Core Insights - The ongoing reform of medical insurance payment methods, primarily focusing on Diagnosis-Related Groups (DRG) and Disease-Related Payment (DIP), presents both opportunities and challenges for commercial health insurance [1][3] - There is a growing consumer demand for "out-of-hospital medication coverage," leading to a shift in preferences towards mid-to-high-end health insurance products that offer fewer restrictions on hospital choices [3][4] - Traditional million medical insurance products are facing challenges due to the new payment models, highlighting gaps in coverage that do not meet evolving patient needs [4][5] Industry Trends - The transition from "fee-for-service" to "value-based payment" under DRG/DIP reforms has resulted in increased outpatient treatment costs and a rise in demand for medications purchased outside hospitals [4][5] - Many insurance companies are responding to these changes by launching new products that include coverage for out-of-hospital medications and medical devices, addressing the gaps left by traditional million medical insurance [9][10] - The introduction of a diversified commercial health insurance system aims to meet the varied health protection needs of different consumer groups [10][11] Product Development - Insurance companies are iterating their products to lower deductibles and expand coverage to include outpatient services and private hospitals, while also removing restrictions on high-value medications [8][9] - New products, such as those from ZhongAn Insurance, are now offering coverage for out-of-hospital medications without disease or treatment limitations, reflecting a significant shift in product offerings [9] - The establishment of a comprehensive drug directory for commercial health insurance is seen as a crucial step in enhancing product design and improving customer experience through direct payment models [12]

南方财经全媒体记者 孙诗卉 上海报道 2017年，中国首款CAR-T细胞治疗产品阿基仑赛注射液获批上市，意味着中国正式迈入CAR-T细胞疗法 的新时代。然而，随之而来的却是尴尬的现实：一针超百万元的天价让多数患者望而却步。 自2015年药品审评审批制度改革以来，中国创新药产业经历了"从无到有、从少到多"的爆发式增长，新 药获批数量激增，上市速度大幅加快。然而，如果支付体系不能随之变革，创新药的价值将难以真正触 达患者。 2025年，中国创新药出海爆发。经过十年探索，商业保险在创新药的支付体系中已经扮演了重要作用， 但显然仍是"初试身手"，广阔的发展空间如同星辰大海。 创新药支付端改革迫在眉睫。 初试身手：惠民保引燃的支付变局 2020年3月，中共中央、国务院《关于深化医疗保障制度改革的意见》正式提出建设"多层次医疗保障体 系"的蓝图，明确将商业健康保险定位为重要支柱。在政策东风下，一颗颗种子破土而出——城市定制 型商业医疗保险"惠民保"以燎原之势席卷全国。 "低门槛、低保费、带病可保"等特性，使惠民保迅速成为现象级产品。《2024中国商业健康险创新药支 付白皮书》显示，历经数年发展，到2023年，超过90%的 ...