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。 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。 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 药事会。 商保创新药"进院"细则待明确 要么纳入商 ...

一老一小，是千家万户的牵挂，也是医保改革的温度表。在广东，生娃几乎不花钱已经照进了现实。 2025年以来，广州1万多名产妇出院结账时自付不到100元，近200位宝妈实现"零自付"。更让宝妈们惊 喜的是，12月起，广州将生育津贴直发个人，单位中转成为历史。新政首月，众多宝妈享受到这份直达 快享。 7月，梅州落地长期护理保险。广东60岁以上老人近1900万，长护险正从广州等试点城市走向全省覆 盖。对失能家庭而言，这不仅是省钱的利好，更是专业的守护。 医保缴费也迎来变革。连续参保满4年，每多缴一年，大病保险最高能多报3800元。但对断保的人，医 保也亮出了"黄牌"。断缴就要等3个月才能享受待遇，断得越久等得越久，这遏制"健康时退保、生病时 赶场"的投机行为，确保医保基金可持续。 同时，职工医保个人账户的钱，也能给配偶、父母、子女，甚至兄弟姐妹、祖父母用了。此外，10种门 诊慢特病已可以跨省直接结算，全省16个地市支持个人账户跨省使用，异地就医更加便捷。 羊城晚报记者 陈辉 年底，国家医保局在广东发布首份《商保创新药目录》，19种百万级的"救命药"上榜。这些药虽不进医 保报销，但医院却被松了绑：不计药占比、不进集采监 ...

问题二：首批19种药品聚焦哪些治疗领域？ 首批纳入目录的19种药品来自18家企业，以新机制、新靶点药物为主，其中包含9个一类新药，体 现了与基本医保目录的错位发展与互补定位。涵盖CAR-T细胞治疗产品以及戈谢病、短肠综合征、神经 母细胞瘤等罕见病治疗药物，填补了当前基本医保目录的保障空白。 问题三：如何理解"三除外"原则？ 我国首版商业健康保险创新药目录（以下简称"商保创新药目录"）近日正式发布，共纳入19种创新 药品。该目录将于2026年1月1日起实施，标志着我国在构建多层次医疗保障体系方面迈出关键一步。 针对社会各界普遍关心的问题，《金融时报》记者进行了梳理。 问题一：为何设立商保创新药目录？ 我国基本医疗保险遵循"保基本"原则，旨在覆盖广泛人群的基本医疗需求。部分临床价值高、价格 昂贵的创新药，若全部纳入医保，可能对基金可持续运行构成压力。为此，国家探索建立医保与商保协 同的"双目录"机制，增设商保创新药目录，重点收录尚未纳入基本医保、但具有显著临床价值的高值药 品，通过商业健康险渠道进行费用补偿，从而缓解患者经济负担。 商保创新药目录的出台，为商业健康险参与创新药保障提供了明确的政策接口与药品范围指引 ...

Group 1: Insurance Sector Performance - The insurance sector has shown strong performance, with China Ping An rising nearly 5%, China Taiping increasing by 3.5%, and China Life and Xinhua Insurance both up over 2.6% [1] - The Securities Insurance ETF (512070) has increased by over 12% year-to-date, with a scale of 16.2 billion yuan, tracking the CSI 300 Non-Bank Financial Index [1] - The Insurance Securities ETF (515630) has risen by over 8% year-to-date, with a scale of 499 million yuan, tracking the CSI 800 Securities Insurance Index [1] Group 2: Regulatory Changes - The National Financial Regulatory Administration has adjusted risk factors for insurance companies, lowering the risk factor for stocks held over three years from 0.3 to 0.27 and for stocks held over two years from 0.4 to 0.36 [2] - The adjustments are expected to release a minimum capital of approximately 19.8 billion yuan, which could lead to an additional 72.6 billion yuan in funds if fully allocated to stock investments [2] Group 3: Market Outlook for Securities and Insurance - Current market conditions indicate a mismatch between fundamentals and valuations in the brokerage sector, with potential catalysts including institutional resumption of trading and performance reports in January [3] - The insurance industry is viewed positively for systemic value reassessment opportunities, with asset management remaining a core driver of insurance company valuations [3] - The combination of wide fiscal and monetary policies is expected to enhance liquidity and stabilize economic growth, benefiting the long-term operating environment for the securities industry [4] Group 4: Health Insurance Innovations - The release of the first commercial health insurance innovation drug directory is expected to enhance the attractiveness of health insurance products [5] - This directory will provide clear guidelines for commercial health insurance, aiding companies in product design and risk management while promoting high-quality market development [5]

Market Overview - The Hong Kong stock market experienced a decline, with the Hang Seng Index closing at 23,831 points, down 145 points or 0.61% [1] - The market turnover decreased to 82.799 billion, with net inflows of 484 million in the Hong Kong Stock Connect [1] - The US stock market faced pressure from negative news regarding major tech companies, leading to declines in major indices, including a 1.69% drop in the Nasdaq Composite Index [2] Industry Insights - The AI industry in China is accelerating, with the core industry expected to exceed 1 trillion yuan by 2025. The application of large models in manufacturing has increased from 19.9% to 25.9% this year [3] - The report emphasizes that technological self-reliance will be a core theme for the Hong Kong stock market, with leading companies in relevant sectors likely to see long-term growth opportunities [3] - Investment recommendations include focusing on sectors such as AI applications, semiconductors, and state-owned enterprises with low valuations and high dividends [3] Company Performance - Baidu Group is highlighted for its AI strategy and performance, with a projected revenue of 32.713 billion yuan for Q2 2025, showing a year-on-year decline of 3.59% but a quarter-on-quarter increase of 0.80% [10] - The report suggests that Baidu's core business remains stable, with growth potential in its AI-driven cloud services [10] - Other companies mentioned for potential investment include Semiconductor Manufacturing International Corporation and ZTE Corporation, which are positioned to benefit from the modernization of China's industrial system [9]

港股创新药板块午后持续反弹，截至14:56，恒生港股通创新药指数上涨1.3%，有望终结四连阴，成分 股中，康方生物涨超5%，映恩生物、云顶新耀、诺诚健华等涨超3%，恒生创新药ETF（159316）成交 额超5亿元。 恒生港股通创新药指数是ETF跟踪的指数中首批"纯度"达100%的创新药指数，聚焦港股创新药领军企 业，恒生创新药ETF（159316）为目前市场上唯一跟踪该指数的产品，可助力投资者便捷把握板块投资 机会。 近日，国家医保局、人力资源社会保障部公布"医保目录"和"商保创新药目录"，将于2026年1月1日起在 全国范围内正式实施。其中，医保目录成功新增114种药品，含50种一类创新药；首版商保创新药目录 纳入19种药品，标志着"医保+商保"多层次医疗保障体系取得实质性突破。 中泰证券研报称，创新药仍是目前医药板块最重要的主线，且近2—3个月实现了震荡调整，股价位置、 市场预期、资金配置等均回到了相对合理偏低的位置，投资安全边际及收益回报价值凸显。可积极布局 2026年伴随价格出清、需求复苏、经营周期拐点有望出现基本面改善的板块及个股。 （文章来源：每日经济新闻） ...

01 12月10日，A股市场调整，个股表现分化。房地产板块异军突起，多只房地产相关ETF位居ETF市场涨幅榜前列。 02 12月10日，农业板块表现亮眼。种业、土地流转、水产品等主题表现强势，农业股整体表现活跃，农业相关主题ETF涨 幅居前。 03 上周，科技类ETF显著吸金，多只相关主题ETF上周净流入额超10亿元。本周前两个交易日，资金持续流入科技类 ETF。其中，科创债、科创板代表指数、恒生科技指数等相关主题ETF显著吸金。 房地产类ETF领涨 今日，房地产板块表现强势，多只成分股涨停，房地产类ETF跻身ETF市场涨幅榜前列。 | 代码 | 名称 | 现价 | 今日涨幅 | | --- | --- | --- | --- | | 159768.SZ | 房地产ETF | 0.575 | 3.79% | | 159707.SZ | 地产ETF | 0.64 | 3.73% | | 512200.SH | 房地产ETF | 1.534 | 3.09% | | 515060.SH | 房地产ETF基金 | 0.732 | 2.95% | | 159542.SZ | 工程机械ETF | 1.419 | 2.23 ...

12月7日，在2025年创新药高质量发展大会上，首版《商业健康保险创新药品目录》（以下简称"商 保创新药目录"）正式发布。商保创新药目录共纳入19种药品，涵盖CAR-T等肿瘤治疗药物、神经母细 胞瘤和戈谢病等罕见病治疗药物，以及阿尔茨海默病治疗药物。 商保创新药目录发布的意义，远不止一份药品清单本身。 长期以来，"救命药买不起、报不了""创新药看得见、用不上"是困扰许多患者的痛点，也是我国多 层次医疗保障体系建设的堵点。基本医保作为"保基本"的民生底线，虽然通过每年动态调整将更多药品 纳入了基本医保目录，但受医保基金承受能力限制，仍需在保障范围与可持续性之间寻求平衡，众多临 床价值高、价格昂贵的创新药难以纳入。作为基本医保的重要补充，商业健康保险能够填补这一保障空 白，满足人民群众多样化、多层次的健康需求。商保创新药目录的出台，正是瞄准了这些"医保之外、 生命所需"的领域，与基本医保目录共同为人民群众健康筑起"双保险"。 对于商业健康险市场而言，商保创新药目录的发布堪称其转型发展的"导航图"。长期以来，商业健 康险产品同质化严重，保障责任趋同，差异化不足。商保创新药目录将有助于保险公司依据目录内药品 特性、适 ...

Core Insights - The establishment of the commercial insurance innovative drug directory marks the entry of China's medical security system into a "dual directory" era, enhancing the coverage of innovative drugs [1][2] - The 2025 National Medical Insurance Drug List has added 114 new drugs, including 50 innovative drugs, addressing gaps in basic medical insurance for major diseases and rare conditions [1] - The total number of drugs in the National Medical Insurance Drug List has increased to 3,253, significantly improving coverage for critical areas such as oncology, chronic diseases, and rare diseases [1] Group 1 - The dual directory system aims to better meet patient medication needs, support the development of innovative drugs, and alleviate the burden on basic medical insurance [2] - The inclusion of innovative drugs in the commercial insurance directory is expected to create a win-win situation for pharmaceutical companies and insurance providers [2] - The first commercial insurance products to adopt the innovative drug directory are anticipated to be community health insurance plans, with high-value drugs like CAR-T already included in some local plans [2] Group 2 - The Shanghai "new group insurance" is expected to launch in December, potentially becoming the first commercial health insurance product to incorporate the innovative drug directory [2] - The measures to promote the high-quality development of commercial health insurance are aimed at supporting the innovation of the biopharmaceutical industry [2]

Core Viewpoint - The introduction of the commercial insurance innovative drug directory will create a win-win situation for patients, insurance companies, and hospitals, allowing patients access to innovative drugs, insurance companies to benefit from discounts, and hospitals to enhance their diagnostic capabilities and influence [1][7]. Summary by Sections Commercial Insurance Directory Release - On December 7, the National Medical Insurance Administration released the adjusted national basic medical insurance directory and the first version of the commercial insurance innovative drug directory, adding 114 new drugs to the basic insurance directory and 19 drugs to the commercial insurance directory [2]. Support for Innovation - The National Medical Insurance Administration aims to clarify the boundaries of basic medical insurance coverage and leave room for the development of commercial insurance, focusing on supporting true and differentiated innovations rather than redundant innovations [3][15]. Drug Selection Criteria - The drugs included in the commercial insurance directory are characterized by high innovation, significant clinical value, non-replaceability by existing basic insurance drugs, and strong insurability [6][11]. Market Dynamics - The commercial insurance directory is expected to provide coverage primarily for high-cost treatments after second and third-line therapies, indicating that it is designed to supplement existing basic insurance rather than simply overlap with it [7][10]. Insurance Product Development - Insurance companies are encouraged to design products that align with the commercial insurance directory, focusing on specific populations and innovative drugs [8][10]. Challenges and Considerations - The main challenges for commercial insurance include improving the efficiency of claims processing, ensuring that products cover truly innovative drugs, and addressing the potential issue of adverse selection if sick individuals are more inclined to purchase insurance [12][13]. Future Outlook - The commercial insurance directory is expected to officially launch on January 1, 2026, with insurance companies likely to introduce corresponding products shortly thereafter [10][12]. Regulatory Support - The National Medical Insurance Administration is committed to supporting true innovation and has implemented stricter evaluation criteria for new drugs, resulting in a lower approval rate for submissions [16][18]. Financial Impact - As of October 2025, the medical insurance fund has paid over 460 billion yuan for negotiated drugs, benefiting over 1 billion patients and driving related sales exceeding 670 billion yuan, demonstrating substantial financial support for the development of innovative drugs [18].