中新网北京1月7日电(记者 赵方园)"如果没降价，每月打针要花四五千。现在好了，一个月两千左 右。"近期，一位家长分享孩子使用长效生长激素费用大幅下降的经历，引发不少家庭共鸣。这份新年 伊始的实惠，源于新版国家医保药品目录的正式落地。 1月7日，国家医保局对最新版医保药品目录进行解读。本次调整新增药品数量多、创新药占比高，并对 部分药品支付范围进行了优化，旨在更好满足临床急需，保障参保患者用药可及性。 新纳入医保的药物，均是"急患者所需" 1月1日，在广西壮族自治区妇幼保健院，乳腺癌患者用上了刚纳入医保的创新药伊那利塞片；上海交通 大学医学院附属第九人民医院，也开出了治疗甲状腺眼病的新药替妥尤单抗的首张医保处方。 这些"首张处方"的背后，是新版目录整体扩容与降价带来的普惠性利好。本次调整共新增114种药品， 覆盖肿瘤、慢性病、罕见病等多个临床急需领域。通过国家医保谈判，新增药品价格平均降幅超过 60%，显著降低了患者用药负担。 一批备受关注的新药、好药通过此次调整惠及广大患者—— 在肿瘤领域，治疗三阴性乳腺癌的芦康沙妥珠、用于治疗胰腺癌的伊立替康脂质体等创新药被纳入； 在慢病管理方面，一年仅需注射两次的降血脂 ...

新版《国家基本医疗保险、生育保险和工伤保险药品目录(2025年)》(以下简称"基本医保目录")和首版 《商业健康保险创新药品目录(2025年)》(以下简称"商保创新药目录")2026年1月1日起在全国范围内正 式实施。作为首版医保"双目录"，此次基本医保目录成功新增114种药品，商保创新药目录成功纳入19 种药品。 记者梳理发现，除新增多款国内企业创新产品外，2025年国家医保目录中也不乏外资原研明星产品的身 影，比如诺华的英克司兰钠注射液、布西珠单抗注射液，强生的古塞奇尤单抗注射液等。"2025年，诺 华共有2个新产品及4个新适应症成功纳入2025年版国家医保药品目录，这是对我们不懈促进创新药物可 及性的肯定。"诺华中国区总裁兼董事总经理李尧表示，截至目前，公司共有40余款药物被纳入国家医 保目录。 "2025年新纳入医保目录的药品呈3个显著特点：或是填补临床治疗空白，或是同类更优，或是拥有更高 的性价比。"国家医保局医药服务管理司司长黄心宇介绍，比如针对KRAS非小细胞肺癌，国内已上市 的三款KRAS G12C靶向药氟泽雷塞片、格索雷塞片、枸橼酸戈来雷塞片均被纳入新版医保目录，填补 临床治疗空白。 专家在 ...

长沙晚报掌上长沙1月3日讯（全媒体记者 徐媛）新版目录新增114种药品，精准覆盖肿瘤、罕见病等关 键领域，首推的商保创新药目录与基本医保目录形成保障互补……今日，记者从湖南省医保局获悉， 《关于切实做好〈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）落地执行工作的通知》已下发。湖南同步落地执行最新版医保目录，2026年1月1日起全 省统一正式执行，有效期至2026年12月31日。 聚焦临床急需，扩展肿瘤、慢性病等领域 本次国家目录调整，共有114个药品新增纳入目录，29个药品调出目录，部分药品从协议期内调入常规 目录，部分药品增补了规格或调整了限定支付范围。调整后，《2025年药品目录》共收录药品3253个， 其中西药部分1446个，中成药部分1335个（含民族药95个），协议期内谈判药品部分472个（含西药411 个、中成药61个）。另外，基金予以支付的中药饮片为892个。 但商保目录不属于社保体系，不是"政府兜底"，最终能否报销，仍然取决于购买的医疗险具体责任。也 就是说，商保目录对保险机构仅具引导参考意义，不具备强制性，后续将由保险公司结合产品设计自主 纳 ...

新版《国家基本医疗保险、生育保险和工伤保险药品目录(2025年)》(以下简称"基本医保目录")和首版 《商业健康保险创新药品目录(2025年)》(以下简称"商保创新药目录")2026年1月1日起在全国范围内正 式实施。作为首版医保"双目录"，此次基本医保目录成功新增114种药品，商保创新药目录成功纳入19 种药品。 专家在接受经济日报记者采访时表示，国家医保目录的调整始终坚持"真支持创新、支持真创新、支持 差异化创新"的原则，此次"双目录"的协同发布，将有助于满足人民群众多元化、多层次用药需求，破 解高值创新药的可及性难题，为医药企业的研发创新注入强劲动力。 重点领域用药保障扩容 进入医保的114种药品中，有36种肿瘤用药、12种糖尿病等慢性病用药、13种抗感染类药品、10种罕见 病用药等，29种临床用不上或有更好替代的药品被调出目录。本次调整后，国家医保药品目录内药品总 数增至3253种，其中西药1857种、中成药1396种。 "从肿瘤到代谢性疾病，从自体免疫性疾病到罕见病，此次医保目录在病种涵盖方面非常全面。"空军军 医大学唐都医院主任药师刘琳娜表示，创新药特效药的快速落地，化解不少临床痛点，比如以前三阴 ...

新版《国家基本医疗保险、生育保险和工伤保险药品目录（2025年）》（以下简称"基本医保目 录"）和首版《商业健康保险创新药品目录（2025年）》（以下简称"商保创新药目录"）2026年1月1日 起在全国范围内正式实施。作为首版医保"双目录"，此次基本医保目录成功新增114种药品，商保创新 药目录成功纳入19种药品。 专家在接受经济日报记者采访时表示，国家医保目录的调整始终坚持"真支持创新、支持真创新、 支持差异化创新"的原则，此次"双目录"的协同发布，将有助于满足人民群众多元化、多层次用药需 求，破解高值创新药的可及性难题，为医药企业的研发创新注入强劲动力。 重点领域用药保障扩容 进入医保的114种药品中，有36种肿瘤用药、12种糖尿病等慢性病用药、13种抗感染类药品、10种 罕见病用药等，29种临床用不上或有更好替代的药品被调出目录。本次调整后，国家医保药品目录内药 品总数增至3253种，其中西药1857种、中成药1396种。 "从肿瘤到代谢性疾病，从自体免疫性疾病到罕见病，此次医保目录在病种涵盖方面非常全面。"空 军军医大学唐都医院主任药师刘琳娜表示，创新药特效药的快速落地，化解不少临床痛点，比如以前三 ...

国家医保局党组书记、局长章轲介绍，国家医保局已连续8年调整了医保药品目录，包括2025年在内累 计调入949种新药，医保基金为协议期内的谈判药支出超过4600亿元，拉动销售超过6000亿元，有力推 动医药市场"腾笼换鸟"迭代升级。 药品进入医保目录后，什么时候才能在医院开到？针对"进得了目录却进不了医院"这个公众关注的老大 难问题，此次政策打出了一套组合拳。一方面，要求所有定点医疗机构原则上在2026年2月底前召开药 事会，及时将新增药品纳入院内采购目录，必要时设立临时绿色通道；另一方面，再次重申谈判药品不 受"一品两规"、药占比、医保总额等行政性限制影响。此外，政策对使用高值创新药且不适合按病种打 包付费的病例，允许医疗机构申报"特例单议"。 高价值创新药加快落地 新版《国家基本医疗保险、生育保险和工伤保险药品目录（2025年）》（以下简称"基本医保目录"）和 首版《商业健康保险创新药品目录（2025年）》（以下简称"商保创新药目录"）2026年1月1日起在全国 范围内正式实施。作为首版医保"双目录"，此次基本医保目录成功新增114种药品，商保创新药目录成 功纳入19种药品。 专家在接受经济日报记者采访时表 ...

Core Insights - The 2025 National Medical Insurance Drug List has been officially released, adding 114 new drugs, including 50 innovative Class 1 drugs, with a negotiation success rate of 88%, the highest in seven years [1][3] - The first version of the commercial insurance innovative drug list has been introduced, featuring 5 CAR-T cell therapies and 19 high-priced innovative drugs, marking a significant expansion in coverage [1][5] - The adjustment reflects a strategic upgrade in China's medical insurance from "basic coverage" to "basic + high-end coverage," addressing the demand for accessible and affordable innovative drugs [1][9] Drug Additions and Market Impact - The new drug list includes 114 drugs, with 44% being Class 1 innovative drugs, and a total of 3,253 drugs now covered under the insurance [3] - Notable winners include Heng Rui Pharma, which secured 20 new drug approvals, and Eli Lilly, whose drug Tirzepatide has entered the Chinese market, benefiting 140 million diabetes patients [3][4] - The inclusion of CAR-T therapies in the commercial insurance list allows for reimbursement of high-cost treatments, which were previously inaccessible to many patients [5][7] Innovations in Treatment - The new list includes significant advancements in treatments for Alzheimer's disease, with two new drugs targeting amyloid beta accumulation, providing options for over 10 million patients in China [7] - The addition of 13 rare disease drugs fills coverage gaps in four rare disease areas, expanding the total number of rare disease drugs covered to approximately 100 [8] - The adjustment also emphasizes pediatric medications, with a separate review channel for children's formulations, indicating a positive shift in addressing children's healthcare needs [9] Strategic Implications - The 2025 adjustment signifies a shift towards a dual-track medical payment system in China, combining basic medical insurance with commercial insurance to meet both fundamental and advanced healthcare needs [9] - The rapid inclusion of innovative drugs into the insurance system reflects a decade of progress in China's pharmaceutical landscape, transitioning from rare domestic innovations to a robust pipeline of new therapies [9]

行 业 及 产 业 海外消费服务 行 业 研 究 / 行 业 点 评 相关研究 证 券 研 究 报 告 证券分析师 黄哲 A0230513030001 huangzhe@swsresearch.com 周文远 A0230518110003 zhouwy@swsresearch.com 贾梦迪 A0230520010002 jiamd@swsresearch.com 研究支持 胡梦婷 A0230524060004 humt@swsresearch.com 联系人 胡梦婷 A0230524060004 humt@swsresearch.com 2025 年 12 月 12 日 海外医药：2025 年国家医保目录及首版商保创新药目录 发布，复星医药子公司口服 GLP-1 药物授权辉瑞 - 看好 ——海外消费周报（20251205-20251211） 本期投资提示： ⚫ 海外医药：2025 年国家医保目录及首版商保创新药目录发布，复星医药子公司口服 GLP-1 药物授权辉瑞 2025 年国家医保目录及首版商保创新药目录发布：12 月 7 日，国家医保局和人力资源社会保障部发布《国家基 本医疗保险、生育保险和工伤保险药 ...

Group 1 - The new National Medical Insurance Drug List includes 114 new drugs, increasing the total number of drugs to 3,253, with 1,857 Western medicines and 1,396 traditional Chinese medicines [1] - The inclusion of 50 innovative drugs marks a historical high, featuring several "global first" and "first domestic" products, enhancing access to breakthrough therapies for patients [1] - Notable multinational pharmaceutical companies like Novartis and Johnson & Johnson have successfully included multiple new products and indications in the updated insurance list, benefiting a large number of patients [1][2] Group 2 - Domestic pharmaceutical company Heng Rui has 11 anti-tumor products included in the new insurance list, showcasing significant innovations and new indications [2] - Innovative drugs filling gaps in basic medical insurance coverage include Sanofi's anti-CD38 monoclonal antibody and Hansoh Pharmaceutical's third-generation EGFR-targeted drug, both of which offer new treatment standards for critical diseases [3] - Since the establishment of the National Medical Insurance Bureau in 2018, a total of 949 new drugs have been added to the insurance list, significantly boosting the pharmaceutical market and enhancing the clinical medication level in China [4]

Core Insights - The National Healthcare Security Administration (NHSA) held a conference on December 9, 2023, to discuss the 2025 Medical Insurance Drug List, attracting significant interest from various stakeholders, including over 23,000 online viewers [1][6]. Group 1: Drug List Adjustments - The basic medical insurance fund, exceeding 3 trillion yuan, is directly linked to the annual release of the National Medical Insurance Drug List [6]. - In 2025, 114 new drugs were added to the basic medical insurance list, with 111 being new drugs launched within the last five years, marking a record high in both proportion and quantity [7]. - The adjustment process for the drug list has become clearer, with specific phases for preparation, application, review, and negotiation [7]. Group 2: Misunderstandings in Drug Pricing - There are misconceptions regarding the negotiation process, particularly the belief that all drugs must reduce prices upon renewal; only 30 out of 178 drugs negotiated for renewal experienced an average price drop of 13.8% [8]. - The average price reduction for the 15 drugs that were renewed was only 8.4% [8]. Group 3: Commercial Health Insurance Innovations - The NHSA introduced the first Commercial Health Insurance Innovative Drug List, which involves a more complex review process, including a re-evaluation by a specialized expert group [9]. - Certain drugs, while deemed valuable by basic medical insurance experts, were not included in the commercial insurance list due to concerns over their insurability and management difficulties [10]. Group 4: Challenges in Implementation - The NHSA aims to leverage the "three exclusions" policy to facilitate drug inclusion in hospitals and encourage the design of insurance products targeting the innovative drug list [11]. - There are significant challenges in aligning commercial insurance products with the innovative drug list, including low efficiency in claims processing and insufficient coverage [12]. Group 5: Differentiated Innovation in Pharmaceuticals - The NHSA emphasizes the need for differentiated innovation in pharmaceuticals, urging companies to provide robust evidence, such as head-to-head clinical trial data, to support claims of being "best in class" [15][16]. - The selection of reference drugs for economic evaluation is crucial, requiring a comprehensive approach that considers multiple dimensions of comparison [16][17].