Core Viewpoint - The National Healthcare Security Administration (NHSA) announced the 2025 version of the National Basic Medical Insurance Drug List and the first Commercial Health Insurance Innovative Drug List, which includes significant updates to enhance drug accessibility for patients [1][2][3]. Group 1: Drug List Adjustments - The new drug list adds 114 new drugs, including 50 innovative drugs, while removing 29 drugs that are either unavailable or can be replaced by others [1][2][3]. - The total number of drugs in the list now stands at 3,253, comprising 1,857 Western medicines and 1,396 traditional Chinese medicines, with improved coverage for critical areas such as cancer, chronic diseases, mental health, rare diseases, and pediatric medications [1][2][3]. Group 2: Financial Implications - The NHSA has assessed the budget impact of new drugs on the medical insurance fund, concluding that the overall financial burden remains manageable within the national budget [3][4][12]. - The introduction of new drugs may lead to increased costs, but many are expected to replace older medications, mitigating the financial impact [3][4][12]. Group 3: Challenges in Hospital Implementation - Despite being included in the insurance list, many "nationally negotiated drugs" face challenges in being adopted by hospitals due to limited capacity in hospital drug lists, which typically accommodate only 1,500 to 2,000 drugs [4][6][8]. - The approval process for new drugs in hospitals can be lengthy, often taking from one to twelve months, which complicates timely access for patients [8][12][44]. Group 4: Dual-Channel Policy - To address the issue of drug availability, the government introduced a "dual-channel" policy, allowing patients to access "nationally negotiated drugs" through designated hospitals and retail pharmacies, ensuring equal reimbursement [14][16][50]. - As of now, 402 nationally negotiated drugs have been integrated into this dual-channel system, significantly increasing sales from under 4 billion yuan in 2020 to nearly 15 billion yuan in 2024 [16][50]. Group 5: Commercial Health Insurance Innovations - The newly established Commercial Health Insurance Innovative Drug List includes 19 drugs, selected from 121 candidates, aimed at covering high-value drugs not included in the basic insurance [27][30][67]. - This list is designed to complement the basic medical insurance system, addressing the gap for high-cost innovative treatments that are crucial for patients with severe conditions [30][32][67]. Group 6: Future Implications - The introduction of the Commercial Health Insurance Innovative Drug List is expected to enhance patient access to high-value treatments, encouraging insurance companies to cover these drugs and potentially increasing patient enrollment in commercial health plans [30][66][73]. - The dual-directory approach aims to create a more robust healthcare financing system, ensuring that patients can access necessary medications while maintaining the sustainability of the insurance funds [30][66][73].

2025年版《国家基本医疗保险、生育保险和工伤保险药品目录》和首版《商业健康保险创新药品目录》 日前正式公布。本次目录调整新增114种药品,其中50种为一类创新药,同时调出了29种临床没有供应或可 被其他药物更好替代的药品。 本次调整后,目录内药品总数增至3253种,其中西药1857种、中成药1396种,肿瘤、慢性病、精神疾病、罕 见病、儿童用药等重点领域的保障水平得到明显提升。新版目录将于2026年1月1日在全国范围内正式实 施。 不断纳入新药 医保基金能承受吗? 今年的药品目录调整与此前有哪些不同? 新增纳入目录的114种药品,是非小细胞肺癌、宫颈癌、罕见病患者等待的创新药、救命药。比如今年有 一款药,打一针可维持半年有效的降血脂效果,上市不久就能纳入医保,患者能以合理的价格控制血脂。因 此,每年一次药品目录的调整,都是对民生需求的回应。 八年八次调整,每次都新增一批药品,今年又纳入了114个药品,不断纳入新药,医保基金能承受吗?复旦大学 药物经济学研究与评估中心主任陈文表示,我们评估过每一个品种,对医保基金会带来什么样的预算影响, 理论上来说,对医保基金不会造成特别大的影响。 "国谈药"进了医保 更关键 ...

Core Viewpoint - The article highlights the significant impact of the inclusion of targeted lung cancer drug Osimertinib (Aozhi) in the national medical insurance directory, which has drastically reduced its price and improved access for patients, thereby enhancing their quality of life and health outcomes [2][3][5]. Group 1: Drug Pricing and Accessibility - Osimertinib was initially priced over 50,000 yuan per box, making it unaffordable for many patients before being included in the national medical insurance directory in 2018, which reduced the price to 15,300 yuan [2]. - The price of Osimertinib has continued to decrease through negotiations, reaching 4,966.2 yuan per box in 2022, allowing patients to afford the medication [2][3]. - The reimbursement system for outpatient specific drugs in the province offers approximately 85% coverage for employee insurance and 80% for rural residents' insurance, significantly lowering out-of-pocket expenses for patients [3]. Group 2: Impact on Patients - The reduction in drug costs has transformed the financial burden for patients, with some reporting monthly expenses dropping from five-digit figures to three-digit figures, thus restoring their dignity and hope [5][6]. - The number of patients benefiting from Osimertinib has significantly increased since its inclusion in the insurance program, demonstrating the positive effects of the policy on patient access to essential medications [5]. - The article emphasizes that the changes in drug pricing not only alleviate financial stress but also enhance the overall quality of life for patients, allowing them to focus on their health rather than financial constraints [4][6]. Group 3: National Health Policy Initiatives - The article discusses the concept of "national negotiated drugs," which refers to the government's efforts to negotiate prices with pharmaceutical companies to make high-quality medications more accessible to the public [2]. - Since 2018, the national drug procurement policy has led to the inclusion of 835 new drugs in the basic medical insurance directory, with 530 of these being negotiated, covering various treatment areas including cancer and rare diseases [3][6]. - The implementation of centralized procurement has resulted in the collection of 1,303 types of drugs, further contributing to the reduction of drug prices and improving accessibility for patients [6].

Core Viewpoint - The pharmacy department in hospitals has undergone significant changes, shifting from a profit center to a cost center and now to a department focused on compliance with various drug-related assessments and regulations [2][30]. Group 1: Changes in Pharmacy Department's Role - The pharmacy department was once a key profit center for hospitals but transformed into a cost center after the cancellation of drug markups in public hospitals in 2017 [2][30]. - The department now faces a multitude of drug-related assessment indicators, such as antibiotic usage intensity and basic drug ratio, complicating its operational landscape [3][4]. - The pharmacy department's responsibilities have expanded to include compliance with both clinical needs and regulatory requirements, creating a complex work environment [4][6]. Group 2: Challenges Faced by Pharmacy Departments - Pharmacy department heads, like Wang Jun, report feeling overwhelmed by the increasing number of policies and assessments they must navigate, often leading to conflicts between clinical needs and regulatory demands [6][9]. - Issues such as drug shortages, particularly for commonly used medications, have become a frequent challenge, leading to patient complaints and added pressure from hospital administration [8][9]. - The pharmacy department must balance various conflicting demands from regulatory bodies, clinical staff, and patients, making their role increasingly complex [17][19]. Group 3: Evolving Assessment Metrics - The performance assessment metrics for pharmacy departments have become more detailed and stringent, with a focus on antibiotic usage and cost management [14][15]. - The introduction of new metrics, such as the average drug cost per outpatient/inpatient, has added to the pressure on pharmacy departments to manage costs effectively while ensuring compliance [15][22]. - The shift in focus from drug ratios to cost metrics reflects a broader trend in healthcare towards more comprehensive performance evaluations [15][22]. Group 4: Future Implications - The pharmacy department's role is evolving from a cost center to a compliance support function, emphasizing the need for effective communication and professional knowledge to navigate complex regulations [26][30]. - As the healthcare landscape continues to change, pharmacy departments must adapt to new policies and assessment criteria, which may lead to further challenges in drug management and patient care [30].