今年1月1日，《国家基本医疗保险、生育保险和工伤保险药品目录（2025年）》（以下简称"新版 国家医保药品目录"）和首版《商业健康保险创新药品目录（2025年）》（以下简称"商保创新药目 录"）同步执行。其中，商保创新药目录共纳入19种药品，5款价格百万元级的CAR-T肿瘤治疗药品悉数 在列。随着这一政策正式落地，商业健康险能否接好高值药支付的"接力棒"，直接关乎多层次医疗保障 的惠民实效。 《金融时报》记者注意到，新年伊始，北京、河北、浙江、湖北等地纷纷开启首版医保"双目录"制 度，积极打通商业健康保险的衔接通道。在业内人士看来，这标志着医保与商保在破解高值创新药支付 难题上迈出实质步伐，商保补充作用被进一步激发，更多百姓有望用上"天价药"。政策利好下，商保公 司也可参照商保创新药目录加速产品创新、更新赔付范围，与基本医保形成保障合力。 商业保险填补创新药保障空白 进入2026年1月，医保商保药品"双目录"迎来启动关键节点，地方政策衔接、险企产品适配、技术 服务支撑的联动效应持续释放，"医保+商保"的协同医疗保障正从制度设计走向实操落地。 据《金融时报》记者观察，全国多地医保部门通过一系列政策举措为商保创新 ...

国家医保局、人力资源和社会保障部于2025年12月正式发布了新版国家基本医疗保险、生育保险和工伤 保险药品目录以及首版商业健康保险创新药品目录。据介绍，用户可进入"国家医保局"微信公众号，点 击菜单栏"微服务"，选择"国家医保药品目录查询"或"商保创新药目录查询"，进入相应查询页面。输入 药品通用名，点击搜索，即可查看该药品是否在目录内、所属分类、报销类别（医保目录）或商保创新 药目录相关信息。用户也可以根据自己的需求，按"药品分类"或"医保报销类别"进行筛选查找。 本报讯（记者孟刚）记者从国家医保局获悉，为了提供更加便捷的服务，国家医保局微信公众号于1月1 日上线新版基本医保目录和首版商保创新药目录查询功能。 （来源：中国消费者报） 国家医保局介绍说，医保药品目录内的西药和中成药分为甲、乙两类。甲类药品是指临床治疗必需、使 用广泛、疗效确切、同类药品中价格或治疗费用较低的药品。参保人使用这类药品时，可以全额纳入报 销范围，之后按规定比例报销。乙类药品是指可供临床治疗选择使用，疗效确切、同类药品中比甲类药 品价格或治疗费用略高的药品。参保人使用这类药品时，须个人先行自付一定比例，剩余部分纳入报销 范围，再按规 ...

Group 1 - The new version of the National Basic Medical Insurance, Maternity Insurance, and Work Injury Insurance Drug Directory has been implemented, adding 114 new drugs to the reimbursement list, including 50 first-class innovative drugs, while removing 29 drugs that are either not clinically available or can be replaced by better alternatives [2] - The total number of drugs in the directory has increased to 3,253, with 1,857 Western medicines and 1,396 traditional Chinese medicines, significantly enhancing coverage for key areas such as cancer, chronic diseases, mental illnesses, rare diseases, and pediatric medications [2] Group 2 - Starting today, all medical institutions are required to fully collect and upload drug traceability codes, which serve as "electronic IDs" for drugs, ensuring traceability throughout the production, circulation, usage, and insurance settlement processes [3] - The National Medical Insurance Information Platform has collected 110.369 billion traceability codes, aiding in the resolution of multiple national counterfeit drug cases and addressing 39,100 illegal institutions, with 188 cases referred to judicial authorities [3][5] Group 3 - A new policy requires kindergartens to implement a directory management system for fees, establishing two separate lists for service fees and kindergarten-specific charges, with strict public disclosure requirements [6] Group 4 - The People's Bank of China will automatically adjust credit information based on repayment conditions, with specific criteria set for overdue debts occurring between January 1, 2020, and December 31, 2025, allowing for the removal of certain overdue information from personal credit reports if conditions are met [8] - The new VAT law and its implementation regulations have come into effect, with 14 out of 18 existing tax types now having legal frameworks, covering a significant portion of tax revenue [8]

Core Insights - The National Healthcare Security Administration and the Ministry of Human Resources and Social Security announced the new National Basic Medical Insurance, Maternity Insurance, and Work Injury Insurance Drug Catalog (2025) and the Commercial Health Insurance Innovative Drug Catalog (2025), which will be implemented nationwide starting January 1, 2026 [1][2] Group 1: National Basic Medical Insurance Drug Catalog - The updated National Medical Insurance Drug Catalog includes 114 new drugs, of which 50 are first-class innovative drugs [1] - A total of 29 drugs that are either not clinically available or can be better replaced by other medications have been removed from the catalog [1] - The total number of drugs in the catalog has increased to 3,253, comprising 1,857 Western medicines and 1,396 traditional Chinese medicines, with significant improvements in coverage for key areas such as oncology, chronic diseases, mental illnesses, rare diseases, and pediatric medications [1] Group 2: Commercial Health Insurance Innovative Drug Catalog - The inaugural Commercial Health Insurance Innovative Drug Catalog includes 19 drugs, which complement the basic medical insurance effectively [2] - This initiative lays the groundwork for the complementary development of commercial insurance and basic medical insurance, contributing to the establishment of a multi-tiered medical security system [2]

Core Insights - The National Healthcare Security Administration (NHSA) held a conference on December 9, 2023, to discuss the 2025 Medical Insurance Drug List, attracting significant interest from various stakeholders, including over 23,000 online viewers [1][6]. Group 1: Drug List Adjustments - The basic medical insurance fund, exceeding 3 trillion yuan, is directly linked to the annual release of the National Medical Insurance Drug List [6]. - In 2025, 114 new drugs were added to the basic medical insurance list, with 111 being new drugs launched within the last five years, marking a record high in both proportion and quantity [7]. - The adjustment process for the drug list has become clearer, with specific phases for preparation, application, review, and negotiation [7]. Group 2: Misunderstandings in Drug Pricing - There are misconceptions regarding the negotiation process, particularly the belief that all drugs must reduce prices upon renewal; only 30 out of 178 drugs negotiated for renewal experienced an average price drop of 13.8% [8]. - The average price reduction for the 15 drugs that were renewed was only 8.4% [8]. Group 3: Commercial Health Insurance Innovations - The NHSA introduced the first Commercial Health Insurance Innovative Drug List, which involves a more complex review process, including a re-evaluation by a specialized expert group [9]. - Certain drugs, while deemed valuable by basic medical insurance experts, were not included in the commercial insurance list due to concerns over their insurability and management difficulties [10]. Group 4: Challenges in Implementation - The NHSA aims to leverage the "three exclusions" policy to facilitate drug inclusion in hospitals and encourage the design of insurance products targeting the innovative drug list [11]. - There are significant challenges in aligning commercial insurance products with the innovative drug list, including low efficiency in claims processing and insufficient coverage [12]. Group 5: Differentiated Innovation in Pharmaceuticals - The NHSA emphasizes the need for differentiated innovation in pharmaceuticals, urging companies to provide robust evidence, such as head-to-head clinical trial data, to support claims of being "best in class" [15][16]. - The selection of reference drugs for economic evaluation is crucial, requiring a comprehensive approach that considers multiple dimensions of comparison [16][17].

Group 1 - The 2025 Innovative Drug High-Quality Development Conference was held in Guangzhou on December 7, announcing the 2025 National Basic Medical Insurance, Maternity Insurance, and Work Injury Insurance Drug Catalog, along with the first edition of the Commercial Health Insurance Innovative Drug Catalog [1] - The adjustment of the National Drug Catalog is the 8th since the establishment of the National Medical Insurance Administration, adding 114 new drugs, including 50 Class 1 innovative drugs [1] - The first edition of the commercial health insurance innovative drug catalog includes 19 drugs, featuring CAR-T cancer treatment drugs and Alzheimer's disease treatment drugs, indicating a sustained rise in innovative drugs from the perspectives of business development, commercialization, and policy [1] Group 2 - The Guotai Innovative Drug ETF (589720) focuses on innovative drug companies listed on the Sci-Tech Innovation Board, tracking an index of 30 representative high-quality companies, primarily in high-growth biotech [1] - From September 24, 2024, to October 31, 2025, during the market rebound, the Sci-Tech Innovative Drug Index and the Hang Seng Hong Kong Stock Connect Innovative Drug Index increased by 143.70% and 135.34% respectively, suggesting that the Sci-Tech Innovative Drug Index may better capture the elasticity of the Sci-Tech Innovation Board when market risk appetite recovers [1]

Core Insights - The National Healthcare Security Administration and the Ministry of Human Resources and Social Security announced the new National Basic Medical Insurance, Maternity Insurance, and Work Injury Insurance Drug Catalog (2025) and the Commercial Health Insurance Innovative Drug Catalog (2025), which will be implemented nationwide starting January 1, 2026 [1] Group 1: National Basic Medical Insurance Drug Catalog - The updated National Medical Insurance Drug Catalog adds 114 new drugs, including 50 first-class innovative drugs, while removing 29 drugs that are either not clinically available or can be better replaced by other medications [1] - After the adjustments, the total number of drugs in the catalog increases to 3,253, comprising 1,857 Western medicines and 1,396 traditional Chinese medicines, significantly enhancing coverage for key areas such as oncology, chronic diseases, mental illnesses, rare diseases, and pediatric medications [1] Group 2: Commercial Health Insurance Innovative Drug Catalog - The inaugural Commercial Health Insurance Innovative Drug Catalog includes 19 drugs, which complements the basic medical insurance, laying a foundation for the differentiated development of commercial insurance and basic medical insurance, and establishing a multi-tiered medical security system [1]

（文章来源：人民日报） 首版商保创新药目录共纳入19种药品，与基本医保形成较好的互补衔接，也为推动商保与基本医保错位 发展、建立多层次医疗保障体系奠定基础。 本报北京12月8日电 （记者孙秀艳）7日，国家医保局、人力资源社会保障部公布《国家基本医疗保 险、生育保险和工伤保险药品目录（2025年）》和《商业健康保险创新药品目录（2025年）》，将于 2026年1月1日起在全国范围内正式实施。 新版国家医保药品目录新增114种药品，其中50种1类创新药，调出了29种临床没有供应或可被其他药物 更好替代的药品。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。 ...

Core Viewpoint - The National Healthcare Security Administration announced the 2025 version of the National Basic Medical Insurance, Maternity Insurance, and Work Injury Insurance Drug Catalog, along with the first edition of the Commercial Health Insurance Innovative Drug Catalog, which will be implemented starting January 1, 2026 [1] Group 1 - The new drug catalog aims to enhance the accessibility and affordability of essential medications for the public [1] - The implementation of the updated drug lists is expected to influence the pharmaceutical industry significantly, particularly in terms of market dynamics and pricing strategies [1] - The introduction of the Commercial Health Insurance Innovative Drug Catalog indicates a shift towards integrating innovative therapies into health insurance coverage [1]

Core Insights - The 2025 Innovation Drug High-Quality Development Conference was held in Guangzhou on December 7, where the 2025 National Basic Medical Insurance, Maternity Insurance, and Work Injury Insurance Drug Catalog was released [1] - This is the 8th adjustment since the establishment of the National Medical Insurance Administration, with the new catalog set to be implemented nationwide on January 1, 2026 [1] - The adjustment adds 114 new drugs, including 50 first-class innovative drugs, while removing 29 drugs that are either not clinically available or can be replaced by better alternatives [1] - The total number of drugs in the catalog increases to 3,253, comprising 1,857 Western medicines and 1,396 traditional Chinese medicines, with significant improvements in coverage for key areas such as cancer, chronic diseases, mental illnesses, rare diseases, and pediatric medications [1] - Additionally, the National Medical Insurance Administration released the first commercial insurance innovative drug catalog, which includes 19 drugs covering rare diseases, neurodegenerative diseases, other solid tumors/blood tumors, and metabolic diseases [1] Summary by Categories Drug Catalog Adjustments - The new drug catalog will include 114 new drugs, with a focus on innovative treatments [1] - 50 of the newly added drugs are classified as first-class innovative drugs [1] - A total of 29 drugs have been removed from the catalog due to lack of clinical supply or better alternatives [1] Coverage and Focus Areas - The total number of drugs in the catalog has increased to 3,253, enhancing the coverage for critical health areas [1] - Key areas with improved coverage include cancer, chronic diseases, mental health, rare diseases, and pediatric medications [1] Commercial Insurance Developments - The first commercial insurance innovative drug catalog includes 19 drugs targeting specific health conditions [1] - The catalog covers treatments for rare diseases, neurodegenerative diseases, solid tumors, blood tumors, and metabolic disorders [1]