除传统的国家医保药品目录外，今年还新增了商业健康保险创新药目录，19种药品纳入其中，既有CAR-T等肿瘤治疗药品，也有 神经母细胞瘤、戈谢病等罕见病治疗药品，还有社会关注度较高的阿尔茨海默病治疗药品，商保创新药目录是对基本医保的有效补 充，患者可以通过商业保险，用上医保不覆盖的创新药。 国家医疗保障局医药服务管理司目录处处长 涂继莹：对商业健康保险来说，因为有国家背书，通过创新药物的品牌效应，能够 吸引更多的人来进行参保，实际上是降低了商业健康保险的获客成本。 央视网消息：12月7日，新版国家医保药品目录及首版商保创新药目录正式发布，114种药品成功纳入医保、19种新药进商保创新 药目录。全面升级后的药品目录，有助于满足民众多元化、多层次用药需求，让新药、好药更加可及，新版目录将于2026年1月1日在 全国范围内正式实施。 聚焦临床急需、医保可负担。本次目录调整新增114种药品，29种临床用不上或有更好替代的药品被调出目录。调整后的目录内 药品总数增至3253种，其中西药1857种、中成药1396种。此次调整有50种药品为一类创新药，创新药正以更快速度惠及患者，肿瘤、 慢性病、精神疾病、罕见病、儿童用药等重点 ...

Group 1 - The core point of the article is the introduction of a commercial health insurance innovative drug directory in the 2025 national medical insurance catalog adjustment, marking the first time the National Healthcare Security Administration has established such a directory [1] - The adjustment aims to enhance the availability of innovative drugs through commercial insurance, addressing the diverse medication needs of the population [1] - The basic medical insurance coverage rate in China has stabilized around 95%, but the overall funding level remains low, necessitating the inclusion of more innovative drugs in commercial insurance [1] Group 2 - There is a lack of collaboration between basic medical insurance and commercial insurance, leading to issues such as "duplicate insurance" and "coverage gaps" for the public [3] - The National Healthcare Security Administration is exploring ways to support the differentiated development of commercial health insurance alongside basic medical insurance [3] - In the past year, several cities have implemented "commercial insurance + medical insurance" one-stop settlement payment platforms, facilitating automatic recognition of patients' insurance qualifications [5] Group 3 - A national "medical insurance + commercial insurance" clearing settlement center has been launched in Beijing to address the challenges faced by patients seeking cross-province medical services [7] - Patients can now achieve one-stop settlement for both medical and commercial insurance at pilot hospitals in Beijing, such as Peking Union Medical College Hospital and Xuanwu Hospital [7]

Core Viewpoint - The National Healthcare Security Administration (NHSA) has introduced a new directory for innovative drugs under commercial health insurance, supporting pharmaceutical innovation in China [1] Group 1 - The NHSA has reported that over 100 drugs have been submitted for the innovative drug directory [1] - This initiative is part of the efforts to achieve high-quality completion of the "14th Five-Year Plan" [1] - The NHSA will proceed with the necessary follow-up work according to established procedures [1]

Core Viewpoint - The National Medical Insurance Administration emphasizes the importance of enhancing the quality of medical insurance services during the "14th Five-Year Plan" period, focusing on improving access and affordability for the public [1][3]. Group 1: Medical Insurance Coverage and Expenditure - The national basic medical insurance coverage rate has remained stable at around 95%, with a cumulative expenditure of 12.13 trillion yuan, averaging an annual growth rate of 9.1% [1]. - By 2024, the number of people covered by basic medical insurance is expected to reach 1.327 billion [1]. - Nearly 200 billion medical insurance reimbursements have been enjoyed by approximately 200 million people from 2021 to 2024 [1]. Group 2: Support for Specific Demographics - Measures have been taken to enhance support for the elderly and children, including the establishment of a long-term care insurance system, with 190 million participants by the end of 2024 [2]. - The cumulative expenditure for maternity insurance has reached 438.3 billion yuan, benefiting over 96 million people [2]. Group 3: Reducing Medical Costs - Policies have reduced the financial burden on rural low-income populations by over 650 billion yuan during the "14th Five-Year Plan" [3]. - The long-term care insurance has benefited over 2 million disabled individuals, reducing care service costs by over 50 billion yuan [3]. - Direct settlement for cross-provincial medical treatment has reduced the need for out-of-pocket expenses by 590 billion yuan [3]. Group 4: Technological Advancements in Medical Insurance - A unified national medical insurance information platform has been established, significantly improving management efficiency [4]. - The number of people using medical insurance codes has exceeded 1.236 billion, facilitating direct payment for medical services [4]. - The number of direct settlements for cross-provincial medical treatment has increased from 5.37 million in 2020 to 23.8 million in 2024, a 44-fold increase [4]. Group 5: Fund Management and Security - By the end of 2024, the cumulative balance of the medical insurance fund is expected to reach 3.86 trillion yuan [5]. - The administration has recovered 104.5 billion yuan through enhanced fund management and monitoring [5]. - Innovative regulatory measures have been implemented to combat fraud, including the use of big data analysis to identify irregularities [6]. Group 6: Support for Innovative Drugs - Expenditure on innovative drugs has increased significantly, with spending in 2024 being 3.9 times that of 2020, reflecting an annual growth rate of 40% [8]. - A total of 402 new drugs have been added to the medical insurance catalog since the beginning of the "14th Five-Year Plan" [8]. - The establishment of a commercial health insurance catalog for innovative drugs has seen over 100 drugs submitted for approval [9]. Group 7: Future Directions - The National Medical Insurance Administration aims to continue managing the medical insurance fund effectively while supporting the development of the pharmaceutical industry [9]. - The focus will be on providing efficient, safe, and accessible medical products and services to the public, contributing to the overall health of the nation [9].

Group 1 - The core viewpoint of the news highlights the active trading and significant inflow of funds into the Hang Seng Innovative Drug ETF (159316), indicating a growing interest in innovative drug investments in the Hong Kong market [1][2] - As of June 26, the latest scale of the Hang Seng Innovative Drug ETF reached 367 million yuan, with a total share of 292 million, both hitting record highs since its inception [1] - The recent issuance of the "2025 Basic Medical Insurance Directory and Commercial Insurance Innovative Drug Directory Adjustment Application Guidelines" by the National Medical Insurance Administration marks a significant step in integrating commercial health insurance into the multi-level medical security system [1] Group 2 - The report from Guosen Securities suggests that the large population of chronic disease and non-standard patients in China, coupled with the reform of medical insurance payment methods, indicates a long-term unmet medical demand [1] - The changing landscape of medical insurance payments is expected to enhance the supplementary role of commercial health insurance, presenting a stable development opportunity for the commercial insurance market in the medium to long term [1] - The Hang Seng Innovative Drug ETF closely tracks the Hang Seng Innovative Drug Index, which reflects the performance of Hong Kong-listed companies involved in the research, development, and production of innovative drugs [1][2]

Core Viewpoint - The recent issuance of the "2025 Basic Medical Insurance Directory and Commercial Health Insurance Innovative Drug Directory Adjustment Application Guidelines" by the National Medical Insurance Administration marks a significant step in integrating commercial health insurance into China's multi-tiered medical security system, enhancing the role of commercial health insurance in the market for innovative drugs [1][2]. Group 1: Policy Changes - The adjustment includes the first-time incorporation of the commercial health insurance innovative drug directory into the adjustment scheme, representing a major transformation in the healthcare insurance landscape [3]. - The guidelines require applicants to register and obtain a unique account for the directory adjustment process, indicating a structured approach to the application [3]. - The government work report emphasizes the need to deepen medical insurance payment reform and support the development of innovative drug directories to better meet the public's multi-tiered medication needs [4]. Group 2: Market Opportunities - The payment reform initiated by the National Medical Insurance Administration since 2019 has aimed to control unreasonable expenditures and improve the efficiency of medical insurance fund usage, creating a favorable environment for the growth of commercial health insurance [5]. - The aging population and the slowdown in medical insurance revenue growth have increased the necessity for payment reform, leading to a diverse demand for medical services and providing broader space for the development of commercial health insurance [5]. - Industry experts believe that as healthcare demands rise, commercial insurance will play a more significant role in enhancing the multi-tiered medical security system and supporting the health of the nation [5]. Group 3: Future Prospects - The current landscape of chronic diseases and non-standard patient populations presents a substantial market for commercial health insurance, especially in light of the ongoing payment reform [6]. - The potential for steady long-term development of commercial health insurance is highlighted, with an emphasis on expanding outpatient coverage and catering to non-standard patient groups [7]. - High-end medical insurance is positioned as a core vehicle for meeting quality healthcare demands due to its broad coverage and high service integration [7].