Core Insights - The National Healthcare Security Administration (NHSA) is seeking public input on trial guidelines for the comprehensive value assessment of medical services and drugs based on real-world data, aiming to establish a unified national evaluation system [1][2] - The traditional pricing and payment methods for medical services have relied on application materials, expert reviews, and historical data, which are inadequate for assessing the efficacy, safety, and cost-effectiveness of innovative technologies like cell therapy and AI-assisted diagnostics [1] - The new evaluation system will focus on real-world data from daily clinical practices, electronic medical records, insurance settlement records, and follow-up results to provide reliable evidence for healthcare decision-making [1] Evaluation Focus - The new system will evaluate various types of drugs, including innovative drugs, generic drugs, and those with insufficient evidence for combination therapies, as well as high-cost drugs that significantly consume healthcare funds [1] - It will also assess drugs with questionable efficacy or safety, off-label use drugs that are clinically necessary, and high-priced drugs that struggle to compete in centralized procurement [1] Implementation Timeline - Pilot programs for the new evaluation system have already been initiated in Beijing and other regions in 2025 [2] - By 2026, pilot areas will establish databases and undertake specific evaluation tasks [2] - The evaluation results will be prioritized as supporting evidence for healthcare decision-making in pilot regions starting in 2027 [2]

Core Viewpoint - The National Healthcare Security Administration emphasizes the need for scientific development of medical insurance by 2026, aiming to enhance new productive forces and establish a comprehensive digital platform for universal healthcare [1] Group 1: Policy Initiatives - The meeting calls for the establishment of a comprehensive value assessment system for medical insurance, utilizing real-world evidence as a key decision-making basis for the entry, dynamic management, removal, and project initiation of medical products [1] - There is a push for broad participation from medical institutions, pharmaceutical companies, and research organizations in advancing artificial intelligence in the healthcare insurance sector [1] Group 2: Technological Development - The initiative includes support for local governments willing to conduct scenario validation competitions related to the development of artificial intelligence in the medical insurance field [1]

Core Viewpoint - The future value-based purchasing of medical insurance will focus on the real-world effectiveness of innovative drugs and devices rather than solely on laboratory data provided at the time of market entry [1][2]. Group 1: Policy and Evaluation Framework - The National Healthcare Security Administration (NHSA) is implementing a comprehensive value evaluation for innovative drugs and devices as part of new policies to support high-quality development [1][3]. - The NHSA is conducting a series of discussions to gather insights on how real-world data can serve the comprehensive value evaluation of drugs and devices [1][2]. - A systematic and complete evaluation framework is needed to scientifically assess the comprehensive value of medical products, addressing issues such as where funds are allocated and whether expenditures are justified [2][3]. Group 2: Stages of Value Evaluation - The comprehensive value evaluation of drugs will occur in three stages: pre-market, post-market before insurance entry, and post-insurance entry [2][3]. - Pre-market evaluation will involve collecting clinical data for drugs not yet available in the domestic market but used in specific regions, serving as a basis for market entry and insurance inclusion [2]. - Post-market evaluation will assess drugs based on safety, efficacy, economic viability, equity, accessibility, and innovation, comparing them with similar products to determine insurance inclusion [3]. Group 3: Implications for the Industry - The establishment of a comprehensive value evaluation system is expected to avoid internal competition among innovations and guide the rational allocation of medical resources [4][5]. - The NHSA's initiative signals a shift from a low-price strategy to a more value-based approach in determining insurance payment standards for innovative drugs [3][5]. - Collaboration opportunities may arise for commercial health insurance companies in areas such as innovative drug directories and one-stop settlement with basic medical insurance [5].