除外支付，更通俗地来说，就是对住院病例使用创新药的费用单独按实结算，不占用医保打包支付中对 应病组额度。 在国家医保局承诺对纳入商保创新药目录内药品执行的"三除外"政策中，"相关商业健康保险保障范围 内的创新药应用病例可不纳入按病种付费范围"被业界普遍视为对商保创新药目录内药品"进院"最为利 好也是最难执行的一条。 正如前述达妥昔单抗β注射液的案例，目前，北京、上海、浙江等省份为支持新药新技术应用而发布的 地方版激励清单中，已可见少数与商保创新药重叠的"身影"。但针对绝大多数商保创新药和更多医保统 筹地区，商保创新药的住院使用，仍面临与其他高倍率病例争夺特例单议名额的不确定性。 同时，创新药"进院"不仅仅要"进住院部"，也要"进门诊"。多名受访业界人士坦言，商保创新药的门诊 用药激励还处于政策空白阶段。 商保创新药的门诊用药激励还处于政策空白阶段。 今年1月1日起，首版商保创新药目录正式落地。在北京，与该目录同一天落地的是"第二批DRG付费新 药新技术除外支付名单"，纳入前述目录的达妥昔单抗β注射液赫然在列。 截至1月8日，据第一财经不完全统计，全国已有至少28个省份明确当地定点医疗机构要在2月底前召开 药事 ...

多天前，首版《商业健康保险创新药品目录》公布，目录中19种创新药被正式推向了商业健康保险的舞台中央。业内正翘首以待，谁会将目录中的创新药纳 入保险保障，成为第一批"吃螃蟹"的保险机构。一则"官宣！复星联合健康保险9款医疗险覆盖商保创新药！"的推文便在保险圈炸开了锅。 不过，此事却出现了"反转"。北京商报记者查看复星联合健康保险微信公众号，该推文显示已删除。 "根据我们接到的通知，官微推文确实已经撤销。"北京商报记者拨通了复星联合健康保险总公司消费者权益保护专线。对于相关公告删除的原因，相关人员 表示，目前还没有商议敲定，所以就撤掉了。 对于是否会再次公告等问题，上述人员告诉记者，到时以实际发布的内容为准。 然而，市场情绪的升温尚未持续太久，便出现了异样。12月18日，北京商报记者注意到，这篇承载着行业期待的"官宣"文章，在其官方微信公众号上已然不 见踪影，只留下"已删除"的提示。一场备受瞩目的"官宣"，在众目睽睽之下上演了"撤回"的戏码。那么，从高调宣布到悄然撤回，这"虚晃一枪"的背后，原 因几何？对于整个健康险市场而言，首版商保创新药目录的发布，究竟意味着怎样的机遇与变局？ 撤回"官宣"，公司回应 "官宣！ ...

Core Insights - The National Healthcare Security Administration (NHSA) has introduced 114 new drugs to the basic medical insurance catalog for 2025, with a significant focus on innovative treatments and a record number of new drugs added [1][5][6] Summary by Sections New Drug Additions - A total of 114 drugs were added to the basic medical insurance catalog, including 105 through negotiation, 7 through competitive bidding, and 2 directly from national procurement [1] - Among the new additions, 111 are new products launched within the last five years, representing nearly 98% of the total, with 50 classified as Category 1 new drugs, marking a historical high in both proportion and quantity [1][5] Therapeutic Areas - The newly added drugs cover critical therapeutic areas such as oncology, anti-infection, chronic diseases, rare diseases, and mental health, addressing diverse clinical needs [1][5][6] Directory Adjustment Process - The adjustment process involved four main stages: application, review, negotiation/bidding, and results. A total of 718 applications were received, with 535 passing the initial review, resulting in an 85% approval rate [3] - In the expert review phase, 311 drugs were evaluated, with 129 passing, leading to a 41.48% approval rate [3][4] Negotiation Success Rates - The negotiation and bidding phase saw 127 drugs participate, with 112 successfully negotiated, achieving a success rate of 88.19%, the highest since 2018 [4][5] Commercial Insurance Innovation - The first commercial insurance innovative drug catalog was released alongside the basic insurance adjustments, featuring 19 innovative drugs from 18 companies, with 9 being Category 1 new drugs [2][7] - The commercial insurance catalog aims to complement the basic insurance, providing additional support for high-cost innovative drugs while ensuring basic medication needs are met [2][8] Future Considerations - The NHSA emphasizes the importance of a multi-layered medical insurance system, encouraging the integration of commercial health insurance and innovative drug catalogs to enhance patient access to diverse treatment options [8][10] - Key challenges include aligning the different execution cycles of basic insurance and commercial products, as well as improving communication between insurance companies and pharmaceutical firms [9][10]

黄心宇表示，纳入商保创新药目录的药品需要有4个特点，分别是：创新程度普遍较高、临床价值比较 大、不能被基本医保目录内药品替代、适合商保使用（即"适保性"）。 北京商报讯（记者 李秀梅）12月9日晚间，国家医保局医药服务管理司司长黄心宇在"2025年医保药品 目录解读活动"中表示，商保创新药目录申报过程中，共收到141个药品申报，有121种通过了形式审 查，最终19种药品进入商保创新药目录。 ...

2025.12. 09 本文字数：2099，阅读时长大约4分钟 作者 | 第一财经 郭晋晖 按照30%的药占比计算，我国每年约3万亿元的医疗保险基金支出中，有超过1万亿元用于药品支出， 这是我国医保基金支持医药创新的"基本盘"。 在12月7日的2025创新药高质量发展大会上，国家医保局局长章轲表示，医保购买创新医药产品，就 是为群众买健康，为健康买未来。医保基金作为中国医药领域最大的购买方，"十四五"期间累计支出 约13万亿元，并保持了年均10%以上的较高增速，为创新提供了稳定的资金来源，注入了持久的发展 动力。 2025年基本目录调整中新增114种药品，其中50种是一类创新药，再创新高。本次调整后，目录内药 品总数增至3253种，其中西药1857种、中成药1396种，肿瘤、慢性病、精神疾病、罕见病、儿童用 药等重点领域的保障水平得到明显提升。 医保仍然是中国创新药主要的支付方。 医保基金已为创新药支付超4600亿元 党的二十届四中全会明确提出，要加快建设健康中国，支持创新药和医疗器械发展。 章轲表示，国家医保局通过价值引领战略购买，实现需方牵引，旗帜鲜明地支持医药创新，有渴望创 新的基因，有服务创新的抓手， ...

Core Insights - The release of the 2025 National Medical Insurance Drug List and the first version of the Commercial Insurance Innovative Drug List marks a significant step in the construction of a multi-tiered medical security system, enhancing the accessibility of essential medications while diversifying options for patients [1] Group 1: National Medical Insurance Drug List - The updated National Medical Insurance Drug List includes 114 new drugs, significantly improving coverage for key areas such as cancer, chronic diseases, mental health, rare diseases, and pediatric medications [1] - The approach of combining basic medical insurance with commercial insurance reflects the government's commitment to improving drug accessibility for the public and addressing diverse medication needs [1] Group 2: Commercial Insurance Innovative Drug List - The first version of the Commercial Insurance Innovative Drug List includes 19 drugs, primarily those with high innovation and clinical value [1] - The dual-list system aims to balance the principles of basic insurance coverage while providing a pathway for high-value innovative drugs, thus encouraging pharmaceutical companies to invest in research and development [1] Group 3: Benefits of the Dual-List System - The implementation of the dual-list system is expected to create a win-win situation for multiple stakeholders, allowing patients to reduce their economic burden through commercial insurance reimbursement for certain medical expenses [1] - Drugs included in the Commercial Insurance Innovative Drug List can benefit from support policies for hospitalization, while commercial insurance can increase enrollment rates by including these innovative drugs [1] Group 4: Future Considerations - Future efforts are needed to break down data barriers between basic medical insurance and commercial insurance, establishing a one-stop settlement system to better leverage the roles of basic insurance and commercial insurance [2]

新华社记者12月7日从国家医保局获悉，2025年国家医保药品目录及首版商保创新药目录在广州发布。 2025年国家医保药品目录成 功新增114种药品，有50种是一类创新药 ，总体成功率88%，较2024年的76%明显提高。 19种药品纳入首版商保创新药目录。 此次调整后， 国家医保药品目录内药品总数增至3253种，其中西药1857种、中成药1396种 ，肿瘤、慢性病、精神疾病、罕见病、 儿童用药等重点领域的保障水平得到明显提升。 来源丨新华社 编辑丨刘雪莹 百万一针抗癌神药有望降至10万以下 Space X冲击5.7万亿估值，马斯克深夜回应 芯片重要并购终止，双方均有小米系参股 SFC 2 1君荐读 2025年国家医保药品目录纳入了一些弥补基本医保保障空白的药品， 如三阴乳腺癌、胰腺癌、肺癌等重大疾病用药；朗格汉斯细胞 组织细胞增生症、螯合剂不耐受的地中海贫血症等罕见病用药；糖尿病、高胆固醇血症、自身免疫性疾病等慢性病用药。 纳入首版商保创新药目录的19种药品中，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，还有阿尔茨 海默病治疗药品等。 ...

Core Insights - The National Healthcare Security Administration (NHSA) has initiated negotiations for the 2025 National Basic Medical Insurance (BMI) drug list and the commercial insurance innovative drug list from October 30 to November 3, with participation from 120 domestic and foreign enterprises [1] - This year marks a significant change as the commercial insurance innovative drug list has been added to the directory adjustment process, running concurrently with the basic medical insurance directory work [1] - The new basic medical insurance drug list and the first version of the commercial insurance innovative drug list are expected to be released online and offline in Guangzhou on the first weekend of December, with implementation set for January 1, 2026 [1] Summary by Categories Negotiation and Participation - A total of 127 drugs outside the directory participated in the BMI drug list negotiations, while 24 drugs were involved in the price negotiations for the commercial insurance innovative drug list [1] Changes in Drug Listing Process - The inclusion of the commercial insurance innovative drug list in the directory adjustment process represents a new approach compared to previous years, indicating a shift towards integrating commercial insurance with basic medical insurance [1] Timeline for Implementation - The NHSA plans to complete the necessary technical, administrative, and legal procedures before the release of the new drug lists, which will be officially implemented starting January 1, 2026 [1]

Core Points - The new basic medical insurance drug catalog and the first version of the commercial insurance innovative drug catalog are set to be released in Guangzhou on the first weekend of December, with implementation starting on January 1, 2024 [1] - The recent negotiations involved 120 domestic and foreign enterprises, with 127 drugs outside the basic medical insurance catalog participating in the negotiations, and 24 drugs involved in price negotiations for the commercial insurance innovative drug catalog [3] - The commercial insurance innovative drug catalog was organized by the National Medical Insurance Administration, allowing companies to apply for inclusion in either the basic medical insurance catalog or the commercial insurance innovative drug catalog, or both [5] Industry Insights - The addition of the commercial insurance innovative drug catalog aims to better meet the diverse medication needs of the population, with 1.326 billion people covered by basic medical insurance in 2024, maintaining a coverage rate of 95% [6] - Total expenditure for the basic medical insurance fund is projected to reach 2.97 trillion yuan in 2024, providing solid support for healthcare access [6] - The commercial health insurance market is experiencing rapid growth, with premium income reaching 977.3 billion yuan in 2024, an increase of 8.2% year-on-year, although there remains significant room for improvement in coverage levels compared to basic medical insurance [6] - Challenges exist in synchronizing medical insurance and commercial insurance settlements across provinces, but initiatives like the "commercial insurance + medical insurance" one-stop settlement payment platforms have been launched in various regions [6]

Core Insights - The National Healthcare Security Administration (NHSA) is organizing negotiations for the 2025 National Basic Medical Insurance (BMI) drug list and the commercial insurance innovative drug list from October 30 to November 3, with participation from 120 domestic and foreign companies [1] - A total of 127 drugs outside the current BMI list are involved in the negotiations, while 24 drugs are participating in the price negotiations for the commercial insurance innovative drug list [1] - The new BMI drug list and the first commercial insurance innovative drug list are expected to be released online and offline in Guangzhou during the first weekend of December, with implementation starting on January 1 of the following year [1]