Core Viewpoint - The era of collaborative development between medical insurance and commercial insurance has arrived, as evidenced by recent policy changes and initiatives aimed at enhancing the synergy between commercial health insurance and the biopharmaceutical industry [1][2]. Group 1: Policy Initiatives - In July 2023, Shanghai introduced 28 measures to support the development of innovative drugs and medical devices, which has sparked industry discussions and set a precedent for nationwide implementation [1]. - Recently, seven departments in Shanghai released 18 specific measures to promote the high-quality development of commercial health insurance, focusing on payment mechanisms, data sharing, service models, and regulatory innovation [1][4]. - The 18 measures represent a systematic approach to creating a dual empowerment mechanism between commercial health insurance and biopharmaceutical innovation, emphasizing the need for diverse payment mechanisms beyond basic medical insurance [1][4]. Group 2: Highlights of Commercial Health Insurance Innovation - One highlight is the support for "pre-existing condition" insurance, allowing the trial development of insurance products for patients with chronic diseases under a regulatory sandbox mechanism [3]. - The measures also aim to activate individual medical account funds, permitting eligible group health insurance to use accumulated personal account balances for payments [3]. - There is encouragement for "insurance + service" models, promoting the development of long-term care insurance and collaboration between insurance companies and health service providers [3]. Group 3: Focus on Group Health Insurance - The 18 measures will prioritize the development of group health insurance, which has proven to be a mature sector, particularly in providing customized corporate supplementary medical insurance [3][4]. - Group health insurance can effectively cover pre-existing conditions and chronic diseases, addressing adverse selection issues while expanding funding and improving management efficiency [3]. - The measures will also focus on innovative drugs and medical devices, encouraging the insurance industry to develop exemplary clauses for group health insurance that include new medical technologies and products [4]. Group 4: Future Outlook for Consumers - The future of insurance products is expected to be more diverse, with broader coverage and more efficient services, reducing the economic burden of using innovative drugs and medical devices for consumers [5]. - Shanghai plans to optimize existing insurance products and develop specialized offerings for specific demographics, such as the elderly and those with pre-existing conditions [5]. - The implementation of policies will continue to signal positive developments in the market, with efforts to eliminate payment bottlenecks for innovative drug applications and support the growth of the biopharmaceutical industry [5].

Core Viewpoint - The National Healthcare Security Administration has issued guidelines for the adjustment of the basic medical insurance directory and the commercial health insurance innovative drug directory, marking a significant shift in the role of commercial health insurance in the multi-tiered medical security system [1][2]. Group 1: Policy Changes - The new guidelines include the first incorporation of the commercial health insurance innovative drug directory into the adjustment scheme, indicating a major adjustment in the design logic and industry positioning of the directory [1][2]. - The commercial insurance companies will exit the price negotiation process, with the directory's nature shifting to a "recommended list," while the healthcare department will lead drug access and price confidentiality negotiations [1][2]. Group 2: Industry Participation - Pharmaceutical companies now have two pathways for submitting information for national negotiations and competitive drug pricing, akin to "filling out college applications," allowing them to choose between the medical insurance directory or the commercial insurance directory [2]. - There is a general expectation within the industry regarding the new directory, particularly as it allows companies to bypass restrictions from DRG/DIP reforms, making participation more attractive [2][4]. Group 3: Market Dynamics - The commercial health insurance market is experiencing a stabilization in growth, with 298 local health insurance products launched across various provinces as of October 31, 2024 [4]. - The participation level of commercial insurance companies may significantly influence the actual implementation of the directory, as it currently resembles a "recommended directory" without strict volume relationships [4][5]. Group 4: Support for Innovative Drugs - There is a consensus in the industry that the payment responsibility for innovative drugs is shifting from medical insurance to commercial insurance, which is seen as an inevitable trend [6]. - The 2023 measures from Shanghai aim to enhance the multi-payment mechanism to support the development of innovative drugs, indicating a broader push for integrating innovative drugs into both basic medical insurance and commercial health insurance [7]. Group 5: Future Outlook - The 2025 government work report emphasizes the need to deepen medical insurance payment reforms and support the development of innovative drugs, highlighting the potential for commercial insurance to play a larger role in this area [8]. - The commercial health insurance sector currently contributes only 7.7% to the payment for innovative drugs, indicating significant room for growth as demand for specialized medical services increases [8].