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 ...

Group 1 - The core viewpoint of the articles highlights the urgent need for reform in the payment system for innovative drugs in China, particularly in light of the high costs associated with treatments like CAR-T therapy [1][5][6] - Since the reform of the drug review and approval system in 2015, the Chinese innovative drug industry has experienced explosive growth, with a significant increase in the number of new drug approvals and faster market entry [1][5] - By 2023, over 90% of the "Hui Min Bao" (a type of commercial health insurance) included special drug coverage, indicating a shift in the insurance landscape towards accommodating high-cost innovative therapies [2][3] Group 2 - The "Sui Xin Bao" series of products launched in Guangzhou represents a significant step in integrating innovative drugs into commercial health insurance, breaking traditional limitations and facilitating one-stop settlement with medical insurance [3][4] - The commercial health insurance market is evolving, with many insurers upgrading special drug coverage from an optional add-on to a core component of their policies [3][4] - The projected sales of innovative drugs in 2024 are expected to reach 162 billion yuan, with a significant portion of costs still borne by patients, highlighting the need for a more balanced payment structure involving commercial health insurance [5][7] Group 3 - The recent policy initiatives emphasize the importance of a multi-tiered medical insurance system, positioning commercial health insurance as a crucial pillar for supporting innovative drug payments [2][6] - The integration of insurance and medical services is becoming a competitive focus, with innovations like "one-code direct payment" aiming to streamline the payment process for patients [6][7] - If the patient self-payment ratio can be reduced from 49% to 20%, the share of commercial health insurance in the innovative drug market could rise significantly, potentially exceeding 440 billion yuan by 2035 [7]