Core Viewpoint - The first version of the commercial insurance innovative drug directory in China has been released, including 19 drugs, and will be implemented starting January 1, 2026 [1][3]. Group 1: Overview of the Innovative Drug Directory - The directory aims to fill gaps in clinical medication coverage by including innovative drugs that are not reimbursed by basic medical insurance [3][4]. - The drugs included are primarily those with significant clinical value and patient benefits, exceeding the coverage of basic medical insurance [3][4]. - Notable drugs in the directory include CAR-T cell therapies and treatments for rare diseases prevalent in children [3][4]. Group 2: Market Impact and Growth - The commercial health insurance market in China has been rapidly growing, with premium income reaching 977.3 billion yuan in 2024 [4]. - The innovative drug directory is expected to enhance the efficiency of insurance coverage by reducing overlaps with basic medical insurance [4][5]. - Experts believe that the directory will create a win-win situation for pharmaceutical companies, patients, and insurance providers, encouraging innovation and market expansion [5][6]. Group 3: Policy Support and Implementation - The National Medical Insurance Administration has provided "three exclusions" to support the implementation of the directory, allowing for easier access to innovative drugs in hospitals [5][7]. - Although the drugs in the directory are not reimbursed by basic medical insurance, patients can still benefit from commercial insurance products that cover these medications [7][8]. - The directory is expected to facilitate the use of high-value drugs and expand the coverage of commercial health insurance products [7][8]. Group 4: Challenges and Recommendations - There are concerns about the sustainability and accessibility of the innovative drug directory, with suggestions for establishing a comprehensive payment control and pricing mechanism [9][10]. - Insurance companies face challenges in managing the introduction of innovative drugs due to the lack of historical claims data, which complicates cost predictions [10]. - Recommendations include enhancing risk management capabilities and integrating data to improve the overall service and coverage of innovative drugs [10].