Core Insights - The first edition of the "Commercial Health Insurance Innovative Drug Directory" has been released, including 19 innovative drugs, marking the first time the National Healthcare Security Administration has established a drug list specifically for commercial health insurance outside the basic medical insurance directory [1][2] Group 1: Drug Selection and Purpose - The selection process for the 19 drugs was rigorous, with a pass rate of less than 16% from an initial review of 121 drugs, highlighting the directory's role in filling gaps in medication not covered by basic medical insurance [1] - The 19 drugs include treatments for cancer, rare diseases, and Alzheimer's disease, emphasizing high clinical value and significant patient benefits, which cannot be replaced by drugs in the basic medical insurance directory [1][2] Group 2: Impact on Pharmaceutical Companies - The commercial health insurance directory provides direct incentives for pharmaceutical innovation, with about half of the selected drugs being Class 1 new drugs, including high-cost medications [2] - The integration of basic medical insurance and commercial health insurance funding is expected to enhance the economic support for the development of innovative drugs, addressing the previous dilemma faced by high-value innovative drugs [2] Group 3: Future Developments and Adjustments - The commercial health insurance innovative drug directory will be implemented on January 1, 2026, and will undergo dynamic adjustments based on advancements in medical technology, clinical needs, and the development of commercial health insurance [3] - There is an expectation for insurance companies to actively update their health insurance products based on the commercial health insurance directory, improving coverage levels to meet diverse medication needs of the public [3]

Core Viewpoint - The release of the commercial health insurance innovative drug directory addresses the issue of "can it be used" at the hospital level, but the "last mile" between high-priced innovative drugs and patients remains unconnected. To achieve seamless transformation from "policy text" to "patient benefit," three key barriers must be crossed [1][3]. Group 1: Release of the Directory - On December 7, 2025, the National Healthcare Security Administration officially released the first version of the "Commercial Health Insurance Innovative Drug Directory," incorporating 19 high-clinical-value, high-cost innovative drugs into the commercial health insurance payment framework for the first time at the national level [2]. - The directory includes 14 anti-tumor drugs (including all 5 CAR-T therapies available in China), 2 rare disease drugs, and 2 Alzheimer's disease new drugs, aligning with the current claims data of commercial health insurance, where malignant tumors are the most prevalent and costly disease area [2]. Group 2: Policy Support and Challenges - The commercial health insurance innovative drug directory is supported by policies that exempt the listed drugs from self-payment rate assessments, collection of alternative monitored varieties, and DRG payment scope, addressing the challenges hospitals face in using innovative drugs under cost control pressures [3]. - Despite the directory solving the "can it be used" issue, the connection between high-priced innovative drugs and patients still needs to be established, requiring standardization and universalization of the directory [3][4]. Group 3: Standardization and Payment Collaboration - The current directory serves as a guiding list rather than a mandatory coverage requirement for commercial insurance products, necessitating the promotion of core drugs in the directory as standard configurations in commercial health insurance, especially in inclusive "benefit insurance" products [4]. - The basic medical insurance market can leverage its large insured population to negotiate lower drug prices, but the fragmented nature of the commercial health insurance market poses challenges in forming a cohesive payment force to negotiate with pharmaceutical companies [4]. Group 4: Service Integration and Patient Experience - An ideal multi-tiered payment system should achieve seamless integration and instant settlement among basic medical insurance, commercial insurance, and patient out-of-pocket expenses, which currently requires patients to prepay and navigate complex claims processes [5]. - Commercial insurance accounts for only 7.7% of the overall payment for innovative drugs, indicating significant growth potential. Bridging the "last mile" between the 19 innovative drugs in the directory and patients requires coordinated efforts from government and market forces [5].

廖杰远称，微医国际云药房正是为系统化破解这些痛点而生，依托其深耕数字医疗领域积累的深度资源，全力打造一个"链接全球药械、贯通院内院外、融 合多元支付、驱动研用协同"的一站式综合解决方案平台。 结合全国多个省市的落地情况，廖杰远介绍了云药房的宝贵实践和实际成效。他介绍称，基于前期探索，平台已形成"贯穿创新药全生命周期，打通医保、 商保、医院、医生、患者，覆盖特许药、创新药与医保药"的综合服务能力。 据了解，其云药房承接、处理各大医院处方流转规模已超过年1000万张，下一步将继续升级技术与服务，打造领先的国际创新药械先导平台，为产业链各方 创造价值。 2025年12月7日，由国家医疗保障局指导，广州市人民政府、广东省医疗保障局联合主办的2025创新药高质量发展大会在广州召开。大会当日，新版《国家 基本医疗保险、工伤保险和生育保险药品目录》及首个《商业健康保险创新药品目录》同步发布。 在政策持续赋能创新药可及性的背景下，一个关乎中国患者未来就医用药的核心议题被提出：如何让全球最前沿、最有效的治疗方案，不再因地域、信息或 支付的壁垒而遥不可及？微医集团董事长廖杰远在主题演讲中给出了微医的答案：通过"微医国际云药房"， ...

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 ...

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 ...

Core Insights - The "2025 Innovative Drug High-Quality Development Conference" was held in Guangzhou, announcing the 2025 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 [1] Group 1: Drug Catalogs - The first edition of the Commercial Health Insurance Innovative Drug Catalog includes 19 drugs, featuring all five CAR-T tumor therapies priced at over one million [1] - High-profile drugs for Alzheimer's disease treatment and rare diseases have also been included in the catalog, reflecting significant public interest [1] Group 2: Industry Perspectives - Fosun Kerry's Chairman Zhang Wenjie emphasized that the quality of innovative drugs is not only determined by the drugs themselves but also by patient accessibility [1] - The negotiation mechanism for commercial insurance is highlighted as a crucial milestone for the accessibility of innovative drugs in China [1]

Group 1 - The core consensus reached at the forum emphasizes the need for "good drugs," "good policies," and a "good support ecosystem" to address the challenges of Developmental Epileptic Encephalopathy (DEE) [1][2] - DEE is characterized by refractory seizures and developmental stagnation or regression in early childhood, representing a heterogeneous group of severe epilepsy syndromes [1] - The integration of multidisciplinary resources and the establishment of a standardized MDT (multidisciplinary team) model are being pursued to provide one-stop services for affected children [1] Group 2 - The forum highlighted the significant burden on families and society due to severe neurological disabilities left by DEE, calling for increased attention and support from all sectors [2] - The launch of the "Early Screening for Prostate Cancer" public awareness initiative aims to enhance public disease awareness and promote early detection [2] - PSA testing is recommended annually for men over 50 as a primary screening method for prostate cancer, which can significantly improve treatment outcomes [2][3] Group 3 - The importance of public education on early screening and diagnosis was emphasized, with expectations for the prostate cancer screening initiative to reach a broader audience [3] - AstraZeneca has been actively collaborating with various stakeholders to enhance disease awareness and screening practices [3] - Strategic partnerships among Alibaba Health, Eli Lilly, AstraZeneca, and Bayer aim to improve patient education, treatment accessibility, and digital health services [3] Group 4 - Abbott and the National Health Commission's Maternal and Child Health Center signed a memorandum to promote a fertility-friendly society and improve maternal health services [4] - Chronic respiratory diseases pose significant public health challenges in China, with ongoing efforts to advance precision treatment through a better understanding of disease mechanisms [4] - GSK is committed to introducing innovative drugs and standardizing treatment protocols in collaboration with various partners to enhance patient care [4]

Group 1 - The core viewpoint emphasizes that innovative drugs are essential for advancing the medical field, providing new treatment hopes for patients with difficult diseases, and driving the pharmaceutical industry towards higher levels of development [1] - China has prioritized the development of innovative drugs, implementing various policies that have led to significant progress in drug research, development, and market access [1] - The "New 18 Measures" policy, jointly developed by multiple Shanghai government departments, aims to enhance the collaboration between basic medical insurance and commercial insurance, addressing key pain points in innovative drug application and patient payment [1] Group 2 - The development of innovative drugs to better serve patients is a complex and systematic project, with recent policies encouraging the growth of commercial insurance, particularly group insurance, which has a stronger risk-bearing capacity compared to individual insurance [2] - The observation that some innovative drugs may not be included in medical insurance but have entered local benefit insurance programs suggests that the development of commercial health insurance could provide new opportunities for these drugs [2] - A multi-channel approach is proposed to improve drug accessibility, allowing for a combination of medical insurance, commercial insurance, charity, and personal payments to support the costs of innovative drugs [3] Group 3 - In the field of gene and cell therapy, the high costs of treatments, which can reach millions, highlight the need for flexible insurance policies that could share the financial burden between medical insurance and commercial insurance [3] - The successful implementation of innovative drugs requires collaboration across the entire chain, from research and approval to medical insurance and clinical use, indicating the importance of exploring multiple channels to facilitate this process [3]

Core Insights - Breast cancer is the most common malignant tumor threatening women's health in China, with HR+/HER2- subtype accounting for approximately 70% of diagnosed cases [1][3] - The standard first-line treatment for HR+/HER2- advanced breast cancer patients is the combination of CDK4/6 inhibitors and endocrine therapy, although overall 5-year survival is less than 50% due to resistance [1][3] - The PAM pathway (PI3K/AKT/mTOR) mutations are critical in the resistance of HR+/HER2- advanced breast cancer, and targeting this pathway with inhibitors may reverse resistance and improve tumor control [1][4] Treatment Landscape - The 5-year survival rate for early-stage breast cancer can reach over 90%, but about 30% progress to advanced stages, where the survival rate drops to 20% [3] - Innovative targeted therapies, such as AKT and PI3K inhibitors, are emerging to overcome endocrine resistance, significantly enhancing treatment efficacy compared to standard endocrine therapy [4][6] - Genetic testing for PAM pathway alterations is recommended for patients experiencing early recurrence or metastasis to guide personalized treatment [5][6] Economic Considerations - The treatment costs for HR+/HER2- advanced breast cancer patients post-resistance are high, necessitating a multi-tiered healthcare support system [2][6] - China is exploring models of "basic medical insurance as a safety net, with commercial insurance involvement" to alleviate the financial burden on patients [2][6] - Basic medical insurance has been instrumental in improving access to innovative drugs by negotiating prices and reducing out-of-pocket expenses for patients [6][7] Challenges and Solutions - The accessibility of innovative PAM pathway drugs is hindered by high costs and limited inclusion in insurance coverage [6][8] - Balancing drug pricing and patient accessibility is a significant challenge, as high R&D costs must be recouped without compromising patient access [8] - Strategies to enhance accessibility include incorporating innovative drugs into insurance plans and expanding commercial insurance options to reduce patient financial pressure [8]

Group 1 - Meituan's pharmaceutical health division has launched a new insomnia treatment drug, Lemborexant, which is the first approved dual orexin receptor antagonist, providing a new treatment option for adult insomnia patients [1] - The drug is not classified as a controlled substance and has not shown addictive properties since its launch [1] - According to the "2025 China Sleep Health Survey Report," approximately 485 million people in China suffer from sleep issues, highlighting the significant market potential for insomnia treatments [1] Group 2 - Meituan has actively introduced innovative drug products, having launched seven new drugs since last year, including Lemborexant, covering various medical fields such as GLP-1, myopia, gout, and insomnia [2] - The company aims to enhance the accessibility of innovative drugs through its e-commerce platform, allowing patients to order medications conveniently [2]