Core Viewpoint - The National Healthcare Security Administration and the Ministry of Human Resources and Social Security have issued new guidelines for the integration of commercial health insurance with the national basic medical insurance system, focusing on innovative drugs and their accessibility for patients [1][2] Group 1: Policy Implementation - Provincial healthcare security departments are required to implement the measures outlined in the notification regarding the support for high-quality development of innovative drugs [1] - The commercial health insurance directory for innovative drugs will not be covered by the medical insurance fund and will not be included in the self-pay rate indicators for designated medical institutions [1] Group 2: Support for Innovative Drugs - The application cases of innovative drugs listed in the commercial health insurance directory will not be included in the payment scope under the disease-based payment system, but can be reimbursed after review [1] - Provincial departments may explore the support for retail pharmacies to stock innovative drugs from the commercial health insurance directory and monitor pricing at medical institutions and retail pharmacies [1] Group 3: Multi-layered Medical Security System - Local healthcare departments are encouraged to promote the construction of a multi-layered medical security system and support the development of inclusive commercial health insurance [2] - Commercial insurance institutions are encouraged to design new products and adjust compensation methods based on the commercial health insurance directory to better meet patient medication needs [2]

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]