Core Viewpoint - The National Healthcare Security Administration (NHSA) has released a work plan for the adjustment of the National Basic Medical Insurance, Maternity Insurance, and Work Injury Insurance drug catalog and the Commercial Health Insurance Innovative Drug Catalog, allowing eligible companies to apply for inclusion starting July 11, 2023 [1][3]. Group 1: Work Plan Details - The work plan allows for the application of new generic names or exclusive drugs for rare diseases approved for marketing within the last five years to be included in the Commercial Health Insurance Innovative Drug Catalog [1]. - The application process includes preparation, submission, initial review, public announcement, re-examination, and final announcement of the drug list [2]. - The timeline for the application process spans from July to November 2023, with specific phases for expert review and negotiation for pricing [2]. Group 2: Benefits for Innovative Drugs - Inclusion in the Commercial Health Insurance Innovative Drug Catalog can enhance sales for innovative drugs by leveraging the scale of basic medical insurance or commercial insurance [4]. - Drugs in the commercial insurance catalog are exempt from being counted in the basic medical insurance self-pay rate indicators and the monitoring of selected alternative products [4]. - The arrangement allows for innovative drugs to be excluded from the Diagnosis-Related Group (DRG) payment system, addressing the issue of high costs associated with innovative treatments [5]. Group 3: Application Choices for Companies - Companies can choose to apply for either the basic medical insurance catalog, the commercial health insurance innovative drug catalog, or both [6]. - The selection criteria for the commercial health insurance catalog focus on high innovation, significant clinical value, and substantial patient benefits, making it unlikely for the same drug to be included in both catalogs simultaneously [6][7]. - For products priced above the set standard, inclusion in the commercial insurance catalog is seen as more favorable compared to the basic medical insurance catalog [8].

Core Insights - The core viewpoint of the articles is the successful implementation of the DRG (Diagnosis-Related Group) payment reform in Nanjing, which has led to a win-win situation for the healthcare system, hospitals, and patients through improved data transparency and management [1][4]. Group 1: DRG Payment Reform - All eligible medical institutions in Nanjing have participated in the DRG payment reform, which is expected to reduce the actual expenditure of the medical insurance fund from projected amounts [1]. - The forecasted medical insurance fund amounts for 2022 to 2024 are 10.1 billion, 12.7 billion, and 12.8 billion yuan, while the actual amounts were 8.8 billion, 10.7 billion, and 10.5 billion yuan, indicating a reduction of 1.3 billion, 2 billion, and 2.3 billion yuan respectively [1]. - The average medical expenses for insured patients are projected to decrease from 14,204 yuan in 2022 to 13,255 yuan in 2024, with personal burdens decreasing by 488 yuan, 161 yuan, and 124 yuan over the same period [1]. Group 2: Data Transparency and Monitoring - Nanjing's medical insurance bureau has expanded the data disclosure from 45 indicators to an additional 30 local indicators, enhancing the monitoring of fund risks and business operations [2]. - The frequency of data publication has increased from once a month to real-time, monthly, quarterly, semi-annual, and annual disclosures, allowing for more timely insights into healthcare operations [2]. - The "Medical Insurance High-speed Rail" mobile cloud platform, initiated four years ago, has integrated over 4,000 doctors and 2,148 designated medical institutions, accumulating a total of 66.764 billion data entries [3]. Group 3: Impact on Hospital Management - The intelligent monitoring and early warning functions of the "Medical Insurance High-speed Rail" platform have enabled hospitals to identify potential risk points and take proactive measures [3]. - Since the launch of the DRG section and outpatient monitoring module in 2022, hospitals have utilized feedback from the platform to enhance their internal performance assessments and improve patient experience [3]. - The ongoing commitment to data transparency and management is expected to assist hospital managers in making informed decisions, thereby enhancing the overall efficiency of the healthcare system in Nanjing [4].