Core Insights - The first edition of the "Commercial Health Insurance Innovative Drug Directory" has been released, including 19 innovative drugs, marking the first time the National Healthcare Security Administration has established a drug list specifically for commercial health insurance outside the basic medical insurance directory [1][2] Group 1: Drug Selection and Purpose - The selection process for the 19 drugs was rigorous, with a pass rate of less than 16% from an initial review of 121 drugs, highlighting the directory's role in filling gaps in medication not covered by basic medical insurance [1] - The 19 drugs include treatments for cancer, rare diseases, and Alzheimer's disease, emphasizing high clinical value and significant patient benefits, which cannot be replaced by drugs in the basic medical insurance directory [1][2] Group 2: Impact on Pharmaceutical Companies - The commercial health insurance directory provides direct incentives for pharmaceutical innovation, with about half of the selected drugs being Class 1 new drugs, including high-cost medications [2] - The integration of basic medical insurance and commercial health insurance funding is expected to enhance the economic support for the development of innovative drugs, addressing the previous dilemma faced by high-value innovative drugs [2] Group 3: Future Developments and Adjustments - The commercial health insurance innovative drug directory will be implemented on January 1, 2026, and will undergo dynamic adjustments based on advancements in medical technology, clinical needs, and the development of commercial health insurance [3] - There is an expectation for insurance companies to actively update their health insurance products based on the commercial health insurance directory, improving coverage levels to meet diverse medication needs of the public [3]

Core Viewpoint - The evolution of commercial health insurance paradigms will reshape product and service models, enhancing its role in the innovative drug protection system, as outlined in the "Several Measures to Support the High-Quality Development of Innovative Drugs" released by the National Healthcare Security Administration and the National Health Commission on July 1, 2025 [1] Group 1: Positioning and Responsibilities - The "Several Measures" clarify the functional positioning and responsibilities of basic medical insurance and commercial health insurance in the innovative drug payment system, emphasizing that commercial health insurance will take on the mission of high-value protection [2][3] - The current structure of "惠民保" (benefit insurance) is limited by its design and funding, which restricts its ability to provide sustainable high-value drug protection, as it primarily operates within the basic medical insurance framework [2][3] Group 2: Payment System Optimization - The "Three Exclusions" mechanism proposed in the "Several Measures" provides a clear path for commercial health insurance to participate in the innovative drug payment system, allowing for the payment of self-funded drugs by commercial insurance [4][5][6] - The mechanism includes exemptions from basic medical insurance self-funded rate indicators, exclusion from centralized procurement monitoring, and the ability for certain drugs to be independently funded by commercial health insurance after review [4][5][6] Group 3: Transformation of Commercial Health Insurance - The "Several Measures" drive a transformation of commercial health insurance from a traditional risk manager to a medical value integrator, prompting a systemic overhaul of product logic, pricing mechanisms, and service models [7] - The evolution includes a shift from insuring only healthy individuals to covering those with pre-existing conditions, enhancing inclusivity in the insurance system [7] - There is a move towards more precise product design, allowing for tailored coverage based on disease classification, treatment pathways, and patient characteristics [7][8] Group 4: Internationalization and Global Market Opportunities - The "Several Measures" signal support for market-oriented payment mechanisms, creating opportunities for the internationalization of commercial health insurance alongside the export of Chinese innovative drugs [9][10] - The flexibility of commercial health insurance allows for collaboration with reinsurance companies and local payers to implement innovative drug protection solutions abroad, enhancing accessibility [9][10]