新版医保目录已进入实质性落地阶段。1月8日，北京商报记者注意到，包括替妥尤单抗N01注射液、夫 那奇珠单抗注射液在内的多款新增创新药，已在多地医院纷纷开出医保首方。这标志着患者使用这些高 价创新药的实际门槛正在快速降低，新版目录的惠民效应开始显现。 倒逼药企研发策略转向真创新 本次医保目录调整不仅新增了114种药品，更首次同步推出《商业健康保险创新药品目录（2025 年）》，通过"基本医保+商保"的双重保障，为肿瘤、罕见病等领域19种高值药品开辟了可及的支付通 路，医保支付体系向多层次保障的实质性转型迈出关键一步，创新药企也迎来了加速商业化放量的重要 节点。 不到一年开出医保首方 创新药迅速落地医保，是新版医保目录对具有高临床价值"真创新"支持力度加大的直接体现。本次调整 中，新版医保目录与商保创新药目录共纳入独家品种124个。 其中，备受关注的替妥尤单抗N01注射液是国内首款用于治疗甲状腺眼病的靶向药物，从2025年3月上 市，到开出医保首方，用时不到一年，填补了我国该领域近70年的治疗空白。 夫那奇珠单抗注射液则是用于治疗银屑病的生物制剂1类创新药，由恒瑞医药自主研发。恒瑞医药在本 次医保目录调整中被视为 ...

新版医保目录已进入实质性落地阶段。1月8日，北京商报记者注意到，包括替妥尤单抗N01注射液、夫那奇珠单抗注射液在内的多款新增创新药，已在多地 医院纷纷开出医保首方。这标志着患者使用这些高价创新药的实际门槛正在快速降低，新版目录的惠民效应开始显现。 本次医保目录调整不仅新增了114种药品，更首次同步推出《商业健康保险创新药品目录（2025年）》，通过"基本医保+商保"的双重保障，为肿瘤、罕见病 等领域19种高值药品开辟了可及的支付通路，医保支付体系向多层次保障的实质性转型迈出关键一步，创新药企也迎来了加速商业化放量的重要节点。 从上市到开出医保首方不足一年 创新药迅速落地医保，是新版医保目录对具有高临床价值"真创新"支持力度加大的直接体现。本次调整中，新版医保目录与商保创新药目录共纳入独家品种 124个。 其中，备受关注的替妥尤单抗N01注射液是国内首款用于治疗甲状腺眼病的靶向药物，从2025年3月上市，到开出医保首方，用时不到一年，填补了我国该 领域近70年的治疗空白。 | | | 基本医保目录"上新"药品定点医药机构销售情况(2026年1月1日至1月6日) | | | | --- | --- | --- | ...

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 ...

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 Viewpoint - WuXi AppTec's management restructuring aims to enhance operational stability and drive growth in the competitive CAR-T therapy market, particularly following the inclusion of its CAR-T product in the national commercial health insurance directory [1][2][5]. Management Changes - Tian Feng will officially become the CEO and Executive Director on December 29, 2025, while Dr. Liu Cheng will assume the role of Chairman of the Board from December 12, 2025 [1]. - The current CEO, Liu Min, will resign on December 12, 2025, due to personal career development plans, and his previously approved stock options will be canceled [1][2]. - The existing management team will temporarily take over the CEO responsibilities to ensure smooth operations during the transition period [1]. New Leadership Background - Tian Feng has over 20 years of experience in the biopharmaceutical industry, with a strong background in commercialization, marketing, and strategic management [2]. - Dr. Liu Cheng has more than 20 years of experience and holds over 300 patents in the biopharmaceutical field, ranking highly in global CAR-T patents [3]. Financial Performance - In the first half of the year, WuXi AppTec reported revenues of 106 million yuan, a year-on-year increase of 22.5%, but also recorded a loss of 267 million yuan, with the loss margin widening by 11.24% [3]. - The company's core product, the CAR-T therapy, has been approved for treating specific types of lymphoma [3]. Strategic Partnerships - WuXi AppTec has entered into several business collaborations, including a technology licensing agreement with Juno Therapeutics valued at up to 10 million USD and a strategic cooperation agreement with Regeneron worth up to 50 million USD [4]. Market Context - The inclusion of WuXi AppTec's CAR-T product in the national commercial health insurance directory is a significant breakthrough, with five CAR-T therapies listed, including WuXi's product priced at 1.29 million yuan per dose [5][6]. - The price reduction for these therapies is expected to range between 15% and 50%, which may facilitate better access to these innovative treatments [6]. Challenges and Opportunities - The new management faces the challenge of improving market penetration for core products and accelerating pipeline development amid intense competition in the new drug development landscape [5][7]. - The company must also navigate hospital access issues to ensure the successful implementation of its products in the healthcare system [6][7].

来源：中新经纬 作者：李自曼 7日，新版国家医保药品目录及首版商保创新药目录(下称商保创新药目录)正式发布。其中，5款CAR-T 产品纳入商保创新药目录，成为业内关注的焦点。 公开信息显示，中国已上市的CAR-T产品价格普遍在百万元左右，被纳入商保目录后，患者能省多少 钱？ 例如，多地惠民保产品覆盖CAR-T用药责任，如龙江惠民保2026版、淄博齐惠保2026、镇江惠民保 2026；不少高端医疗险和特药险，也将CAR-T疗法包含在保障范围内，例如，友邦智选逸生医疗保险； 一些百万医疗险也包含CAR-T相关的特药保障责任，例如众安尊享e生2025版、人保寿险金医保3号等。 今年2月，中再寿险、镁信健康与波士顿咨询公司联合发布的《中国创新药械多元支付白皮书(2025)》 (下称白皮书)显示，据统计，截至2024年12月，奕凯达®已被80余款商业医疗险产品纳入；倍诺达®已 被70余款商业医疗险产品纳入。同样，惠民保也以特药责任或单独的CAR-T责任为其提供保障。据统 计，目前超过60%的惠民保项目提供了CAR-T保障。 此前有患者报销80多万元医疗费 公开信息显示，CAR-T(嵌合抗原受体T细胞)是通过基因修饰使T ...

Core Insights - The newly released National Medical Insurance Drug List and the first Commercial Insurance Innovative Drug List include five CAR-T products, attracting significant industry attention [1][2] Group 1: CAR-T Products and Pricing - The five CAR-T products included in the Commercial Insurance Innovative Drug List are priced around one million yuan each, with specific prices as follows: Fosun Kairui's Acalabrutinib at 1.2 million yuan, WuXi AppTec's Ruxolitinib at 1.29 million yuan, Reindeer Biotech's Ibrutinib at 1.166 million yuan, Huyuan Bio's Naxitamab at 999,000 yuan, and Kexing Life Science's Ziv-aflibercept at 1.15 million yuan [2][4] - Patients previously reported out-of-pocket expenses exceeding 800,000 yuan for CAR-T therapy, highlighting the financial burden before the inclusion in the insurance list [1][4] Group 2: Impact on Patients and Insurance - Following the inclusion of CAR-T products in the insurance list, patients can expect to reduce their out-of-pocket expenses to between 100,000 and 200,000 yuan after insurance reimbursement [2][4] - A case study of a patient who received over 800,000 yuan in reimbursement through a commercial health insurance policy illustrates the potential financial relief for patients undergoing CAR-T therapy [4][6] Group 3: Insurance Market Dynamics - The inclusion of CAR-T products in the insurance list is expected to lead to more health insurance products covering CAR-T therapy, with some existing policies already including partial coverage [5][8] - Current health insurance products that cover CAR-T therapy have varying premium costs, with basic plans starting around 69 yuan annually and more comprehensive plans exceeding 120 yuan [8][9] - The market for commercial health insurance is projected to grow, with estimates indicating that by the end of 2024, commercial medical insurance payouts for CAR-T therapies could exceed 190 million yuan [6][9]

2025 年 12 月 10 日 行业研究 医保和商保目录并轨，扩容与提质并重，支持创新药高质量发展 ——2025 年版医保目录调整政策点评 作者 分析师：王明瑞 执业证书编号：S0930520080004 021-52523867 wangmingrui@ebscn.com 分析师：黄素青 执业证书编号：S0930521080001 021-52523570 huangsuqing@ebscn.com 行业与沪深 300 指数对比图 -12% -4% 4% 12% 20% 12/24 03/25 06/25 09/25 医药生物 沪深300 资料来源：Wind 要点 事件：2025 年 12 月 7 日，国家医保局、人力资源社会保障部发布《国家基本医疗 保险、工伤保险和生育保险药品目录（2025 年）》以及首版《商业健康保险创新药 品目录（2025 年）》，要求进一步推动商业健康保险与基本医保的有效衔接。 点评： 医药生物 基本医保谈判成功率创 7 年新高，首版商保目录纳入 19 种药品。本次调整后，医 保目录内药品总数从 3159 种增加至 3253 种，其中西药 1857 种、中成药 1396 种， 协 ...

今日（12.10），港药探底回升，创新药纯度100%的港股通创新药ETF(159570)微跌0.12%，全天成交额超15亿元！资金面上，昨日净流入超1.1亿元，今日 再获超1亿元净流入，近20日累计"吸金"超19亿元！截至12月9日，港股通创新药ETF(159570)最新规模超230亿元，同类持续领先！ 消息面上，美联储即将于北京时间周四凌晨3点公布最新利率决议。在经历了一段时间对于美联储决策方向的明显犹豫之后，市场目前已基本确信，美联储 将连续第三次降息25个基点，使联邦基金利率降至3.5%-3.75%。 因美联储联邦公开市场委员会（FOMC）出现严重的内部分歧，"鹰派降息（hawkishcut）"已成为本次政策会议的流行说法。在市场术语中，这指的是美联 储虽然会降息，但同时传递出一个信号——没人该指望下一次降息很快到来。 港股通创新药ETF(159570)标的指数权重股多数飘绿：科伦博泰生物-B、康哲药业跌超3%，康方生物跌超2%，百济神州、中国生物制药、三生制药跌超 1%，信达生物微跌；上涨方面，石药集团涨超3%，翰森制药涨超1%。 | 序号 | 代码 | 名称 | 估算权重 | 涨跌幅 | 成交额 | ...

Core Insights - The National Healthcare Security Administration and the Ministry of Human Resources and Social Security have released the new National Medical Insurance Directory and the first Commercial Health Insurance Innovative Drug Directory, set to be implemented nationwide from January 1, 2026 [1][2] Summary by Sections National Medical Insurance Directory - A total of 114 new drugs have been added to the National Medical Insurance Directory, with 111 of them being new products launched within the last five years, representing 97.3% of the new additions [2] - Among the new drugs, 50 are classified as Category 1 innovative drugs, with a success rate of 88%, an increase from 76% in 2024 [2] - The total number of drugs in the directory has increased to 3,253, including 1,857 Western medicines and 1,396 traditional Chinese medicines [2] Company Announcements - Several listed companies, including Heng Rui Medicine, Fosun Pharma, and Hai Si Ke, announced new drug inclusions or renewals in the updated National Medical Insurance Directory [3] - Heng Rui Medicine reported that 20 products/indications were included, with significant coverage across various diseases such as tumors and cardiovascular conditions [3][4] - Hai Si Ke's two Category 1 innovative drugs were included, with one being a new addition and the other a renewal [4] Commercial Health Insurance Innovative Drug Directory - The first Commercial Health Insurance Innovative Drug Directory includes 19 new drugs from 18 innovative pharmaceutical companies, with 9 being Category 1 innovative drugs [7] - Notably, five CAR-T products were included, representing over half of the CAR-T products available in China, which previously faced challenges in entering the insurance market due to high pricing [7][8] - The directory also includes treatments for rare diseases and high-profile conditions such as Alzheimer's disease, enhancing the complementarity with the basic medical insurance [7][10] Notable Drug Inclusions - The directory includes drugs for significant diseases such as triple-negative breast cancer and pancreatic cancer, as well as treatments for rare diseases like Gaucher disease [5][9] - In the diabetes sector, several domestic drugs were newly included, such as a long-acting GLP-1 receptor agonist [6] - Companies like Bei Hai Kang Cheng and Bai Ji Shen Zhou have also successfully included their innovative drugs in the Commercial Health Insurance Directory [9]