Core Viewpoint - The National Healthcare Security Administration (NHSA) has announced the preliminary review results for the 2025 National Basic Medical Insurance, Maternity Insurance, and Work Injury Insurance drug catalog, with 534 drugs passing the initial review for basic insurance and 121 innovative drugs for commercial health insurance [1][2] Summary by Sections Commercial Health Insurance Innovative Drug Directory - The commercial health insurance innovative drug directory is voluntary for pharmaceutical companies and insurance firms, meaning that the success of negotiations remains uncertain [3][4] - The directory aims to include innovative drugs that exceed the basic insurance coverage, focusing on high clinical value and significant patient benefits [5][6] Market Dynamics and Drug Coverage - The directory primarily covers unmet needs in areas such as oncology, rare diseases, and chronic conditions, with several CAR-T therapies included [6][7] - The inclusion of domestic pharmaceutical products has increased, enhancing the controllability of the drug supply chain [6][7] Challenges in Implementation - The process from preliminary review to final inclusion in the directory involves multiple steps, including expert evaluation and price negotiations, which introduces uncertainty [9][11] - Concerns exist regarding the balance between patient accessibility and the sustainability of insurance companies, particularly regarding the definition of coverage limits and risk management [10][11] Impact on Insurance Products - The innovative drug directory is expected to stimulate discussions on product innovation within the insurance industry, encouraging companies to optimize their product strategies based on the directory [13][14] - Insurance companies are advised to design products that cater to different consumer capabilities, enhancing the appeal of high-end medical insurance [14][15] Future Market Potential - The innovative drug market in China is projected to reach 1 trillion yuan by 2035, with commercial health insurance expected to cover a significant portion of this market [16][17] - The NHSA's recent measures aim to establish a multi-layered payment system for innovative drugs, enhancing their accessibility and reducing the financial burden on patients [17][18]

Core Insights - The National Healthcare Security Administration (NHSA) has announced the preliminary review results for the 2025 National Basic Medical Insurance, Maternity Insurance, and Work Injury Insurance drug catalog, with 534 drugs passing the initial review for basic insurance and 121 innovative drugs for commercial health insurance [1][3] - The commercial health insurance innovative drug catalog aims to include high-value innovative drugs that are not covered by basic insurance, focusing on areas such as oncology and rare diseases [4][15] - The process for drugs to be included in the commercial health insurance catalog involves multiple steps, including expert review and price negotiations, which introduces uncertainty regarding the final inclusion of these drugs [7][10] Industry Dynamics - The NHSA's new policies are seen as a significant step towards creating a multi-layered payment system for innovative drugs, addressing the historical challenges of insufficient insurance coverage and high out-of-pocket costs for patients [15][16] - The commercial health insurance sector is expected to play a crucial role in expanding access to innovative drugs, with the potential to cover a larger patient base and enhance the financial viability of drug companies [17] - The introduction of the commercial health insurance innovative drug catalog is anticipated to stimulate product innovation within the insurance industry, as companies adapt their offerings to meet the needs of patients seeking coverage for high-cost medications [11][12] Market Opportunities - The innovative drug market in China is projected to reach 1 trillion yuan by 2035, with commercial health insurance expected to cover 44% of this market, translating to approximately 440 billion yuan [14][15] - The inclusion of domestic drug companies in the innovative drug catalog is increasing, which may enhance the stability of the drug supply chain and improve pricing negotiations [4][16] - The potential for specialized insurance products targeting high-net-worth individuals seeking coverage for innovative drugs is growing, as insurers look to differentiate their offerings in a competitive market [12][13]

Core Insights - The National Healthcare Security Administration (NHSA) and the National Health Commission have introduced measures to support the high-quality development of innovative drugs in China, focusing on five key areas with 16 specific initiatives aimed at enhancing the R&D and accessibility of innovative drugs [1][2] Group 1: Policy Measures - The measures emphasize strengthening support for innovative drug R&D, facilitating their entry into the medical insurance catalog, and encouraging clinical application [1] - A multi-channel payment system for innovative drugs is being established, which includes regular adjustments to the medical insurance catalog and the introduction of a commercial health insurance catalog for innovative drugs [1][2] - The initiatives aim to enhance the accessibility of innovative drugs by proposing actionable policies across various stages, including listing, hospitalization, payment, and distribution [2] Group 2: Financial Impact - As of the end of May, the expenditure on negotiated drugs under the medical insurance fund reached 4.1 trillion yuan, driving drug sales to exceed 6 trillion yuan [2] - In 2024, the original insurance premium income for commercial health insurance is projected to reach 977.3 billion yuan, reflecting an 8.2% year-on-year growth, indicating a significant funding scale approaching that of resident medical insurance [2] - Despite the growth in commercial health insurance, there remains substantial room for improvement in its coverage and effectiveness compared to the over 95% utilization rate of basic medical insurance [2]

Core Insights - The article discusses the recent measures introduced by the National Healthcare Security Administration (NHSA) and the National Health Commission (NHC) to support the development of innovative drugs in China, focusing on policy support and pricing guarantees for companies while ensuring accessibility and safety for the public [1][2]. Group 1: Policy Measures - The "Several Measures to Support the High-Quality Development of Innovative Drugs" includes 16 measures across five areas, addressing the entire chain of innovative drug development, approval, hospital use, and multi-channel payment [1]. - The NHSA has made significant progress in the approval of innovative drugs, with the number of Class 1 innovative drugs approved reaching 48 in 2024, over five times the number in 2018, and nearly 40 already in the first half of this year [1]. Group 2: Multi-Payment System - The NHSA is establishing a multi-payment system for innovative drugs, which includes regular adjustments to the medical insurance drug list and the introduction of a commercial health insurance innovative drug list [2][3]. - The commercial health insurance innovative drug list will focus on highly innovative drugs with significant clinical value that exceed the basic medical insurance coverage, enhancing the multi-layered medical security system [2]. Group 3: Market Dynamics - The commercial health insurance market in China has been growing rapidly, with the original insurance premium income for commercial health insurance reaching 977.3 billion yuan in 2024, a year-on-year increase of 8.2% [3]. - The NHSA aims to streamline the application process for innovative drugs to be included in both the medical insurance and commercial health insurance lists, reducing the administrative burden on companies [3][4]. Group 4: Support for Global Expansion - The measures also aim to support the global market development of Chinese innovative drugs, with over 90 overseas licensing transactions completed by Chinese pharmaceutical companies in 2024, totaling over 50 billion USD [6]. - The NHSA will facilitate the entry of domestic drugs into ASEAN countries and support innovative drugs in overseas markets, including the implementation of price confidentiality for certain drugs [6][7].

Group 1 - The development of innovative pharmaceutical companies shows positive signals, with some profitable companies experiencing significant revenue growth, while losses for unprofitable companies are narrowing [1] - In Q1 2023, Dizhi Pharmaceutical achieved revenue of 160 million yuan, a year-on-year increase of 96.32%, primarily due to the inclusion of core products in the new national medical insurance catalog [1] - The Chinese medical insurance department is supporting the development of innovative drugs with unprecedented efforts, but balancing the needs of insured individuals, the insurance fund, and companies' returns remains a critical challenge [1][2] Group 2 - Since 2018, the efficiency of including new drugs in the medical insurance catalog has significantly improved, with a success rate of over 90% for innovative drugs during negotiations [2][3] - The average price reduction for newly added drugs outside the catalog has exceeded 50%, impacting the profit margins of innovative drug companies [3] - The market size for innovative drugs and devices in China is expected to reach 162 billion yuan in 2024, with medical insurance fund expenditures accounting for approximately 44% [3] Group 3 - The traditional single-payer market environment poses challenges for the commercialization of innovative drugs, necessitating a multi-payer system that includes commercial insurance [4][5] - The introduction of a class B drug catalog aims to include high-innovation drugs that cannot be covered by basic medical insurance, enhancing the payment structure [5][6] - Pilot programs in cities like Guangzhou are testing commercial insurance products that cover innovative drugs, indicating a shift towards a multi-channel payment system [6] Group 4 - The commercial health insurance sector currently accounts for only 7.7% of the innovative drug market, indicating a need for further collaboration to enhance the multi-payer mechanism [6][7] - The future competitiveness of innovative drugs will depend not only on R&D capabilities but also on the expansion of payment mechanisms and the construction of a health ecosystem [7][8] - The integration of AI in insurance product design and claims processes is expected to optimize risk management and improve patient access to innovative treatments [7][9]