北京商报讯（记者 丁宁）12月7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》以及《商业健康保险创新药品目录》（2025年）。其中提出，各省（自治 区、直辖市）医保局要落实《国家医保局 国家卫生健康委关于印发<支持创新药高质量发展的若干措施 >的通知》各项要求，商保创新药目录内药品的挂网、配备工作原则上参照医保谈判药品执行，保障临 床诊疗需求和患者合理用药权益。 各地医保部门要会同有关部门推动多层次医疗保障体系建设，积极支持普惠型商业健康保险发展，商保 创新药目录推荐商业健康保险、医疗互助等多层次医疗保障体系参考使用。支持商保机构根据商保创新 药目录设计新产品、更新赔付范围、调整赔付方式，更好满足患者用药需求，切实减轻患者医疗费用负 担。鼓励有条件的地区探索开展医保、工伤保险与商保"一站式"结算。 商保创新药目录内药品医保基金不予支付，不计入医保定点医疗机构基本医保自费率指标和集采中选可 替代品种监测的范围。相关商业健康保险保障范围内商保创新药目录中的创新药应用病例可不纳入医保 按病种付费范围，经审核评议程序后支付。各省（自治区、直辖市）医保部门可探索支持医保定点零售 ...

新华社北京12月3日电 题：健全多层次医疗保障体系 筑牢民生保障底线——访国家医保局局长章 轲 新华社记者彭韵佳 医保，关系每个参保人的切身利益。党的二十届四中全会审议通过的《中共中央关于制定国民经济 和社会发展第十五个五年规划的建议》（以下简称《建议》），提出"健全多层次医疗保障体系""推进 基本医疗保险省级统筹"等系列部署。 如何健全多层次医疗保障体系？如何让医保改革成果更好惠及群众健康？新华社记者专访了国家医 保局局长章轲。 破解看病难、看病贵问题取得突破性进展 问："十四五"时期，医疗保障制度改革如何提升百姓获得感？ 答：党的十八大以来，全民医疗保障制度改革持续推进，参保质量明显提升，人民群众医保获得感 显著提高。 国家医保局持续推进"1+3+N"多层次医疗保障体系建设，基本医保、大病保险、医疗救助三重基本 医疗保障制度进一步巩固提升。职工医保、居民医保政策范围内住院费用报销比例分别达到80%和70% 左右，普遍开展普通门诊统筹和门诊慢性病、特殊疾病保障，减轻参保人员门诊医疗费用负担。大病保 险进一步减负，城乡居民大病保险保障水平在基本医保基础上提高10到15个百分点。健全统一规范的医 疗救助制度。 ...

新华社北京12月3日电（新华社记者彭韵佳）医保，关系每个参保人的切身利益。党的二十届四中全会 审议通过的《中共中央关于制定国民经济和社会发展第十五个五年规划的建议》（以下简称《建 议》），提出"健全多层次医疗保障体系""推进基本医疗保险省级统筹"等系列部署。 如何健全多层次医疗保障体系？如何让医保改革成果更好惠及群众健康？新华社记者专访了国家医保局 局长章轲。 破解看病难、看病贵问题取得突破性进展 问："十四五"时期，医疗保障制度改革如何提升百姓获得感？ 答：党的十八大以来，全民医疗保障制度改革持续推进，参保质量明显提升，人民群众医保获得感显著 提高。 国家医保局持续推进"1+3+N"多层次医疗保障体系建设，基本医保、大病保险、医疗救助三重基本医疗 保障制度进一步巩固提升。职工医保、居民医保政策范围内住院费用报销比例分别达到80%和70%左 右，普遍开展普通门诊统筹和门诊慢性病、特殊疾病保障，减轻参保人员门诊医疗费用负担。大病保险 进一步减负，城乡居民大病保险保障水平在基本医保基础上提高10到15个百分点。健全统一规范的医疗 救助制度。 以"减负、提质、便民"为导向，多举措强化保障实效。"十四五"期间，医保基 ...

原标题：贯彻落实党的二十届四中全会精神权威访谈|健全多层次医疗保障体系 筑牢民生保障底线—— 访国家医保局局长章轲 新华社北京12月3日电（新华社记者 彭韵佳）医保，关系每个参保人的切身利益。党的二十届四中全会 审议通过的《中共中央关于制定国民经济和社会发展第十五个五年规划的建议》（以下简称《建 议》），提出"健全多层次医疗保障体系""推进基本医疗保险省级统筹"等系列部署。 如何健全多层次医疗保障体系？如何让医保改革成果更好惠及群众健康？新华社记者专访了国家医保局 局长章轲。 破解看病难、看病贵问题取得突破性进展 国家医保局持续推进"1+3+N"多层次医疗保障体系建设，基本医保、大病保险、医疗救助三重基本医疗 保障制度进一步巩固提升。职工医保、居民医保政策范围内住院费用报销比例分别达到80%和70%左 右，普遍开展普通门诊统筹和门诊慢性病、特殊疾病保障，减轻参保人员门诊医疗费用负担。大病保险 进一步减负，城乡居民大病保险保障水平在基本医保基础上提高10到15个百分点。健全统一规范的医疗 救助制度。 以"减负、提质、便民"为导向，多举措强化保障实效。"十四五"期间，医保基金累计支出超13万亿元， 惠及近200亿 ...

Core Viewpoint - The recent rumor claiming that only 2% of approved drugs are included in the medical insurance catalog has been clarified, revealing that 3,159 drugs are listed, accounting for approximately 63% of the total market drugs [1] Group 1: Medical Insurance Catalog - The medical insurance catalog has been continuously expanded, with 835 new drugs added in recent years, enhancing the basic medical insurance coverage [1] - The catalog reflects a response to public medication needs, with updates ensuring better coverage for cancer treatments, rare diseases, and children's medication safety [2] - The adjustment mechanism for the medical insurance catalog has become regularized and scientific, aiming to improve the quality and structure of clinical medication [2] Group 2: Multi-layered Medical Security System - The need for a multi-layered medical security system is emphasized, as basic medical insurance alone cannot meet diverse health demands [3] - The "14th Five-Year Plan" suggests optimizing drug procurement and insurance payment policies to support a multi-tiered medical security framework [3] - The introduction of a commercial health insurance innovative drug catalog aims to enhance the multi-layered medical security system, even though basic medical insurance does not cover these drugs [3] Group 3: Commitment to Public Health - The focus is on ensuring that every penny spent on health maximizes benefits rather than just purchasing expensive drugs, maintaining the principle of "basic protection" [4] - The ongoing reforms aim to alleviate the healthcare burdens of the population, reflecting a commitment to improving public health and well-being [4]

Group 1: Core Insights - The commercial health insurance market is evolving to meet diverse needs through differentiated and specialized services, with three main segments: Huiminbao, chronic disease insurance, and high-end medical insurance [1] - By 2024, medical insurance is projected to surpass critical illness insurance, accounting for approximately 44% of the health insurance market, marking the beginning of a specialized era dominated by medical insurance [1] Group 2: Huiminbao - Huiminbao, a city-level commercial health insurance, serves as a crucial link between basic medical insurance and commercial health insurance, aiming to provide universal health coverage [2] - The 2026 Huiminbao policies maintain low premiums (195 yuan per person per year) while increasing coverage limits to 3.5 million yuan and expanding the list of covered diseases and medications [2] - As of July 2023, there are 313 local Huiminbao products launched nationwide, with 202 products actively operating [2] Group 3: Chronic Disease Insurance - Chronic disease insurance is gaining traction due to the rising prevalence of chronic diseases, which account for over 80% of total deaths in the population [4] - The market is responding to the needs of specific groups, including the elderly and those with pre-existing conditions, by offering various insurance models that support long-term management of chronic diseases [4][5] - The integration of health management services with chronic disease insurance is becoming common, providing comprehensive support throughout the treatment cycle [6] Group 4: High-End Medical Insurance - The high-end medical insurance market is rapidly growing, driven by rising income levels and increased health awareness among consumers [7] - The number of new customers for high-end medical insurance has surged by 445% year-on-year in 2024, indicating a significant shift towards this segment [7] - High-end medical insurance products are designed to fill the coverage gaps left by basic medical insurance, catering to the high-quality medical needs of the middle-income population [8]

Core Insights - During the "14th Five-Year Plan" period, Shandong's medical insurance benefits have steadily improved, with the hospitalization reimbursement ratio for grassroots medical institutions exceeding 85% [1][2] Group 1: Medical Insurance Reforms - The hospitalization reimbursement ratios for employee and resident medical insurance remain stable at approximately 80% and 70%, respectively [2][3] - A comprehensive outpatient coordination system has been established, increasing the reimbursement ratio for outpatient services at grassroots medical institutions to 65% [3] - The reimbursement ratio for outpatient medications for residents with hypertension and diabetes has been raised to 75% [3] Group 2: Support for Vulnerable Groups - The rescue ratio for major disease medical insurance and assistance for vulnerable groups, including low-income families, has been increased to over 70% [3] - Shandong has achieved nationwide coverage for long-term care insurance for employees and is steadily advancing long-term care insurance for residents [3] Group 3: Collaborative Development in Healthcare - Shandong has been actively promoting centralized procurement of drugs and medical consumables, with 890 types of drugs and 40 categories of high-value medical consumables procured over the past five years [4] - The province has implemented a payment reform based on disease diagnosis-related groups (DRG) and disease-specific values (DIP), achieving coverage rates of 97.21% for disease types and 89.76% for funds [4] Group 4: Optimization of Public Services - The province has maintained a stable insurance coverage rate of 95% for the resident population during the "14th Five-Year Plan" period [5] - The direct settlement rate for cross-province hospitalization has improved from less than 50% during the "13th Five-Year Plan" to 94.49% [5] - A total of 35,000 grassroots medical insurance workstations have been established, achieving full coverage of the five-tier medical insurance service system [5]

二是稳步提高医保报销水平。目前，参保居民、职工住院使用报销范围内的药品、耗材等，分别可以享 受到70%左右、80%以上的报销待遇。不断健全门诊慢特病保障政策，统一将恶性肿瘤门诊治疗、肾透 析等门诊维持治疗周期长、医疗费用相对较高的81种慢性病，纳入门诊慢特病保障范围，参照住院报销 政策予以保障，减轻了患者大额门诊医疗费用负担。同时，全面建立普通门诊报销制度，参保群众因头 痛脑热、感冒发烧、腹泻等常见病、多发病发生的日常门诊费用，也能享受报销待遇，比如，城乡参保 居民在基层医疗机构发生的报销范围内的普通门诊费用，可以报销65%，城乡居民诊断为高血压、糖尿 病后，购买降压药、降糖药还能享受到75%的专项报销待遇。 三是完善大病保险和医疗救助政策。统一居民大病保险起付标准，分段报销比例均达到60%以上，一个 医疗年度内最高可报销40万元。特困人员、低保对象、返贫致贫人口、低保边缘家庭成员和防止返贫监 测帮扶对象等困难群众，可享受居民医保个人缴费部分补贴和医疗费用救助，年度救助限额提高到5万 元以上。"十四五"期间，医疗救助对象累计就医4292.02万人次，医保基金支付544.35亿元。 四是持续完善生育医疗费用报销 ...

Core Viewpoint - China Life Insurance Company is committed to the mission of "protecting people's health" and actively participates in the construction of a multi-level medical security system, aligning with national policies to address aging population and rural revitalization [1][2][10] Summary by Sections Multi-level Health Security Development - The company has developed a multi-level health security system that aligns with national trends and policies, focusing on policy health insurance, long-term care insurance, and urban customized commercial medical insurance [2][10] - The national policy emphasizes the sustainable development of commercial insurance and the improvement of urban and rural residents' major illness insurance mechanisms [1][2] Major Illness Insurance - As one of the first institutions to undertake major illness insurance, China Life has built a comprehensive operational system covering underwriting, claims, medical verification, and risk control since 2012 [2][3] - The company has served over 40 million insured individuals in Guangxi, significantly reducing the financial burden of major illnesses through efficient claims processes [3][5] Long-term Care Insurance - China Life is a pioneer in the long-term care insurance system, responding to the challenges of an aging population and establishing a standardized operational framework since the pilot program began in 2016 [3][5] - The company has developed various representative service models in cities like Chengdu, Guangzhou, and Tianjin, contributing valuable experience for the establishment of a long-term care insurance system suitable for China's context [3][5] Urban Customized Commercial Medical Insurance - The company has actively participated in over 100 "惠民保" projects, which provide effective supplementary insurance for low-income and elderly populations [5][6] - Projects like "大爱无疆" in Zhuhai and "西湖益联保" in Hangzhou have been successful in bridging the gap in insurance coverage for vulnerable groups, promoting the development of the pharmaceutical industry [6][8] Future Development Plans - Looking ahead to the "15th Five-Year Plan," the company aims to consolidate its position in major illness insurance, enhance urban medical insurance, and accelerate the development of long-term care insurance [9][10] - The company plans to innovate in new fields and strengthen cooperation with government policies to meet diverse health insurance needs [9][10]

Core Viewpoint - The article emphasizes the acceleration of innovation in the pharmaceutical and medical device industries in China, driven by supportive policies and a shift from generic to innovative drug development, which is expected to enhance the industry's quality and global competitiveness [2][3][5]. Policy Support for Innovation - Since 2020, numerous favorable policies have been introduced to improve the ecosystem for innovative drugs, focusing on research standards, review and approval systems, patent protection, and reimbursement mechanisms [2]. - The "14th Five-Year Plan" highlights the importance of supporting innovative drugs and medical devices, indicating their critical role in national health and economic development [3][5]. Clinical Trials and Market Dynamics - The number of clinical trials for innovative drugs in China has surpassed 1,900, outpacing the US, Europe, and Japan, reflecting a significant increase in research quality and efficiency [3][8]. - By 2024, 39 innovative drugs approved for the first time in China were domestically developed, increasing from 31% in 2020 to 42% in 2024, indicating a strong trend towards domestic innovation [3][5]. Medical Insurance and Payment Systems - The narrowing surplus of the national medical insurance fund has created a mismatch between the commercialization of innovative drugs and their approval timelines, necessitating improvements in the commercial insurance system [8][27]. - The "15th Five-Year Plan" aims to establish a multi-tiered medical insurance system, which is expected to enhance the role of commercial health insurance in providing payment support for innovative drugs [27][32]. Medical Devices and Technological Innovation - The approval of innovative medical devices has increased by 43% from 2016-2020 to 2021-2024, driven by improved regulatory mechanisms and support for high-end medical device innovation [10][13]. - The article notes that while domestic brands are gaining global competitiveness, the industry still faces challenges in achieving systematic original innovation and key technology breakthroughs [13][19]. Emerging Technologies - The application of AI and brain-machine interfaces in healthcare is progressing towards industrialization, with the establishment of preliminary frameworks for clinical applications and payment rules [14][18]. - The integration of high-quality data flow in healthcare is anticipated to enhance the clinical benefits of new technologies, improving resource utilization and patient outcomes [18][19]. Biomanufacturing Developments - The biomanufacturing sector in China is transitioning from a "follower" to a "runner" stage, with significant advancements in technology and policy support, laying a solid foundation for future growth [19][20]. - The article highlights the importance of focusing on high-value, environmentally friendly products, such as biodegradable materials, to expand market opportunities [22][26].