据券商中国消息，国家医保局近日发布《2025年基本医保目录及商保创新药目录调整申报操作指南》， 首次将商业健康保险创新药目录纳入调整方案。这一举措标志着商保在多层次医疗保障体系中作用增 强，是商保创新药市场准入的重要一步。业内人士认为，随着医疗保障需求增加和供给多样化，商保将 在完善多层次医疗保障体系中发挥更大作用。国家医保局推动医保支付方式改革，为商保发展提供广阔 空间。商业健康险需探索产品转型，以更好满足居民优质医疗需求。 ...

券商中国记者独家获悉，国家医保局近日印发《2025年基本医保目录及商保创新药目录调整申报操作指 南》（下称《指南》），首次将商业健康保险创新药目录纳入调整方案。 药品以往纳入惠民保和其他补充商业健康保险相关也需要填写。据《指南》，若"申报目录类别"选【商保创新 药目录】或【基本医保目录、商保创新药目录】，须填写"药品纳入惠民保及其他补充商业健康保险情况"，包 括药品纳入情况、产品描述、价格/折扣水平、赔付情况等，并上传盖章后的惠民保及其他补充商业健康保险 相关证明材料。 在基本医保甲乙类药品目录的基础上研究制定出台商业健康保险创新药品目录，是完善我国医疗保障药品目录 体系的一次重要尝试。 2025年政府工作报告提到"深化医保支付方式改革"，并明确提出"制定创新药目录，支持创新药发展"。 6月9日，中共中央办公厅、国务院办公厅印发《关于进一步保障和改善民生 着力解决群众急难愁盼的意 见》。其中提到：完善基本医疗保险药品目录调整机制，制定出台商业健康保险创新药品目录，更好满足人民 群众多层次用药保障需求。 创新药支付空间巨大 上述调整，标志着商业健康保险在多层次医疗保障体系中将发挥更重要的作用，此次调整也是商保创 ...

Core Viewpoint - The upcoming 2025 National Negotiation (国谈) is causing anxiety among pharmaceutical companies, as the latest signals regarding the Class B drug directory indicate that it may still proceed in sync with the negotiations, with the National Healthcare Security Administration (国家医保局) holding a meeting to discuss the adjustment plan for the drug directories [1][2][3]. Group 1: Changes in Drug Directory - The Class B drug directory will be renamed to the "Commercial Health Insurance Innovative Drug Directory" [2]. - The first version of the directory is expected to be developed in conjunction with the 2025 National Negotiation [2]. - The recent meeting did not invite representatives from the commercial insurance sector, suggesting that these companies may no longer directly participate in the directory formulation [2][7]. Group 2: Implications for Price Negotiation - Analysts indicate that the most significant change in the new directory is the withdrawal of commercial insurance companies from the directory formulation, which may lead to the cancellation of price negotiations [7][9]. - The National Healthcare Security Administration is expected to take the lead in formulating the innovative drug directory, which will have a nature closer to a recommendation list, significantly reducing the constraints on commercial insurance companies [8][10]. - The absence of commercial insurance in the directory formulation raises concerns about the feasibility of price negotiations, as pricing is typically determined collaboratively by payers and pharmaceutical companies [9]. Group 3: Selection Criteria and Market Impact - The selection criteria for the new directory are expected to remain largely unchanged, focusing on filling gaps and enhancing standards, primarily including innovative drugs that cannot be included in the basic medical insurance directory due to their high clinical value [13][14]. - The demand for price reductions in the new innovative drug directory may decrease or even disappear, potentially increasing the chances for high-priced innovative drugs to be included [16][17]. - The mechanism for transitioning drugs from the basic medical insurance directory to the innovative drug directory is anticipated to be established, allowing for a more seamless integration of the two directories [18][19][20].

Core Viewpoint - The article highlights China's commitment to sharing its healthcare insurance experiences with developing countries, particularly through a recent training program aimed at enhancing medical security capabilities in Africa and Southeast Asia [1][2][12]. Group 1: Training Program Overview - The training program was the first of its kind organized by China for developing countries, marking a significant milestone in international healthcare cooperation [1]. - It involved 50 government representatives and experts from 12 countries, focusing on China's healthcare insurance system and its practical experiences [2][4]. - The program included lectures from officials of the National Healthcare Security Administration, showcasing China's journey from "lack of medical resources" to "universal healthcare" [4][5]. Group 2: Key Insights on China's Healthcare System - The training emphasized the importance of universal coverage as the foundation for public health, with a focus on mutual assistance and basic security [4][5]. - Participants learned about China's centralized procurement mechanisms for medicines and medical supplies, which have made healthcare more accessible and affordable [8][10]. - The program also addressed the challenges faced by developing countries in establishing effective healthcare systems, with China offering its experiences as potential solutions [12][13]. Group 3: Opportunities for Chinese Pharmaceutical Companies - The training provided a platform for Chinese pharmaceutical companies to showcase their products and explore international markets, particularly in Southeast Asia and Africa [8][10]. - Participants expressed interest in the quality and pricing of Chinese medical products, indicating a potential market for these products in their home countries [8][9]. - The program highlighted the support from the Chinese government for domestic companies to expand internationally, enhancing their competitiveness in global markets [9][10].

Core Viewpoint - The training program on medical insurance capacity building for developing countries, hosted by China, marks a significant milestone in international cooperation in healthcare, focusing on sharing experiences and enhancing collaboration with African and Southeast Asian nations [1][10]. Group 1: Training Program Overview - The training program involved 50 government representatives and experts from 12 countries, emphasizing China's commitment to sharing its medical insurance experiences [1]. - The program served as a platform for discussing key issues in global healthcare, including the construction of medical insurance systems and the reduction of drug prices [3][10]. - Participants engaged in practical sessions, including site visits to Chinese medical institutions and discussions on China's centralized procurement mechanisms [1][8]. Group 2: Insights on China's Medical Insurance System - China's medical insurance system, which covers over 1.3 billion people, is viewed as a model for developing countries seeking to establish sustainable healthcare systems [5]. - The program highlighted the importance of universal coverage as a fundamental guarantee for public health, with insights shared on China's policies and mechanisms for achieving this goal [3][10]. - The training addressed various aspects of medical assistance, including the identification of beneficiaries and the role of different departments in providing support [4][10]. Group 3: Opportunities for Chinese Pharmaceutical Companies - The training facilitated connections between Chinese pharmaceutical companies and representatives from developing countries, showcasing the potential for collaboration in healthcare [6][11]. - Participants expressed interest in the quality and affordability of Chinese medical products, with discussions on the challenges and opportunities for Chinese companies to enter international markets [6][9]. - The program emphasized the strategic importance of centralized procurement in enhancing the competitiveness of Chinese medical products abroad [9][10]. Group 4: Future Collaboration and Impact - The training is seen as a bridge connecting China's medical insurance solutions with the healthcare needs of African and Southeast Asian countries, fostering long-term partnerships [11]. - Representatives from various countries expressed optimism about applying the knowledge gained to improve their own healthcare systems and enhance cooperation with China [10][11]. - The initiative is expected to contribute to addressing the challenges of "difficult and expensive medical care" in developing countries [10].

外卖骑手刘某驾驶电动自行车送餐途中，与驾驶电动自行车的吕某发生碰撞，致吕某受伤，电动自 行车受损。公安交管部门认定，刘某负事故的全部责任，吕某无责任。刘某是甲公司的员工，甲公司曾 为其在保险公司投保雇主责任险附加第三者责任险。保单特别约定载明，在保障期间，骑手遭受意外伤 害保险事故，保险公司承担相关医疗费用，但事故发生地的社会医疗保险或其他公费医疗管理部门规定 的自费项目和自费药品费用以及医保统筹基金、附加支付，均为保险责任以外。 事故发生后，吕某就相关损失向人民法院提起诉讼，法院判决甲公司赔偿损失合计20万余元。甲公 司履行完相应赔付义务后，向保险公司理赔未果，故诉至法院，要求保险公司承担相应的保险责任。 本报讯（记者 郭燕 通讯员 夏梦 潘志川）骑手送外卖途中与他人相撞，导致他人受伤，公司为骑手 购买了雇主责任险附加第三者责任险，赔付伤者后向保险公司理赔却被保险公司告知非医保用药不赔。 那么，交通事故中，非医保用药的责任应由谁来承担？近日，上海市虹口区人民法院审理了一起有关保 险理赔过程中扣除非医保用药医疗费争议的案件。 综上，法院判决保险公司向甲公司支付保险金20万余元。该案判决后，双方未提起上诉，现已 ...

Group 1: Healthcare Legislation and Regulation - The draft of the Medical Security Law aims to establish a comprehensive basic medical insurance system and protect the rights of insured individuals [1] - The National Medical Products Administration (NMPA) held a meeting to enhance monitoring and management of medical device sales online, emphasizing risk governance and public safety [2] - Tianjin's health authorities issued a notice to promote the implementation of centralized procurement results, ensuring that selected drugs and consumables are procured within three months [3] Group 2: Medical Data and Technology - Hubei province launched a new feature for its medical insurance information platform to enable nationwide sharing of medical imaging data by 2026 [4] - The Gates Foundation announced a commitment to donate $1.6 billion to the Global Vaccine Alliance over the next five years, contributing to vaccine development and delivery [6] Group 3: Pharmaceutical Developments - Lizhu Group received approval for clinical trials of YJH-012 injection, a new siRNA drug aimed at long-term suppression of uric acid production [5] - Haisheng Pharmaceutical's HSK47388 tablet for autoimmune diseases has had its clinical trial application accepted by the NMPA [6] - Baiyue Shenzhou announced the clinical use of its bispecific HER2 inhibitor in China, targeting patients with HER2-positive biliary tract cancer [8] - Haichuang Pharmaceutical's new anti-cancer drug, Dihengzalu, has been prescribed in multiple cities, marking its entry into clinical practice [9] - Fuhong Hanlin completed the first patient dosing in Japan for its drug Hanshuang in a trial for extensive-stage small cell lung cancer [10] Group 4: Corporate Actions - Wantai Biological Pharmacy responded to investor concerns regarding the efficacy data of its 9-valent HPV vaccine, stating that the circulating data is inaccurate [12] - A senior executive at Kew Flower Pharmaceutical resigned due to retirement, effective immediately [13]

国家医疗保障局近日印发《关于进一步加强医疗保障定点医疗机构管理的通知》（以下简称《通 知》），要求各地医保部门从严从实抓好医保基金监管，守好老百姓的"看病钱""救命钱"，促进医疗机 构高质量发展。 《关于进一步加强医疗保障定点医疗机构管理的通知》要求，加强定点医疗机构日常管理，对定点医疗 机构上传的费用进行智能审核全覆盖。逐步实现本地费用与异地费用同质化审核。落实预付金政策，加 快推动与定点医疗机构即时结算。 《通知》指出，定点医疗机构应积极配合医保部门推进按病种付费等多元复合医保支付方式。 ·严禁以病组或病种费用限额、医保政策规定等为由，要求患者院外购买或自备药品、医用耗材，以及 强制患者出院或减少必要的医疗服务。 ·因自身配备等原因，住院期间定点医疗机构要求患者院外购买或自备药品、医用耗材的，原则上应计 入按病种付费费用及医疗机构医保总额。 定点公立医疗机构需通过省级医药集中采购平台统一采购所需药品和医用耗材。省级医药集中采购平台 要应用药品耗材追溯码，实现"无码不采""无码不付"。鼓励和引导医保定点非公立医疗机构自愿参加集 中采购。确需自主采购的医保定点非公立医疗机构，要按不超过平台挂网价销售药品和医用 ...

新华社北京6月24日电 题：医保定点医院"新规范"！让每一分医保钱花得更有意义 新华社记者彭韵佳、徐鹏航 守好老百姓的"看病钱""救命钱"，让每一分医保钱都花得更有意义。 国家医保局6月24日发布《关于进一步加强医疗保障定点医疗机构管理的通知》，强调从严从实抓好医保基金监管，促进定点医疗机构提升管理服 务水平，让参保群众健康更有"医"靠。 "提高门槛"，把好定点医疗机构"入口关"—— 把好"第一道关"，通知细化定点医疗机构申报条件。申请成为医保定点的医疗机构，要按规定使用药品耗材追溯码；开展检查检验服务的，严禁 医务、医技人员"挂证"行医等。 新纳入定点医疗机构还有了"试用期"。"试用期"为期6个月，对定点医疗机构落实相关政策要求做针对性指导，如出现违反相关规定的，医保部门 应及时辅导、纠正；若出现违规问题，情节较轻的，延长6个月，延长期内整改不到位的不予续签医保协议；情节严重的，解除医保协议。 "这既有利于规范医疗医药服务行为，强化定点医疗机构合规意识和风险管理，也有利于把好'入口关'，确保新纳入医疗机构能够符合医保管理的 要求。"国家医保局医药管理司司长黄心宇说。 "规范"先行，加强定点医疗机构日常管理— ...

小而美、高弹性：港股创新药ETF（159567）跟踪国证港股通创新药指数，创新药企业权重90%为全市 场医药主题类指数中最高，有望把握AI赋能创新药研发、国产创新药出海、商业健康保险逐步完善的 创新药利好浪潮。 大而全：创新药ETF（159992）跟踪创新药指数，该指数布局创新药产业链龙头企业，既汇聚全球CXO 龙头企业，又包含国内仿创药企龙头，有望同时受益于AI赋能创新药、国产创新药出海、针对高价创 新药的医保丙类目录出台等。 6月24日，港股市场高开高走，港股创新药板块走势较强。港股创新药ETF（159567）过去10个交易日 获得超5.3亿元资金净流入，市场热度较高。 消息面上，第85届美国糖尿病协会科学年会（ADA）近日召开，多家国产创新药企发布具有竞争力的 管线数据。相关研究机构表示，从国内市场来看，众多药企进入GLP-1赛道，在研药物包括GLP-1创新 药以及生物类似药两大类。随着更多GLP-1药物的上市，预计2030年中国GLP-1的市场规模将超600亿 元。 港股创新药板块高盈利持续消化估值。港股创新药指数2月21日市盈率为64倍，6月24日最新市盈率仅为 32倍，约为4个月前的一半，当前布局 ...