长沙晚报掌上长沙1月3日讯（全媒体记者 徐媛）新版目录新增114种药品，精准覆盖肿瘤、罕见病等关 键领域，首推的商保创新药目录与基本医保目录形成保障互补……今日，记者从湖南省医保局获悉， 《关于切实做好〈国家基本医疗保险、生育保险和工伤保险药品目录〉以及〈商业健康保险创新药品目 录〉（2025年）落地执行工作的通知》已下发。湖南同步落地执行最新版医保目录，2026年1月1日起全 省统一正式执行，有效期至2026年12月31日。 聚焦临床急需，扩展肿瘤、慢性病等领域 本次国家目录调整，共有114个药品新增纳入目录，29个药品调出目录，部分药品从协议期内调入常规 目录，部分药品增补了规格或调整了限定支付范围。调整后，《2025年药品目录》共收录药品3253个， 其中西药部分1446个，中成药部分1335个（含民族药95个），协议期内谈判药品部分472个（含西药411 个、中成药61个）。另外，基金予以支付的中药饮片为892个。 但商保目录不属于社保体系，不是"政府兜底"，最终能否报销，仍然取决于购买的医疗险具体责任。也 就是说，商保目录对保险机构仅具引导参考意义，不具备强制性，后续将由保险公司结合产品设计自主 纳 ...

Core Points - The National Healthcare Security Administration (NHSA) has released the interim results of expert reviews for the 2025 National Basic Medical Insurance Directory and the Commercial Insurance Innovative Drug Directory [1] - Companies can access the evaluation results through the National Medical Insurance Service Platform, specifically in the "2025 Basic Medical Insurance Directory and Commercial Insurance Innovative Drug Directory Adjustment" module [1] - The evaluation results categorize drugs as "proposed for negotiation addition," "proposed for competitive bidding addition," or "proposed for price negotiation," indicating eligibility for negotiation or bidding but not confirmation of inclusion in the directories [1]

Core Viewpoint - The collaboration between basic medical insurance and commercial health insurance in China is advancing significantly, with new measures and systems being implemented to enhance efficiency and accessibility for patients [1][2][3][4]. Group 1: Policy Developments - The first national "medical insurance + commercial insurance" clearing settlement center has begun operations in Beijing, reducing the time lag in claims settlement between the two systems [1]. - A joint initiative by the Shanghai Financial Regulatory Bureau and seven other departments has been launched to promote the high-quality development of commercial health insurance, focusing on payment mechanisms and data sharing [1][2]. - The preliminary review of the innovative drug directory for commercial insurance, which includes several high-priced cancer drugs, has been completed, providing new payment avenues for innovative drugs [1][2]. Group 2: Market Insights - As of 2024, the basic medical insurance system covers 1.326 billion people, maintaining a coverage rate of 95%, with total fund expenditures reaching 2.97 trillion yuan [2]. - The commercial health insurance market is experiencing rapid growth, with original insurance premium income reaching 977.3 billion yuan in 2024, a year-on-year increase of 8.2% [2]. - Despite the growth, there remains significant room for improvement in the coverage and effectiveness of commercial health insurance compared to the over 95% utilization rate of basic medical insurance funds [2]. Group 3: Operational Enhancements - The new clearing settlement center allows patients to complete basic insurance reimbursement and directly use commercial insurance for remaining costs, streamlining the payment process [2][3]. - The National Medical Insurance Administration is exploring synchronized settlement between basic and commercial health insurance, aiming to reduce patient burden through data sharing [3]. - Future developments will include collaborative efforts to expand the coverage of commercial health insurance and enhance the integration of data and regulatory frameworks between the two systems [4].

Core Points - The National Healthcare Security Administration (NHSA) announced the preliminary review of the 2025 National Basic Medical Insurance, Maternity Insurance, and Work Injury Insurance drug catalog adjustments [1] - The adjustment process includes multiple stages: enterprise declaration, formal review, expert evaluation, and price negotiation [1] - Passing the preliminary formal review indicates that a drug meets the initial application conditions but does not guarantee inclusion in the basic medical insurance catalog or commercial health insurance innovative drug catalog [1]