharmaceutical ETF category [1] - The latest scale of the Hong Kong innovative drug ETF reached 13.4 billion yuan, indicating its leading position in the market [1] - The innovative drug ETF (515120) also performed well, with a trading volume of 145 million yuan and a net inflow of nearly 200 million yuan over five consecutive days [1]

Core Viewpoint - The National Healthcare Security Administration and the National Health Commission have introduced measures to support the high-quality development of innovative drugs, including the establishment of a commercial health insurance innovative drug directory to enhance multi-level medical security systems [1] Group 1: Policy Changes - The new policy includes the addition of a commercial health insurance innovative drug directory, which will focus on innovative drugs that have high innovation levels, significant clinical value, and substantial patient benefits that exceed the basic medical insurance coverage [1] - The directory will serve as a reference for commercial health insurance and medical mutual assistance within the multi-level medical security system [1] Group 2: Pricing and Monitoring - The policy aims to reasonably determine the settlement prices of drugs within the commercial health insurance innovative drug directory through negotiation, while exploring stricter price confidentiality mechanisms [1] - Drugs listed in the commercial health insurance innovative drug directory will not be included in the self-payment rate indicators of basic medical insurance or in the monitoring of alternative varieties selected through centralized procurement [1] Group 3: Integration with Existing Systems - There will be a coordinated effort to ensure the integration of the commercial health insurance innovative drug directory with the existing medical insurance directory [1]

Group 1 - The National Healthcare Security Administration has developed guidelines for the adjustment of the basic medical insurance catalog and the commercial health insurance innovative drug catalog for 2025, indicating a more significant role for commercial health insurance in the multi-tiered medical security system [1] - The 2025 government work report emphasizes the need to deepen the reform of medical insurance payment methods and supports the development of innovative drugs by establishing an innovative drug catalog [1] - The guidelines outline the process for submitting applications for the adjustment of the drug catalogs, requiring detailed information about the drugs, including inclusion in supplementary commercial health insurance and pricing details [1] Group 2 - The aging population and the slowdown in medical insurance revenue growth have increased the necessity for reform in medical insurance payment methods, creating a broader space for the development of commercial health insurance [2] - As medical security demands rise, the diversification and personalization of medical supply will enhance the positive role of commercial health insurance in improving the multi-tiered medical security system and supporting the Healthy China initiative [2]

Core Viewpoint - The National Healthcare Security Administration (NHSA) has released the "2025 Basic Medical Insurance Catalog and Commercial Insurance Innovative Drug Catalog Adjustment Application Guidelines," marking the inclusion of commercial health insurance innovative drug catalog in the adjustment plan, which enhances the role of commercial insurance in the multi-tiered medical security system [1] Group 1 - The inclusion of the commercial health insurance innovative drug catalog is a significant step for market access in the commercial insurance innovative drug sector [1] - Industry experts believe that with the increasing demand for medical security and diversified supply, commercial insurance will play a larger role in improving the multi-tiered medical security system [1] - The NHSA is promoting reforms in medical insurance payment methods, providing ample space for the development of commercial insurance [1] Group 2 - Commercial health insurance needs to explore product transformation to better meet residents' demand for high-quality medical services [1]

Core Viewpoint - The National Healthcare Security Administration has released the "2025 Basic Medical Insurance Directory and Commercial Insurance Innovative Drug Directory Adjustment Application Guidelines," marking the first inclusion of the commercial health insurance innovative drug directory in the adjustment plan, indicating a significant role for commercial health insurance in the multi-tiered medical security system [1] Group 1 - The adjustment signifies an important step for market access of innovative drugs under commercial health insurance [1] - The inclusion of the commercial health insurance innovative drug directory highlights the evolving landscape of healthcare financing in China [1] - This move is expected to enhance the role of commercial health insurance in providing comprehensive medical coverage [1]

南方财经全媒体记者 林汉垚 北京报道 最近正在挑选健康险产品的张杰发现，似乎在传统保障责任外，创新药成为最大"卖点"。 张杰的感受是对的。在深化医保改革、推动多层次医疗保障体系的背景下，保险公司正通过升级产品或 推新产品，将高价值创新药纳入保障范围。 根据21世纪经济报道记者不完全统计，近段时间，新华保险推出"医药无忧医疗保险"，将保障范围延伸 至住院及特定门急诊期间院外购买的药品和医疗器械，满足患者对原研药、进口药、进口医疗器械等先 进医疗资源的使用诉求。 众安保险与铂生卓越生物科技（北京）有限公司合作，将国内首款干细胞治疗药品艾米迈托赛注射液纳 入旗下核心健康险产品系列尊享e生、众民保赔付范围。 互联网保险平台蚂蚁保宣布，旗下百万医疗险品牌"好医保"系列的核心产品进行新版升级，在先进药械 的资源拓展上新增全目录进口药、近400种原研药和国家指定的创新药械等1500多种先进药械。 对于本轮健康险产品密集升级和推新，北京大学应用经济学博士后朱俊生教授向21世纪经济报道记者表 示，在国家深化医保改革、"保基本、兜底线"的大方向下，保险公司主动纳入高值创新药，是对多层次 医疗保障体系建设的积极响应。 "基本医保对 ...

Core Insights - The contradiction between cost control and patient satisfaction creates significant opportunities for commercial insurance to deeply engage in the medical security system [1][3] - The medical security system in China is undergoing profound changes, driven by heightened public health awareness and rapid advancements in medical technology [2] Group 1: Current State of Medical Insurance - As of the end of 2024, the number of people covered by basic medical insurance in China is expected to reach 1.326 billion, maintaining a coverage rate of around 95% [3] - The total number of outpatient treatment cases benefiting from medical insurance has increased by 37% year-on-year, with average hospitalization costs around 8,000 yuan [3] - Despite the extensive coverage, basic medical insurance faces limitations due to fund constraints, leading to cost control measures that may reduce patient satisfaction [3][4] Group 2: Evolution of Commercial Medical Insurance - Commercial medical insurance is transitioning from a supplementary role to a core component of the medical security system, particularly with the rise of million medical insurance products that offer high coverage at low premiums [3][4] - Early million medical insurance products faced challenges such as renewal difficulties and high deductibles, impacting user experience [4] - Current market trends show that companies like ZhongAn Insurance and Ping An Health are developing mid-tier medical insurance and upgrading million medical insurance to include high-quality medical services [4] Group 3: Policy and Future Directions - The 2024 "National Ten Articles" for the insurance industry aims to include new medical technologies, drugs, and devices in the coverage of commercial insurance, enhancing its role in the multi-tiered medical security system [5] - Experts suggest that commercial health insurance should leverage risk-based pricing advantages and explore coverage for pre-existing conditions to fill gaps left by basic medical insurance [5][6] - The long-term vision for commercial health insurance is to take on a more significant role in medical security, addressing the increasing demand for better healthcare and diverse insurance products [6]