"当化疗成为唯一选项时，我们需要的不仅是技术，更是支付的勇气。"一位鼻咽癌患者曾在其自述中如 是写道。这句话背后，是无数癌症患者面对天价创新药时的无奈——即便新药能带来生存希望，但高昂 的费用却让希望沦为奢望。这种困境在罕见病领域尤为突出，患者往往需自费承担数十万元甚至上百万 元的年治疗费用。 这种支付与需求的错配正在找到新的解决路径。12月13日，全国医疗保障工作会议在北京召开，明确提 出2026年要支持商业健康保险发展，健全多层次医疗保障体系，并特别强调要"积极落地商保创新药品 目录"，在个人充分授权和确保数据安全基础上，为有需要的商业健康保险产品提供"医保+商保"一站式 清分结算服务。 12月7日，2025年国家基本医保药品目录及首版商保创新药目录在广州正式发布，将于2026年1月1日起 正式实施。此次国家医保局首次在基本医保目录之外增设商保创新药目录，共纳入19种药品，涵盖 CAR-T等肿瘤治疗药品、神经母细胞瘤等罕见病治疗药品，以及社会关注度较高的阿尔茨海默病治疗药 品。 国家医保局表示，商保创新药目录重点纳入创新程度高、临床价值大、患者获益显著且超出基本医保保 障范围的创新药，推荐商业健康保险、医 ...

来源：财经五月花 作者：丁艳 杨芮 这种支付与需求的错配正在找到新的解决路径。12月13日，全国医疗保障工作会议在北京召开，明确提 出2026年要支持商业健康保险发展，健全多层次医疗保障体系，并特别强调要"积极落地商保创新药品 目录"，在个人充分授权和确保数据安全基础上，为有需要的商业健康保险产品提供"医保+商保"一站式 清分结算服务。 12月7日，2025年国家基本医保药品目录及首版商保创新药目录在广州正式发布，将于2026年1月1日起 正式实施。此次国家医保局首次在基本医保目录之外增设商保创新药目录，共纳入19种药品，涵盖 CAR-T等肿瘤治疗药品、神经母细胞瘤等罕见病治疗药品，以及社会关注度较高的阿尔茨海默病治疗药 品。 商保创新药目录的出台标志着医保与商保协同进入实质性阶段，开辟了一条市场化的支付通 道，提升了创新药可及性 "当化疗成为唯一选项时，我们需要的不仅是技术，更是支付的勇气。"一位鼻咽癌患者曾在其自述中如 是写道。这句话背后，是无数癌症患者面对天价创新药时的无奈——即便新药能带来生存希望，但高昂 的费用却让希望沦为奢望。这种困境在罕见病领域尤为突出，患者往往需自费承担数十万元甚至上百万 元的 ...

21世纪经济报道记者季媛媛上海报道 绿谷医药的母公司上海绿谷制药有限公司成立于1996年，主要从事中药天然药物和创新型糖类药物研发生产。这家企业聚焦阿尔茨海默病等领 域，历时22年研制出全球首个糖类多靶点抗阿尔茨海默病药物甘露特钠胶囊(商品名：九期一)，并于2019年通过国家优先审评程序获批上市， 成为2003年以来全球首个被批准的阿尔茨海默病新药。不过，与国际上主流的"β淀粉样蛋白"靶点假说不同，甘露特钠胶囊是以海洋褐藻提取 物为原料制备而成的低分子酸性寡糖化合物，是首个针对脑肠轴机制的AD新药。 同时，"附条件批准"意味着甘露特钠胶囊上市后需在规定期限内完成药物临床试验，并申请常规上市批准。 近日，阿尔茨海默病药物赛道异常热闹。在两款近年来最具突破性的阿尔茨海默病对因治疗药物——仑卡奈单抗注射液和多奈单抗注射液双双 入选我国首版《商业健康保险创新药品目录》后，争议与机遇并存的国产阿尔茨海默病药物甘露特钠，在面临停产、换证危机之际，迎来了中 国医药巨头复星医药（600196）的入局。 12月15日，复星医药(600196.SH；02196.HK)宣布控股子公司复星医药产业与绿谷(上海)医药科技有限公司("绿 ...

12月15日，复星医药（600196.SH；02196.HK）宣布控股子公司复星医药产业与绿谷（上海）医药科技 有限公司（"绿谷医药"）及其现有相关股东共同签订相关投资协议，拟出资约人民币14.12亿元控股收 购绿谷医药。本次收购完成后，绿谷医药将成为复星医药控股子公司，其核心药品甘露特钠胶囊也将纳 入复星医药创新药品管线，主要用于治疗轻度至中度阿尔茨海默病（Alzheimer's disease，AD）。 在今年6月8日，绿谷被爆出将关闭甘露特钠胶囊相关的办公区、生产区。且早在5月19日，绿谷方面曾 在官网发布公告回应，"我们陆续收到各地患者关于甘露特钠胶囊'购药难'的情况，以及个别购药渠道 急速涨价。我们深知用药中断会对病情产生重大影响，对此我们深表遗憾。我们正与有关部门紧密沟 通，全力以赴处理相关供货问题，以尽早满足患者迫切的治疗需求。"但该公告随后被删除。绿谷方面 更是多次被媒体报道近期面临严峻的经营压力，现金流极度紧张。 事实上，甘露特钠胶囊自2019年上市以来一直存在学术争议，其作用机制的相关论文，以及临床试验过 程、临床疗效等均受到质疑。此外，2022年5月，绿谷制药方面称，因疫情导致的临床试验 ...

Core Viewpoint - The inclusion of 19 drugs in the first version of the commercial health insurance innovation drug directory marks a significant step towards improving access and affordability of innovative drugs, particularly high-cost CAR-T therapies, while presenting challenges for insurance companies in product development and risk management [1][4][10]. Group 1: Policy and Implementation - The National Medical Security Work Conference emphasized the support for the development of commercial health insurance and the establishment of a multi-tiered medical security system, with a focus on the implementation of the commercial health insurance innovation drug directory by January 1, 2026 [1][2]. - The first version of the commercial health insurance innovation drug directory includes 19 drugs, focusing on high-cost and innovative treatments, including five CAR-T products and drugs for rare diseases [2][4]. Group 2: Challenges for Insurance Companies - Insurance companies face significant challenges in translating the drug directory into viable insurance products, including issues related to pricing, risk control, and compliance [4][5]. - Accurate pricing for insurance products relies on detailed data regarding potential patient populations, disease incidence, treatment cycles, and real-world efficacy, which are primarily held by pharmaceutical companies and hospitals [4][5]. Group 3: Risk Management and Compliance - The inclusion of Alzheimer's disease treatments raises concerns about adverse selection risks, as these drugs have high costs and long treatment durations, necessitating strict eligibility criteria for insurance coverage [5][6]. - Establishing transparent and compliant financial flows between insurance companies and pharmaceutical firms is crucial for effective collaboration [5][6]. Group 4: Data Sharing and Integration - The "医保+商保" one-stop clearing and settlement model aims to break down data silos, enhancing the efficiency of claims processing and improving patient experiences [6][8]. - Successful implementation of data sharing initiatives in regions like Shanghai and Beijing indicates potential for nationwide adoption, which could facilitate better integration of commercial health insurance with innovative drug offerings [8][10]. Group 5: Investment in Innovative Drugs - The policy encourages insurance funds to invest in the upstream of the pharmaceutical industry, positioning them as "patient capital" for innovative drug development [10][11]. - Major insurance companies are already investing in health industry funds, supporting numerous innovative drug companies and enhancing the overall funding environment for drug development [10][11]. Group 6: Future Outlook - Despite the potential for increased investment in innovative drugs, insurance companies remain cautious due to the high risks and costs associated with drug development, which may lead to a preference for established pharmaceutical firms over smaller, innovative companies [12].

Core Insights - The National Healthcare Security Administration (NHSA) held a conference on December 9, 2023, to discuss the 2025 Medical Insurance Drug List, attracting significant interest from various stakeholders, including over 23,000 online viewers [1][6]. Group 1: Drug List Adjustments - The basic medical insurance fund, exceeding 3 trillion yuan, is directly linked to the annual release of the National Medical Insurance Drug List [6]. - In 2025, 114 new drugs were added to the basic medical insurance list, with 111 being new drugs launched within the last five years, marking a record high in both proportion and quantity [7]. - The adjustment process for the drug list has become clearer, with specific phases for preparation, application, review, and negotiation [7]. Group 2: Misunderstandings in Drug Pricing - There are misconceptions regarding the negotiation process, particularly the belief that all drugs must reduce prices upon renewal; only 30 out of 178 drugs negotiated for renewal experienced an average price drop of 13.8% [8]. - The average price reduction for the 15 drugs that were renewed was only 8.4% [8]. Group 3: Commercial Health Insurance Innovations - The NHSA introduced the first Commercial Health Insurance Innovative Drug List, which involves a more complex review process, including a re-evaluation by a specialized expert group [9]. - Certain drugs, while deemed valuable by basic medical insurance experts, were not included in the commercial insurance list due to concerns over their insurability and management difficulties [10]. Group 4: Challenges in Implementation - The NHSA aims to leverage the "three exclusions" policy to facilitate drug inclusion in hospitals and encourage the design of insurance products targeting the innovative drug list [11]. - There are significant challenges in aligning commercial insurance products with the innovative drug list, including low efficiency in claims processing and insufficient coverage [12]. Group 5: Differentiated Innovation in Pharmaceuticals - The NHSA emphasizes the need for differentiated innovation in pharmaceuticals, urging companies to provide robust evidence, such as head-to-head clinical trial data, to support claims of being "best in class" [15][16]. - The selection of reference drugs for economic evaluation is crucial, requiring a comprehensive approach that considers multiple dimensions of comparison [16][17].

（原标题：年费超10万的老年痴呆症新药，首次进商保） 无论是卫材公司的仑卡奈单抗还是礼来的多奈单抗，患者一年的治疗费用均需超过10万元。高昂的治疗 费用一度让不少阿尔茨海默病（AD）患者家庭在希望与绝望间徘徊，直到首版商保创新药目录为这种 困境带来了转机。 日前，在2025创新药高质量发展大会上，我国首版《商业健康保险创新药品目录》正式发布。两款近年 来最具突破性的阿尔茨海默病对因治疗药物——仑卡奈单抗注射液和多奈单抗注射液双双入选。而被纳 入商保目录的两款AD药物，都代表了当前阿尔茨海默病治疗领域的最高水平。 AD，作为老龄化社会中的"沉默杀手"，国内患者数量已超1000万。然而，过去由于药物疗效有限且价 格高昂，其临床使用率一直极低。眼下，商保目录意味着，政策在破局。在商保目录推动下， 全球阿 尔茨海默病治疗市场正在经历一场深刻变革。 ...

Core Points - The National Healthcare Security Administration and the Ministry of Human Resources and Social Security released the new National Basic Medical Insurance, Maternity Insurance, and Work Injury Insurance Drug Catalog (2025) along with the first Commercial Health Insurance Innovative Drug Catalog (2025), focusing on high-innovation and clinically valuable drugs [1] - A total of 24 drugs participated in the price negotiation, with 19 successfully included, achieving a success rate of approximately 79% [1] - The included innovative drugs feature 5 CAR-T cell therapies, 6 rare disease drugs, and the only immune oncology drug in the commercial health insurance catalog [1] Group 1: CAR-T Cell Therapies - Five CAR-T cell therapies have been included in the commercial health insurance innovative drug catalog, which had previously attempted to enter the national insurance catalog four times without success [2][3] - The therapies included are from various companies, with the first approved CAR-T therapy being the Axicabtagene Ciloleucel injection from Fosun Kite [3] - Despite high treatment costs, the inclusion in the commercial catalog is expected to improve patient access and reduce financial burdens [3] Group 2: Oncology Drugs - The commercial health insurance innovative drug catalog includes a significant number of oncology drugs, with 14 drugs in total, accounting for nearly 74% of the catalog [5] - Notably, the CTLA-4 inhibitor Ipilimumab injection, the only immune oncology drug included, is expected to enhance treatment accessibility for liver cancer patients [6] Group 3: Rare Disease Drugs - The catalog also includes 6 innovative drugs for rare diseases, such as the drugs for neuroblastoma and phenylketonuria [8][10] - These drugs are aimed at addressing urgent patient needs and are part of a broader strategy to enhance treatment options for rare diseases [8] Group 4: Policy Implications - The establishment of the commercial health insurance innovative drug catalog is a significant step towards improving the multi-tiered medical insurance system in China [9] - The government encourages commercial health insurance providers to incorporate these drugs into their coverage, promoting a more comprehensive healthcare solution for patients [9]

日前，国家医保局、人力资源社会保障部印发《国家基本医疗保险、生育保险和工伤保险药品目录》（下称"新版国家医保目录"）、首版《商业健康保险 创新药品目录》（下称"首版商保创新药目录"）。新版医保商保"双目录"将于2026年1月1日起在全国范围内正式实施。 12月7日至8日，恒瑞医药、复星医药、海思科、北海康成、君实生物等多家上市公司公告药品新进、续约或新增适应症纳入新版国家医保目录、首版商保 创新药目录。 新版国家医保目录新纳入114种药品 弥补基本医保保障空白 值得注意的是，今年是医保目录调整首次实施"双轨制"，即基本医保目录聚焦基础保障，商保创新药目录则针对符合"独家新药"或"罕见病用药"条件的药 品提供补充保障通道。 新版国家医保目录方面，在此次新纳入的114种药品中，111个为5年内新上市品种，占比97.3%。有50种为1类创新药，总体成功率88%，较2024年的76% 再度提高。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。 12月7日至8日，多家上市公司公告药品新进、续约或新增适应症纳入新版国家医保目录的"喜讯"。 恒瑞医药此次收获颇丰，共有20款产品/适应症通过新版国 ...

Core Insights - The first version of the commercial insurance innovative drug directory has been released, including 19 new drugs from 18 innovative pharmaceutical companies, with a roughly equal share of domestic and imported drugs [1][2] - Approximately 70% of the drugs included are oncology treatments, featuring five high-cost CAR-T products, indicating a significant focus on cancer therapies [1][8] - The inclusion of rare disease medications and Alzheimer's treatments in the directory is expected to enhance commercial insurance payment opportunities and favorable policies for hospital access [1][10] Summary by Category Drug Inclusion - A total of 19 drugs have been included in the first commercial insurance innovative drug directory, with a selection rate of about 16%, aligning with industry expectations [4][6] - The directory features a mix of oncology drugs, rare disease treatments, and Alzheimer's medications, with a notable emphasis on high-priced innovative drugs [1][8] Market Dynamics - The directory's limited number of drugs (around 20) is seen as a strategic move to facilitate implementation and avoid complications in local insurance products [6][10] - The commercial insurance market is expected to leverage the directory to enhance patient access to high-value drugs, particularly in the oncology sector [9][11] Regulatory and Policy Framework - The National Healthcare Security Administration (NHSA) encourages local insurance departments to support the integration of the commercial insurance innovative drug directory into retail pharmacies and monitor pricing [7][14] - The directory aims to provide a reference for various commercial insurance entities, allowing them to negotiate with innovative drug companies without the need for exclusive selections [11][14] Patient Impact - The drugs listed in the directory are characterized by a small patient base or specific indications, minimizing the risk of clinical misuse and aligning with commercial insurance risk management strategies [8][13] - The directory includes several drugs for rare diseases, which are expected to fill clinical gaps and provide essential treatments previously unavailable in China [12][13]