● 本报记者 王宇露 历经两个多月的调整，医药主题基金正悄然吹响反攻的号角。近期多只医药主题基金业绩止跌回稳，部 分基金甚至重拾涨势。与此同时，医保谈判首次引入"商保创新药目录"机制，犹如一剂强心针，极大点 燃了市场热情，相关ETF火爆放量。机构认为，医药板块特别是创新药领域，在支付体系革新与业绩兑 现的双轮驱动下，其长期投资价值正迎来新一轮的释放窗口。 医药基金重拾涨势 据悉，"商保创新药目录"主要纳入超出基本医保定位、暂时无法纳入基本目录，但创新程度高、临床价 值大、患者获益显著的创新药，推荐商业健康保险、医疗互助等多层次医疗保障体系参考使用。 湘财证券研究报告显示，商业保险对创新药的支付金额预计从2024年的124亿元大幅增长至2035年的 4400亿元，占比从8%提升至44%，商业保险有望成为未来创新药支付的重要方式。 华泰柏瑞基金认为，推动创新药支付体系从单一医保走向"医保+商保"的双轮驱动，高价值创新药的支 付压力有望通过商保渠道分流，从而推动未来创新药市场规模扩容和业绩持续兑现。 创新药板块前景向好 展望后市，机构对医药行业和创新药的投资前景仍较为乐观，前期的调整反而带来了布局窗口。 今年以来， ...

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，精准汇聚港股创新药领军 企业；中证创新药产业指数则聚焦于A股创新药赛道，由不超过50家主营业务涵盖创新药研发的龙头公 司组成，在当前政策与产业趋势双重利好下，指数成分股有望持续受益于行业高质量发展。 近期创新药板块资金布局意愿强烈，11月以来，全市场创新药相关ETF合计净流入超80亿元，一定程度 上反映出市场对板块投资价值的青睐。 政策面上，首版"商保创新药目录"将于12月初正式发布，为创新药支付开辟了重要渠道；产业层面，中 国创新药"出海"势头迅猛，2025年1-10月License-out总金额已突破千亿美元，同比增速超190%，交易覆 盖了ADC、双抗等多个前沿技术领域。 分析指出，中国在全球创新药BD交易中的项目数占比已从2019年的3%跃升至2024年的13%，金额占比 从1%提升至28%，显示了中国创新药企强劲的全球竞争力。 恒生创新药ETF（159316）与创新药ETF易方达（516080）分别跟踪上述指数，为投资者提供了便捷布 局前沿创新药企业的工具。 （文章来源：每日经济新闻） ...

2025.11. 10 本文字数：3877，阅读时长大约6分钟 作者 | 第一财经 吴斯旻 首版商保创新药目录拟于12月第一个周末发布，于明年1月1日起正式实施。 今年有121个药品通过商保创新药目录的形式审查，其中80个左右药品同时申报了基本医保目录和 商保创新药目录。国家医保局11月4日撰文称，今年的"国谈"中参与商保创新药目录价格协商的药 品有24个。 "几个月前，业界就讨论认为如CAR-T、阿尔茨海默症治疗药物等用药指征明确或适应证人群规模可 控、商保价格杠杆作用较大的高价值创新药有可能率先纳入商保目录，首版目录纳入的药品数量不会 过多，大概在30个。从谈判结果来看，大致符合业界预期。"一名受访商保业界人士表示。 国家医保局提出，"通过协商合理确定商保创新药目录内药品结算价，探索更严格的价格保密机 制"。 通俗来说，在确保创新药市场定价不改变的前提下，药企通过厘定返现条款，承诺给予保司一定的支 付折扣，以换取药品在商保报销目录中的优先位置。对于协商内容（如折扣比例）、具体方案和相关 条款等则不予公开，双方承诺履行保密责任。 "比如，假设药企承诺让利商保公司10%，两地惠民保对该药赔付规模分别是100万 ...

Core Insights - The industry has not reached a consensus on the relationship between negotiated discount prices and claims for innovative drugs under commercial insurance [1][2] - The first version of the commercial insurance innovative drug directory is set to be released on the first weekend of December and will be implemented starting January 1 of next year [1] - A total of 121 drugs have been reviewed through the commercial insurance innovative drug directory this year, with around 80 drugs applying for both the basic medical insurance directory and the commercial insurance innovative drug directory [1] Group 1: Expectations and Challenges - Different stakeholders have varying expectations from the commercial insurance innovative drug directory; pharmaceutical companies hope to expand coverage through discount commitments, while commercial health insurance companies aim to manage high-cost drug reimbursement risks [1][2] - Two main challenges identified include clarifying the relationship between negotiated prices and claims responsibilities, and establishing a clear mechanism for pharmaceutical companies to return discounts to insurers [2][5] Group 2: Pricing Mechanisms - The introduction of the commercial insurance innovative drug directory aims to enhance the payment capabilities for innovative drugs and strengthen the associated policy framework [3] - The National Healthcare Security Administration (NHSA) proposes a mechanism for price confidentiality, allowing pharmaceutical companies to negotiate discounts with insurers while keeping the negotiated prices confidential [3][4] Group 3: Implementation and Operational Challenges - The successful implementation of the directory requires addressing challenges related to the existing actuarial models of commercial insurance products and compliance with industry regulations [7][8] - The path for returning discounts from pharmaceutical companies to insurers remains unclear, with the NHSA requiring the industry to explore solutions within three months of the directory's launch [9][10] Group 4: Opportunities and Market Dynamics - The directory's introduction provides an opportunity for insurers to engage directly with pharmaceutical companies, enhancing negotiation capabilities [14] - The complexity of discount return mechanisms and price confidentiality may still involve intermediaries, indicating potential challenges in the practical application of these agreements [14]

Core Points - The National Healthcare Security Administration (NHSA) announced that the new basic medical insurance drug list and the first commercial insurance innovative drug list will be released online and offline in Guangzhou on the first weekend of December, with implementation starting January 1, 2024 [1] - The recent negotiations involved 120 domestic and foreign enterprises, with 127 drugs outside the basic medical insurance drug list and 24 drugs for the commercial insurance innovative drug list participating in price negotiations [3] - The commercial insurance innovative drug list was established to better meet the diverse medication needs of the public, with 121 high-value drugs approved through this new list [7] Industry Insights - The commercial health insurance market in China is experiencing rapid growth, with the original insurance premium income reaching 977.3 billion yuan in 2024, an increase of 8.2% year-on-year [7] - The total expenditure of the basic medical insurance fund is projected to reach 2.97 trillion yuan in 2024, providing solid support for healthcare services [7] - The NHSA is exploring solutions to synchronize settlements between basic medical insurance and commercial health insurance, with several regions already implementing one-stop payment platforms [9]

Core Viewpoint - The pharmaceutical sector shows mixed performance in early trading, with various indices reflecting slight fluctuations in value, indicating a cautious market sentiment towards innovative drugs [1] Group 1: Market Performance - As of midday close, the Hang Seng Hong Kong Stock Connect Innovative Drug Index increased by 0.03%, while the China Securities Hong Kong Stock Connect Pharmaceutical and Health Comprehensive Index rose by 0.02% [1] - The China Securities Innovative Drug Industry Index decreased by 0.6%, and the China Securities Biotechnology Theme Index fell by 0.5% [1] - The CSI 300 Pharmaceutical and Health Index saw a modest increase of 0.1% [1] - The Hang Seng Innovative Drug ETF (159316) experienced a net inflow of approximately 400 million yuan over the previous four trading days [1] Group 2: Policy Developments - The first version of the commercial insurance innovative drug catalog is set to be officially released on the first weekend of December, with implementation starting on January 1, 2026 [1] - The price negotiation work for this catalog has been successfully completed in conjunction with the 2025 National Medical Insurance Drug Directory negotiation and bidding [1] - This catalog is a significant measure to support the high-quality development of innovative drugs, linking with the medical insurance drug directory and broadening payment channels for innovative drugs, thereby enhancing drug accessibility [1]

Core Points - The National Healthcare Security Administration (NHSA) is organizing negotiations for the 2025 National Basic Medical Insurance Drug List and the Commercial Insurance Innovative Drug List, with participation from 120 domestic and foreign companies [1] - The new Basic Medical Insurance Drug List and the first Commercial Insurance Innovative Drug List are set to be released online and offline in Guangzhou on the first weekend of December, with implementation starting January 1, 2025 [1] - The introduction of the Commercial Insurance Innovative Drug List aims to promote more innovative drugs into commercial insurance [3] Group 1 - The NHSA has established a Commercial Insurance Innovative Drug List for the first time, allowing companies to apply for inclusion in either the Basic Medical Insurance Drug List or the Commercial Insurance Innovative Drug List, or both [2][3] - The Commercial Insurance Innovative Drug List will respect the market position of commercial insurance companies, differing from the Basic Medical Insurance Drug List adjustments [3] - In 2024, the total expenditure of the Basic Medical Insurance Fund reached 2.97 trillion yuan, with a coverage rate of 95% among 1.326 billion insured individuals [5] Group 2 - The commercial health insurance market in China has been growing rapidly, with original insurance premium income reaching 977.3 billion yuan in 2024, a year-on-year increase of 8.2% [5] - There is significant room for improvement in the effectiveness and coverage of commercial health insurance compared to the over 95% utilization rate of basic medical insurance funds [5] - The NHSA is exploring the integration of commercial health insurance with basic medical insurance to address issues such as overlapping coverage and gaps in protection [7] Group 3 - The NHSA has initiated a one-stop settlement platform for commercial insurance and basic medical insurance in several provinces, allowing for automatic recognition of patient information and streamlined claims processes [7][8] - As of August this year, over 36 million transactions have been settled through the synchronized settlement platform in Shandong, totaling over 2.1 billion yuan [7] - A national "Insurance + Commercial Insurance" clearing and settlement center has been launched in Beijing to facilitate one-stop settlements for patients seeking care outside their home provinces [8]

Core Insights - The National Healthcare Security Administration (NHSA) has initiated negotiations for the 2025 National Basic Medical Insurance Drug List, involving 120 domestic and foreign companies [1] - A total of 127 drugs not included in the current list participated in the basic medical insurance negotiations, while 24 drugs were involved in the commercial insurance price negotiations [1] - The new version of the basic medical insurance drug list and the first edition 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 starting January 1 of the following year [1]

Group 1 - The 2025 National Medical Insurance negotiation has officially introduced the "Commercial Insurance Innovative Drug Directory" mechanism, which aims to include innovative drugs that are not yet part of the basic medical insurance directory but have high clinical value and significant patient benefits [2] - A total of 535 drug generic names have passed the formal review for the basic drug directory, while 121 drug generic names have passed for the commercial insurance innovative drug directory, with 79 of them applying for both directories [2] - The introduction of the commercial insurance innovative drug directory is expected to open up broader market opportunities for innovative drugs in the context of a growing number of "global new" drugs emerging in China [2] Group 2 - The innovative drug industry is currently benefiting from three core positive factors: performance realization, policy support, and improved market environment [3][4] - The performance realization is driven by high-demand business development (BD) transactions, as domestic innovative drug companies have accumulated a wealth of quality patents since 2016, which can effectively complement the needs of large pharmaceutical companies facing patent expirations [3] - Continuous policy support includes the inclusion of 37 high-priced innovative drugs in commercial insurance to supplement the Class C directory of medical insurance, and the optimization of priority review and approval processes, which shortens clinical review to 30 working days [3] Group 3 - The market environment has improved since mid-June 2025, with the A-share market entering a "slow bull" phase, enhancing overall risk appetite and providing strong support for the innovative drug sector [4] - The innovative drug industry is expected to see significant growth opportunities driven by continuous breakthroughs in international markets, ongoing policy benefits, and the steady improvement of R&D capabilities among Chinese innovative drug companies [5] - The Science and Technology Innovation Drug ETF (589720) has outperformed the Hang Seng Hong Kong Stock Connect Innovative Drug Index since the "924 market" began, indicating strong investment potential in this sector [6]

Core Viewpoint - The initiation of the commercial insurance innovation drug directory adjustment by the National Medical Insurance Administration marks a significant step towards the practical implementation of commercial insurance innovation drug coverage, potentially leading to a revaluation of the healthcare industry [1][2] Group 1: Investment Opportunities - The healthcare industry is expected to experience a "Davis Double Hit," with a restructured valuation system due to the introduction of the commercial insurance innovation drug directory [1] - Three main investment themes are suggested: 1. Innovative drugs and medical devices, which are likely to benefit from increased payment amounts from commercial insurance [1] 2. Comprehensive service providers that enhance insurance companies' product design capabilities and negotiation power for medical products [1][2] 3. Differentiated medical terminals that could open up future growth opportunities and elevate valuation levels [1] Group 2: Market Growth Projections - From 2023 to 2030, the payment amount from commercial health insurance for innovative drugs and medical devices is projected to grow from 7.3 billion to 126.2 billion, with a compound annual growth rate (CAGR) of 50.3% [1] - The introduction of the commercial health insurance directory is expected to increase the usage rate of innovative drugs and medical devices in hospitals, thereby encouraging upstream innovation [1] Group 3: Comprehensive Service Providers - Comprehensive service providers are anticipated to benefit from the commercial insurance innovation drug directory by offering solutions such as clinical value analysis and marketing to insurance companies, as well as consulting and medical inquiry services to insurance clients [2] - Companies like Sipai Health (00314) and Shanghai Pharmaceuticals (601607) with its subsidiary Meixin Health are highlighted as potential beneficiaries [2] Group 4: Multi-layered Payment System - The expansion of commercial health insurance is expected to enhance China's multi-layered payment system, unlocking potential in diverse medical needs that were previously limited [2] - New payment sources are likely to emerge for medical terminals and pharmacies, creating future growth opportunities for medical service companies and the pharmacy sector [2]