在过去的十年里，中国创新药支付几乎依赖医保一条腿走路。健睿康诺咨询业务负责人黄东临指出，尽 管我国建成了覆盖14亿人的全民医保体系，但基本医保体系保障有限，难以负担高价创新药。破解之道 在于构建"多方风险共担、数据互联互通、支付工具创新"的可持续生态圈，其中商保是撬动生态的关键 支点，而政府需在政策设计、数据开放与跨部门协作中发挥核心作用。 政策红利的释放，推动各类支付工具加速涌现，惠民保、商业保险、慈善赠药及药企共付等创新支付工 具已逐步形成多元供给格局。其中，惠民保以其低门槛、广覆盖的特点，成为许多患者补充保障的选 择，通过将部分创新药纳入保障范围，减轻患者用药压力。商业健康保险作为重要补充，通过开发针对 性产品，试图为患者提供更全面保障。慈善赠药项目则聚焦贫困患者，通过药企捐赠、公益组织运作的 模式为困境中的患者免费提供药品援助。药企共付则通过引入疗效保险、分期付款等多样化的创新形 态，从支付节奏、风险分担等维度，为患者减轻即时经济压力。 然而，多元支付体系在实践中仍面临碎片化难题。患者往往需要在不同渠道、不同机构间奔波，了解、 申请各项支付福利，流程繁琐复杂。不同支付工具之间缺乏有效协同，无法形成强大 ...

Core Insights - The core viewpoint of the articles is that commercial health insurance is increasingly incorporating high-value innovative drugs into their coverage, responding to the gaps in basic medical insurance and the evolving healthcare needs of consumers [1][2][3]. Group 1: Market Trends - Insurance companies are launching new products and upgrading existing ones to include innovative drugs, driven by the demand for advanced medical resources [1][3]. - The recent upgrades in health insurance products are a response to the national healthcare reform aimed at providing basic coverage while addressing the diverse medical needs of residents [3][4]. Group 2: Payment Structure - The current payment structure for innovative drugs is imbalanced, with basic medical insurance covering only a fraction of the costs, leading to a significant burden on patients [3][4]. - In 2024, the innovative drug market is expected to reach 162 billion yuan, with basic medical insurance covering approximately 710 billion yuan (44%), while personal cash payments account for about 786 billion yuan (49%), and commercial health insurance only contributes around 124 billion yuan (7.7%) [3]. Group 3: Challenges and Solutions - The commercial health insurance sector faces challenges in balancing the risk of claims with the need for high coverage of innovative therapies [6][7]. - To mitigate risks, insurance companies are employing big data modeling and dynamic risk assessment, setting parameters like deductibles and reimbursement ratios, and establishing reinsurance mechanisms [6][7]. Group 4: Accessibility Issues - Despite the increased coverage of innovative drugs, patients may still encounter barriers to access, such as hospitals prioritizing drugs listed in the basic medical insurance directory [8][9]. - Solutions proposed include creating a direct payment network with pharmacies, real-time monitoring of drug availability, and simplifying the claims process for patients needing urgent access to innovative therapies [9].