Core Points - The National Healthcare Security Administration and the Ministry of Human Resources and Social Security released the new National Basic Medical Insurance, Maternity Insurance, and Work Injury Insurance Drug Catalog (2025) along with the first Commercial Health Insurance Innovative Drug Catalog (2025), focusing on high-innovation and clinically valuable drugs [1] - A total of 24 drugs participated in the price negotiation, with 19 successfully included, achieving a success rate of approximately 79% [1] - The included innovative drugs feature 5 CAR-T cell therapies, 6 rare disease drugs, and the only immune oncology drug in the commercial health insurance catalog [1] Group 1: CAR-T Cell Therapies - Five CAR-T cell therapies have been included in the commercial health insurance innovative drug catalog, which had previously attempted to enter the national insurance catalog four times without success [2][3] - The therapies included are from various companies, with the first approved CAR-T therapy being the Axicabtagene Ciloleucel injection from Fosun Kite [3] - Despite high treatment costs, the inclusion in the commercial catalog is expected to improve patient access and reduce financial burdens [3] Group 2: Oncology Drugs - The commercial health insurance innovative drug catalog includes a significant number of oncology drugs, with 14 drugs in total, accounting for nearly 74% of the catalog [5] - Notably, the CTLA-4 inhibitor Ipilimumab injection, the only immune oncology drug included, is expected to enhance treatment accessibility for liver cancer patients [6] Group 3: Rare Disease Drugs - The catalog also includes 6 innovative drugs for rare diseases, such as the drugs for neuroblastoma and phenylketonuria [8][10] - These drugs are aimed at addressing urgent patient needs and are part of a broader strategy to enhance treatment options for rare diseases [8] Group 4: Policy Implications - The establishment of the commercial health insurance innovative drug catalog is a significant step towards improving the multi-tiered medical insurance system in China [9] - The government encourages commercial health insurance providers to incorporate these drugs into their coverage, promoting a more comprehensive healthcare solution for patients [9]

仅仅依靠基本医保难以承担支持创新的重任，医保要有边界，要给市场"留白"。 按照30%的药占比计算，我国每年约3万亿元的医疗保险基金支出中，有超过1万亿元用于药品支出，这 是我国医保基金支持医药创新的"基本盘"。 在12月7日的2025创新药高质量发展大会上，国家医保局局长章轲表示，医保购买创新医药产品，就是 为群众买健康，为健康买未来。医保基金作为中国医药领域最大的购买方，"十四五"期间累计支出约13 万亿元，并保持了年均10%以上的较高增速，为创新提供了稳定的资金来源，注入了持久的发展动力。 国家医保局在这次会议上同步发表了医保商保的"双目录"。2025年国家医保药品目录新增114种药品， 有50种是一类创新药，总体成功率88%。同时，19种药品纳入首版商保创新药目录。 国家医保局表示，商保创新药目录的推出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了基础。 市场上有种声音说，国家医保局推出商保创新药目录可能是基本医保不想为创新药付费了。对此，国家 医保局医药管理司司长黄心宇明确表示，国家医保局从来没有这种打算，而且在可见的未 ...

Core Insights - The first national commercial insurance innovative drug directory for 2025 has been released, including 19 high-value innovative drugs covering key treatment areas such as oncology, rare diseases, and neurodegenerative diseases [1][3][4] - Shenzhen's "Shenzhen Huiminbao" has proactively included all 19 innovative drugs in its coverage for 2025, significantly reducing out-of-pocket expenses for insured residents when using these drugs [1][2][3] Summary by Sections National Drug Directory - The newly published commercial insurance innovative drug directory serves as a supplement to basic medical insurance, focusing on drugs with high innovation, significant clinical value, and substantial patient benefits that exceed the coverage of basic medical insurance [1][4] - Included drugs feature CAR-T therapies for cancer treatment, medications for rare diseases like Gaucher disease, and drugs for Alzheimer's disease, which has garnered significant public attention [1][4] Shenzhen Huiminbao - "Shenzhen Huiminbao" has achieved full coverage of the 19 innovative drugs, providing a crucial supplement to the existing medical insurance framework in Shenzhen [1][4] - The insurance plan supports a "one-stop settlement" service, alleviating the financial burden on insured individuals when seeking medical treatment [2][4] - The program has been operational for three years, maintaining a public welfare characteristic with no restrictions on age, occupation, or health status, allowing for an annual premium of 88 yuan for coverage exceeding 4 million yuan [5] - As of 2025, the number of insured individuals has surpassed 6.15 million, with a total of over 18 million insured instances in three years [5]

来源：险联社 "全国首版《商业健康保险创新药品目录》正式发布，共纳入19种药品，既有肿瘤、罕见病、慢性病治疗药品，也有广受关注的阿尔茨海默病 治疗药品等。" 12月7日，2025创新药高质量发展大会在广州召开，大会发布了全国首版《商业健康保险创新药品目录》。首版《目录》共纳入19种药品，既 有肿瘤、罕见病、慢性病治疗药品，也有广受关注的阿尔茨海默病治疗药品等。 2025年6月，国家医保局、国家卫生健康委联合印发了《支持创新药高质量发展的若干措施》，国家医保局牵头组织制定《商业健康保险创新 药品目录》，重点纳入临床价值大、创新程度高、患者受益明显但超出基本医保保障范围的药品。 近年来，医保目录持续扩容，但部分救急、救命的创新药在刚上市时价格高昂，基本医保目录难以覆盖，不少患者依然难以负担。 《商业健康保险创新药品目录》可以推动商业健康保险与基本医保的有效衔接，构建多层次医疗保障体系建设。 19种药品入围 涵盖多种罕见病 国家医保局在2025年8月发布的通告中曾披露，共收到商保创新药目录申报信息141份，涉及药品通用名141个，经初步审核，121个药品通用名 通过形式审查。 而最终这版名单中，经过自主申报、专家评 ...

Investment Rating - The industry investment rating is "Outperform the Market" with an expectation of over 10% relative increase in the industry index compared to the market in the next six months [5][10]. Core Insights - The new medical insurance drug list has been released, adding 50 first-class innovative drugs. A total of 114 new drugs were added, with a success rate of 88%, higher than last year's 76%. The total number of drugs in the list has increased to 3,253, including 1,857 Western medicines and 1,396 traditional Chinese medicines. This new list will be implemented starting January 1, 2026 [3]. - The first commercial health insurance innovative drug list has been published, including 19 drugs from 18 pharmaceutical companies, covering treatments for cancer, rare diseases, and Alzheimer's disease. These drugs are not included in the medical insurance fund payment scope, promoting the development of a multi-tiered medical security system and increasing accessibility to high-value innovative drugs [4]. - The collaboration between the new medical insurance drug list and the commercial health insurance innovative drug list aims to create a new payment structure for innovative drugs, addressing the affordability issue for patients and providing a sustainable return mechanism for pharmaceutical companies, thus driving high-quality development in China's innovative drug industry [4]. Summary by Sections - **New Medical Insurance Drug List**: 50 first-class innovative drugs added, total drugs increased to 3,253, with a record number of 69 innovative drugs approved for market entry this year [3]. - **Commercial Health Insurance Drug List**: 19 innovative drugs included, enhancing accessibility and complementing the basic medical insurance system [4]. - **Policy Impact**: The synergy between the two lists is expected to accelerate the development of China's innovative drug research and create a robust engine for high-quality growth in the industry [4].

商保创新药目录的积极探索，能为高价药物开辟新空间，并通过"进入商保—收集真实世界数据—过渡 到医保"的路径，实现制度衔接。 阿尔茨海默疾病负担沉重 阿尔茨海默病是全球主要致死病因之一，疾病负担沉重。我国阿尔茨海默病早诊率低，95%的患者确诊 即中晚期，错失早期诊疗良机。 12月7日，中国国家医疗保障局公布的首版商保创新药目录，纳入卫材及礼来公司的两款阿尔茨海默病 治疗药物引发关注。阿尔茨海默病药物的研发门槛极高，目前在全球范围内的治疗选择都较为有限。 全程治疗费最高近50万元 去年，卫材公司的仑卡奈单抗（商品名：乐意保）以及礼来公司的多奈单抗（商品名：记能达）先后在 国内获批，但治疗费用高昂。复旦大学附属华山医院神经内科郁金泰教授对第一财经记者表示，仑卡奈 单抗和多奈单抗一年的治疗费用分别超过20万元和30万元，一般治疗周期为一年半。这也意味着，患者 全程用药需要支付至少30万元，最高近50万元的治疗费。 第一财经记者了解到，到2025年，礼来的多奈单抗已纳入包括北京、广州、深圳在内的10个省市的城市 商业医疗险。尽管如此，要惠及更多患者，仅靠大城市的商业医疗险仍然不够。 此次两款阿尔茨海默病治疗药物纳入商保 ...

智通财经APP获悉，国泰海通发布研报称，12月7日，国家医保局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发布。本次目录调整新增114种药品，肿瘤等重 点领域的保障水平得到明显提升。通过战略购买成功建立医保支持真创新、支持差异化创新的鲜明导 向。该行认为，商保目录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，为建立多层次医疗保障体系奠定基础。 通过战略购买成功建立医保支持真创新、支持差异化创新的鲜明导向 落实政府工作报告要求，首版商保创新药目录出路 今年6月30日国家医保局会同国家卫生健康委出台《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，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、医疗互助等多层次医疗保障体系参考使用。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。该行认为，商保目录与基本医保形成较好的互补衔接，也为进一步厘 清基本 ...

Core Insights - The National Healthcare Security Administration (NHSA) has released the 2025 version of the 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, marking the eighth consecutive year of adjustments to the national drug catalog [1][2] Group 1: Drug Catalog Adjustments - The new drug catalog will be officially implemented starting January 1, 2026, replacing the 2024 version [1] - A total of 114 new drugs have been added to the 2025 National Medical Insurance Drug Catalog, with 50 being innovative drugs, resulting in an overall success rate of 88%, a significant increase from 76% in 2024 [3] - The total number of drugs in the adjusted National Medical Insurance Drug Catalog has increased to 3,253, including 1,857 Western medicines and 1,396 traditional Chinese medicines [4] Group 2: Coverage and Management - The NHSA emphasizes the need to strengthen the management of the medical insurance payment scope, ensuring that only drugs that align with diagnosis, treatment, and legal indications are covered [2] - The NHSA is promoting the inclusion of the innovative drug catalog in commercial health insurance coverage, encouraging the development of multi-tiered medical security systems [2][4] - The new catalog includes drugs that address gaps in basic medical insurance, covering treatments for major diseases such as triple-negative breast cancer, pancreatic cancer, and rare diseases like Gaucher disease [4]

Core Insights - The 2025 Innovation Drug High-Quality Development Conference was held in Guangzhou, where the 2025 National Basic Medical Insurance, Maternity Insurance, and Work Injury Insurance Drug Catalog and the first Commercial Health Insurance Innovative Drug Catalog were released [1] - The new National Medical Insurance Drug Catalog includes 114 new drugs, of which 50 are Class 1 innovative drugs. The first Commercial Health Insurance Innovative Drug Catalog includes 19 drugs, including CAR-T and treatments for rare diseases like neuroblastoma and Gaucher disease [1] - The National Healthcare Security Administration (NHSA) and the National Health Commission have introduced measures to support the high-quality development of innovative drugs, emphasizing the inclusion of high-innovation, clinically valuable drugs in the commercial health insurance catalog [1] Summary by Sections National Medical Insurance Drug Catalog - The updated catalog adds 114 new drugs, with a significant portion being innovative [1] - The focus is on drugs that provide substantial clinical benefits and are beyond the basic insurance coverage [1] Commercial Health Insurance Innovative Drug Catalog - The catalog includes 19 drugs, highlighting treatments for both common and rare diseases, particularly those affecting children [2] - The catalog aims to bridge the gap between basic medical insurance and commercial insurance, allowing for a wider range of innovative treatments [2] Support for Innovative Drug Development - The NHSA encourages local medical insurance departments to support commercial insurance institutions in designing new products based on the innovative drug catalog [3] - There is a push for a complementary relationship between commercial insurance and basic medical insurance to enhance healthcare coverage for the population [3]

12月7日，2025年《国家基本医疗保险、生育保险和工伤保险药品目录》和首版《商业健康保险创新药 品目录》正式发布，新版药品"双目录"将于2026年1月1日起正式执行。 医保药品目录方面，2025年新增114种药品，其中50种是一类创新药；调出29种临床没有供应或可被其 他药物更好替代的药品，其中9种尚有相同治疗主成分的其他剂型在目录内，不减少目录编号。本次调 整后，目录内药品总数增至3253种，其中西药1857种、中成药1396种。 国家医保局表示，商保创新药目录与医保药品目录形成良好的互补衔接，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。下一步，国家医保 局、人力资源社会保障部将认真贯彻落实党的二十大及二十届历次全会精神，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。 据国家医保局局长章轲介绍，国家医保局连续八年调整了医保药品目录，包括今年在内累计调入949种 新的药品，医保基金为协议期内的谈判药品支出超过4600亿元，拉动销售超过6000亿元。 商保创新药目录方面，共有 ...