为此，国家医保局拟建立以"真实世界数据"为核心依据的医疗服务评价新体系。这些数据来源于日常诊 疗实践、电子病历、医保结算记录、药品使用信息及随访结果等，能反映技术在普通患者和常规医疗条 件下的真实表现，将其转化为科学可靠的"真实世界证据"，可为医保决策提供更贴近临床实践的依据。 在药品方面，新体系将重点评价多类药品，包括创新药、仿制药、证据不足的联合用药、"天价药"或医 保基金消耗较大的药品、有效性或安全性受质疑的药品、临床确有需要但"超说明书"使用的药品，以及 价格偏高且难以通过集采竞争的医保目录内药品等。 国家医保局已于2025年在北京市等地启动了相关试点工作。2026年各试点地区将建设数据库，并承担具 体评价任务。2027年评价成果将优先作为试点地区医保决策的支撑证据。 （来源：千龙网） 国家医保局近期就医疗服务、药品真实世界医保综合价值评价管理的试行指南，向社会公开征求意见， 旨在加快建立全国统一的真实世界医保综合价值评价体系，利用真实诊疗数据为医药产品与服务"精准 画像"，促进医保基金更合理使用。 长期以来，医保对医疗服务项目的定价与支付主要依赖申报材料、专家评议及历史经验数据。随着细胞 治疗、人工 ...

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].