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].

经济观察报 记者 张铃 12月7日，国家医保局发布了调整后的国家基本医保目录，以及首版商保创新药目录。基本医保目录共 新增114种药品，商保目录纳入19种药品。 目录发布后，人们普遍关心的问题是，两大目录会带给患者哪些保障，医保是如何支持创新的。对于处 于探索期的商保目录，人们有更多好奇：怎么落地？怎么报销？带病可以投保吗？医院会进药吗？ 12月9日，针对公众关切，国家医保局举行了2025年医保药品目录解读会。经济观察报记者参会并现场 采访了有关专家。 "通过今年的双目录并行，我们要厘清基本医保的保障边界，为商保发展留出空间，共同构建多元化医 疗保障体系。"在12月9日的解读会上，国家医保局医药服务管理司司长黄心宇介绍，在基本医保目录调 整时，国家医保局更愿意支持真创新、差异化创新，不愿意支持内卷式创新。 对于商保目录的落地，黄心宇提到国家医保局的三点考虑：其一，国家医保局会和各地加强沟通，用好 用足"三除外"（即商保目录内药品不纳入基本医保自费率指标、 不纳入集采中选可替代品种监测范 围、 不纳入按病种付费范围）政策，推动药品入院；其二，不改变药品市场挂网价，折扣让利于商保 公司，并传导至患者以及创新药行业 ...