证券研究报告 商业医疗险报告三： 探索受益于商业医疗险发展的细分赛道 生物医药行业 强于大市（维持） 证券分析师 叶寅 投资咨询资格编号:S1060514100001 邮箱：YEYIN757@PINGAN.COM.CN 倪亦道 投资咨询资格编号:S1060518070001 邮箱：NIYIDAO242@PINGAN.COM.CN 王钰畅 投资咨询资格编号:S1060524090001 邮箱：WANGYUCHANG804@PINGAN.COM.CN 2025年12月3日 请务必阅读正文后免责条款 行业观点 2 政策利好医疗险发展，资金增量具备潜力。2009年以来政策持续支持建立多层次医疗保障体系，发展商业健康险，同时自2020年以 来持续推动医保数据与商保共享，2024年底会议明确医保数据与商保公司进行合作，数据共享进入落地阶段。 《商业医疗险报告二： 他山之石，辩证看待美国健康管理医疗模式》通过分析商业医疗险面临问题以及梳理美国管理式医疗模式，认为若实现医保数据共 享，从需求端看在带病体、老年群体投保方面，从供给端看在特药保障范围、免赔额设置等方面将有改善，此外，我们认为支持商 业医疗发展政策将持续推进，或有 ...

Group 1 - The establishment of a "Commercial Health Insurance Innovative Drug Directory" aims to address the payment challenges for high-priced innovative drugs outside of basic medical insurance [1][2][3] - The new policy signals a shift in the role of commercial insurance in supporting innovative drug payments, creating a multi-tiered medical security system [2][4] - The commercial health insurance sector is expected to develop specialized insurance products to support innovative drug payments, leveraging standardized drug lists and pricing mechanisms [3][4] Group 2 - The current basic medical insurance system has limitations in funding, particularly for high-cost treatments like CAR-T therapy, which can exceed one million yuan [4][5] - Commercial health insurance has a small market share in innovative drug payments, with only 7.7% of the innovative drug market being covered by commercial health insurance expenditures [5][6] - The "Hui Min Bao" program has made significant contributions to innovative drug payments, but its compensation for innovative drugs remains low compared to the overall market size [6][5] Group 3 - The implementation of the new policy presents challenges for insurance companies, including directory management, payment negotiations, cost impacts, risk control, and market education [7][8] - A robust evaluation system is necessary for assessing the clinical value and cost-effectiveness of innovative drugs, which poses a significant challenge for insurers [7][8] - The lack of historical data and the need for effective risk management strategies complicate the pricing and compensation models for innovative drugs [9][10] Group 4 - Data sharing between basic medical insurance and commercial health insurance is crucial for enhancing the effectiveness of innovative drug payment systems [11][13] - The development of specialized data interfaces and standardized coding for diseases and drugs is recommended to facilitate better collaboration between insurance sectors [14][13] - The focus on improving data collaboration can lead to more precise product development and risk management in the commercial health insurance market [13][14]