Core Viewpoint - The release of the 2025 National Medical Insurance Drug List and the first version of the Commercial Insurance Innovative Drug List marks a significant step in the construction of a multi-tiered medical security system, balancing basic healthcare coverage with diverse options [1] Group 1: Dual Directory System - The introduction of the "dual directory" system signifies a collaborative approach between basic medical insurance and commercial insurance, ensuring that essential medications are covered while also allowing for the inclusion of high-value innovative drugs [1] - This system adheres to the principle of "basic insurance for basic needs," preventing high-priced drugs from overwhelming the insurance fund [1] Group 2: Future Directions - Future efforts are needed to break down data barriers between basic medical insurance and commercial insurance, aiming to establish a one-stop settlement system for "medical insurance + commercial insurance" [1] - Continuous exploration and optimization by relevant departments are essential to enhance the roles of medical insurance as a safety net and commercial insurance as an expansion tool, ultimately improving health security for over 1.4 billion people [1]

Core Viewpoint - The article discusses the recent update of China's National Medical Insurance Drug List, which includes 114 new drugs, highlighting the introduction of a commercial health insurance innovative drug directory alongside the basic insurance list, aiming to enhance patient access to innovative treatments and address gaps in drug coverage [6][13]. Group 1: New Drugs in the National Medical Insurance Directory - A total of 114 new drugs have been added to the directory, covering various treatment areas including 36 for tumors, 12 for chronic diseases, and 10 for rare diseases, with the number of class 1 new drugs increasing from 38 to 50, setting a new historical high [6][7]. - Notable "star drugs" include LuKangsa Tazhu (for tumors), Fluorazirase tablets, and Spilumab (for specific dermatitis), which will benefit a wide range of patients, including those with triple-negative breast cancer and chronic sinusitis [7][8]. Group 2: Financial Impact on Patients - The average price reduction for negotiated drugs has historically been around 60%, with 112 out of 127 drugs successfully negotiated this year, resulting in significant cost savings for patients [9]. - The introduction of Spilumab, priced at around 1,000 yuan per injection, is expected to significantly lower the financial burden on patients, making innovative treatments more accessible [9]. Group 3: Implementation Challenges - There are concerns regarding the "last mile" issue in drug availability at hospitals, as many negotiated drugs are still provided through external pharmacies, and hospitals may hesitate to prescribe these due to cost concerns [10][11]. - The new regulations require that hospitals must not limit the availability of negotiated drugs based on overall budget constraints, ensuring that these drugs are accessible to patients [11]. Group 4: Changes in the Drug Directory - This year, 29 drugs were removed from the directory due to being replaced or not produced, with a total of 467 drugs removed over the past eight years for similar reasons [12]. - A six-month transition period has been established for patients using drugs that are not renewed in the directory, ensuring continuity of care [12]. Group 5: Commercial Health Insurance Innovative Drug Directory - The newly established commercial health insurance innovative drug directory includes 19 drugs, focusing on high-value innovative treatments that cannot be covered by the basic insurance directory [13][15]. - The drugs in this directory are characterized by high innovation, significant clinical value, and the need for diverse payment options, with 50% being class 1 new drugs [15]. Group 6: Benefits for Patients - The commercial health insurance directory aims to provide a curated list of high-quality drugs, reducing the selection burden for insurance companies and potentially lowering costs for patients through reduced premiums or increased reimbursement rates [16]. - The integration of the commercial insurance directory with existing medical insurance systems is being explored to enhance patient experience and access to innovative treatments [16]. Group 7: Future Prospects and Challenges - The implementation of the commercial health insurance innovative drug directory is dependent on market mechanisms, with insurance companies determining the usage and timing of these drugs [19]. - Emphasis on actuarial pricing and collaboration between insurance companies and pharmaceutical firms is crucial for the sustainable rollout of these innovative drugs [19].

Core Insights - The release of the 2025 National Medical Insurance Drug List and the first version of the Commercial Insurance Innovative Drug List marks a significant step in the construction of a multi-tiered medical security system, enhancing the accessibility of essential medications while diversifying options for patients [1] Group 1: National Medical Insurance Drug List - The updated National Medical Insurance Drug List includes 114 new drugs, significantly improving coverage for key areas such as cancer, chronic diseases, mental health, rare diseases, and pediatric medications [1] - The approach of combining basic medical insurance with commercial insurance reflects the government's commitment to improving drug accessibility for the public and addressing diverse medication needs [1] Group 2: Commercial Insurance Innovative Drug List - The first version of the Commercial Insurance Innovative Drug List includes 19 drugs, primarily those with high innovation and clinical value [1] - The dual-list system aims to balance the principles of basic insurance coverage while providing a pathway for high-value innovative drugs, thus encouraging pharmaceutical companies to invest in research and development [1] Group 3: Benefits of the Dual-List System - The implementation of the dual-list system is expected to create a win-win situation for multiple stakeholders, allowing patients to reduce their economic burden through commercial insurance reimbursement for certain medical expenses [1] - Drugs included in the Commercial Insurance Innovative Drug List can benefit from support policies for hospitalization, while commercial insurance can increase enrollment rates by including these innovative drugs [1] Group 4: Future Considerations - Future efforts are needed to break down data barriers between basic medical insurance and commercial insurance, establishing a one-stop settlement system to better leverage the roles of basic insurance and commercial insurance [2]