Core Insights - The first version of the commercial insurance innovative drug directory has been officially released, listing 121 drugs, marking the approach of a "dual directory" era [1] - The inclusion of commercial health insurance in the directory system by the National Medical Insurance Administration breaks the previous single payment model, providing a new pathway for innovative drugs to overcome payment bottlenecks in clinical applications [1] - The "first commercial insurance, then basic medical insurance" model allows innovative drugs to accumulate real-world data before considering inclusion in the basic medical insurance directory [1] Industry Perspective - The past decade has seen transformative changes in China's innovative drug sector, driven significantly by government policies, yet there are still notable gaps in the commercial logic of the industry [2] - Even innovative drug companies with a market value of 10 billion yuan may struggle to achieve profitability, indicating deficiencies in the payment system [2] - The development of commercial insurance in the payment sector is crucial for establishing a complete commercial loop for innovative drugs, which is essential for sustainable industry growth [2] Company Strategies - Companies like Fosun Pharma have multiple products listed in the initial review of the commercial insurance innovative drug directory, including the CAR-T therapy, which has faced challenges in entering the basic medical insurance negotiations [2][3] - The uncertainty surrounding the commercial insurance system includes issues related to fairness, price negotiation, and the lack of mature operational experience [3] - Companies are exploring differentiated pricing strategies based on pharmacoeconomic evaluations to ensure that patients have access to medications while maintaining profitability [5][6] Regulatory Environment - The "Support Measures for High-Quality Development of Innovative Drugs" outlines how to reasonably determine the medical insurance payment standards for innovative drugs, emphasizing the use of pharmacoeconomic methods [7] - This policy direction aims to balance the demands of the medical insurance fund's sustainability with the recognition of the research and clinical contributions of innovative drugs [7]

Core Insights - The introduction of the first commercial insurance innovative drug directory marks a significant shift in China's healthcare payment landscape, allowing for a dual-directory system that includes both basic medical insurance and commercial health insurance [2][3] - This new model aims to alleviate the financial burden on patients for high-priced innovative drugs and provides pharmaceutical companies with more flexible pricing strategies and market coverage options [2][3] - The concept of "first commercial insurance, then basic insurance" is proposed for innovative drugs that are not yet covered by basic medical insurance, allowing for the accumulation of real-world data before negotiating for inclusion in the basic insurance directory [2][3] Industry Dynamics - The commercial insurance sector's involvement in innovative drug payments is seen as crucial for creating a complete commercial loop in the Chinese innovative drug market, which has undergone significant transformation over the past decade [3][4] - Despite the potential benefits, uncertainties remain regarding the implementation of commercial insurance policies, including fairness, price negotiation, and the lack of mature operational experience [4][5] - The current commercial insurance innovative drug directory serves as a guideline, with local execution and detailed implementation still needing observation and refinement [4][5] Pricing and Economic Evaluation - Drug economic evaluation is becoming an essential tool for drug reimbursement and payment decisions, focusing on the effectiveness, safety, economic viability, and patient benefits of drugs [6][8] - Companies are exploring differentiated pricing strategies based on economic evaluations to achieve a balance between patient access, corporate returns, and manageable healthcare costs [6][8] - The recent policy direction emphasizes the use of drug economic evaluation in determining reimbursement standards, aiming to align with China's national conditions and market status while recognizing the value of innovative drug development [8]