经济观察网2月12日，北京市医疗保障局等部门印发《北京市支持商业健康保险高质量发展的若干措 施》。其中提出，支持创新药械临床应用。支持商保创新药通过绿色通道快速挂网，不计入基本医保自 费率指标和集采中选可替代品种监测范围。不得以医疗机构用药目录数量、药占比等为由影响商保创新 药配备使用。商保创新药可不受"一品两规"限制，探索通过"双通道"机制在定点医疗机构或协议药店保 障供应。对符合条件的新药新技术费用，不计入DRG病组支付标准，单独支付；商保创新药应用病例 可不纳入医保按病组付费范围，经审核评议程序后支付。 ...

Core Viewpoint - The article discusses the implementation and sales performance of the newly established commercial insurance innovative drug directory, highlighting the concentration of sales in major cities and the challenges faced in expanding access to these drugs across the country [3][7]. Summary by Sections Sales Performance of New Drug Directories - As of January 20, 2026, 99 new drugs from the basic medical insurance directory have been sold in 12,198 designated medical institutions, while 14 drugs from the commercial insurance innovative drug directory have been sold in 223 institutions [3][4]. - Over 70% of the commercial insurance innovative drugs have recorded sales, with Alzheimer's disease treatments showing the highest penetration in the hospital market [4][5]. Specific Drug Sales Insights - The drug Lecanemab, developed by Eisai, has been sold in 158 institutions, while Eli Lilly's Donanemab has been recorded in 46 institutions [4]. - The number of patients with mild cognitive impairment or mild dementia due to Alzheimer's disease in China is projected to reach 17 million by 2024, indicating a broad patient base for these treatments [5]. Challenges in Rare Disease Drug Sales - Rare disease drugs face challenges due to their limited patient populations and the concentration of prescriptions in specialized hospitals, resulting in sparse sales data [5][6]. - For instance, Takeda's drug for short bowel syndrome has only been sold in one designated pharmacy in Shenzhen this year [5]. Market Access and Policy Implications - Five innovative drugs have yet to achieve sales in designated medical institutions, including CAR-T products priced between 990,000 to 1.3 million yuan per injection [6]. - The National Healthcare Security Administration has implemented a "three exclusions" policy to facilitate the entry of high-cost drugs into hospitals, but the transition from "entry" to "sales" remains complex due to various factors [6][7]. Regional Disparities in Sales - Sales of commercial insurance innovative drugs are still concentrated in major provinces like Beijing, Shanghai, Jiangsu, and Guangdong, with retail pharmacies accounting for less than 10% of sales [7][8]. - Some regions, such as Guangdong and Chongqing, have begun to support the prescription flow of commercial insurance innovative drugs, but broader implementation is needed [8].

Core Insights - The sales of commercial insurance innovative drugs remain concentrated in public hospitals in a few provinces such as Beijing and Shanghai, with a low proportion of sales through pharmacies [1][5] - As of January 20, 2023, 99 new basic medical insurance drugs were sold in 12,198 designated medical institutions, while 14 commercial insurance innovative drugs were sold in 223 institutions [1][5] Group 1: Sales Data and Trends - Over 70% of commercial insurance innovative drugs have recorded sales, but the specific sales performance varies among the 14 drugs [2] - Alzheimer's disease treatment drugs have the highest penetration in the hospital market, with drugs like Lecanemab and Donanemab achieving sales in 158 and 46 institutions respectively [2] - Multiple anti-tumor drugs are also penetrating the hospital market, with drugs like Ipilimumab and Lurbinectedin being sold in 35 and over 10 institutions respectively [2] Group 2: Challenges and Market Dynamics - Five innovative drugs have not yet formed sales in designated medical institutions, including CAR-T products priced between 990,000 to 1,300,000 yuan per injection [3] - The lack of sales does not imply that these drugs are not benefiting from the supportive policies for commercial insurance innovative drugs [3] - The transition from "hospital entry" to "sales" involves several factors, including physician prescriptions and patient payments, which may hinder the sales volume of these drugs [3] Group 3: Policy and Implementation - Most provinces have clarified that the entry of commercial insurance innovative drugs into hospitals will follow the guidelines of "nationally negotiated drugs" [4] - There is a push for the inclusion of all 19 drugs in the commercial insurance innovative drug directory into the procurement lists of hospitals, which may improve access for patients [4] - The integration of commercial insurance innovative drugs with the dual-channel policy of medical insurance is essential for enhancing confidence in the allocation of these drugs in hospitals [5]

Core Viewpoint - The article discusses the implementation of the first commercial insurance innovative drug directory in China, highlighting the challenges and opportunities for innovative drugs to enter hospitals and outpatient settings under the new policies [3][4][6]. Group 1: Policy Implementation and Impact - The "three exclusions" policy allows innovative drugs included in the commercial insurance directory to be billed separately for inpatient cases, not affecting the bundled payment limits [3][6]. - As of January 8, at least 28 provinces have issued notifications regarding the execution of the national drug directory and the commercial insurance innovative drug directory [6]. - The sales data from the National Healthcare Security Administration indicates that from January 1 to 6, over 15 medical institutions recorded sales of commercial insurance innovative drugs, although most had already stocked these drugs prior to the directory's release [6][7]. Group 2: Challenges in Outpatient Use - The outpatient use of commercial insurance innovative drugs remains largely unregulated, with no clear incentives established for outpatient prescriptions [4][10]. - The article notes that while inpatient use may be supported by the "three exclusions" policy, outpatient scenarios face significant barriers, including a lack of payment guarantees from commercial insurance products [10][11]. - The need for clearer guidelines and incentives for outpatient use is emphasized, as many innovative drugs, particularly for cancer and Alzheimer's treatment, are typically administered in outpatient settings [10][11]. Group 3: Market Dynamics and Future Outlook - The article suggests that the success of commercial insurance innovative drugs in hospitals will depend on balancing interests among stakeholders and creating differentiated plans based on local healthcare financing conditions [11][12]. - There is a call for establishing specific standards for exceptional case applications to ensure that patients using commercial insurance innovative drugs are not competing for limited resources with those using nationally negotiated drugs [12][13]. - The potential for hospitals to receive more definitive incentives through "exceptional payments" is highlighted, as this could significantly impact the market volume of commercial insurance innovative drugs [13][14]. Group 4: Retail Pharmacy Integration - The National Healthcare Security Administration has proposed supporting retail pharmacies in stocking drugs from the commercial insurance innovative drug directory, which could enhance access to these medications [15][16]. - However, concerns remain regarding how pricing negotiations and reimbursement rules will be implemented, which could affect the willingness of commercial insurance companies to include these drugs in their coverage [15][16]. - The article stresses the importance of aligning the commercial insurance innovative drug directory with existing healthcare policies to build confidence among healthcare providers in prescribing these medications [16].

Group 1: National Healthcare Administration Updates - The National Healthcare Security Administration has announced the preliminary review results for the 2025 medical insurance directory and the commercial insurance innovative drug directory, with 534 out of 633 drug names passing the initial review [1] - A total of 121 drug names were approved for the commercial insurance innovative drug directory, which includes high-innovation drugs not yet included in the basic medical insurance directory [1] - The review results are a preliminary step, and the approved drugs will undergo further evaluation and negotiation before being officially included in the directories [1] Group 2: Drug Traceability in Qingdao - Qingdao has implemented a drug traceability code system, with 10.1 billion data entries collected, accounting for 26.5% of the total in the province [2] - The city has connected 4,268 retail pharmacies and 5,946 medical institutions to the traceability system, achieving over 99% and 90% scanning rates, respectively [2] - The traceability system aims to enhance drug safety and improve the supervision of medical insurance funds [2] Group 3: Drug Approvals and Clinical Trials - Heng Rui Medicine's application for the marketing license of Haqubopam Ethanolamine Tablets has been accepted by the National Medical Products Administration [3] - Fosun Pharma's application for the registration of Nadaplatin Injection has also been accepted, targeting various types of cancer [4] - Xingqi Eye Medicine has completed the first patient enrollment for the Phase II clinical trial of Voriconazole Eye Drops, aimed at treating fungal keratitis [5] - Haishi Ke has received approval for clinical trials of HSK47977 Tablets, a potential first-in-class drug for non-Hodgkin lymphoma [6] Group 4: Mergers and Acquisitions - Nanhua Biological is planning to acquire a 51% stake in Hunan Huize Biological Pharmaceutical Technology Co., which will become a subsidiary [7] - The acquisition aims to enhance Nanhua's capabilities in drug research and clinical evaluation [7] Group 5: Strategic Partnerships and Collaborations - East China Pharmaceutical's subsidiary has signed an exclusive commercialization agreement with Jiangsu Weikail, acquiring rights for the VC005 oral formulation in mainland China [8] - The agreement includes an upfront payment of 50 million RMB and potential milestone payments up to 180 million RMB [8] - KQ Bio plans to sign a collaborative research agreement with Huazhong Agricultural University, involving four projects with a total payment of 4.9 million RMB [9]

Investment Rating - The report maintains a "Recommended" investment rating for the healthcare sector [7]. Core Insights - The healthcare sector has shown a mixed performance, with the Shenyin Wanguo Pharmaceutical Bio Index rising by 1.60% from June 23 to June 27, 2025, underperforming the CSI 300 Index by 0.35 percentage points [2][12]. - Year-to-date, the pharmaceutical sector has increased by 6.24%, outperforming the CSI 300 Index by 6.57 percentage points, ranking 11th among 31 sectors [2][14]. - As of June 27, 2025, the valuation of the pharmaceutical sector stands at 27.54 times (TTM overall method, excluding negative values), with a premium of 140.94% compared to the CSI 300 [2][17]. Summary by Sections 1. Market Performance - The pharmaceutical sector's performance from June 23 to June 27, 2025, was a 1.60% increase, ranking 23rd among 31 sectors [12]. - The year-to-date performance shows a 6.24% increase, ranking 11th among 31 sectors [14]. 2. Important Events - The National Healthcare Security Administration released the "2025 Basic Medical Insurance Directory and Commercial Insurance Innovative Drug Directory Adjustment Application Guidelines," marking a significant step for commercial health insurance in the multi-level medical security system [4][21]. 3. Industry Perspective - The inclusion of the commercial insurance innovative drug directory indicates an enhanced role for commercial insurance in the multi-level medical security system, providing greater opportunities for the industry [5][22]. - The report expresses optimism for innovative drugs, overseas expansion, and the clearing of procurement in specific segments, suggesting a focus on companies involved in these areas [22].