Group 1 - The core viewpoint of the article highlights the introduction of several high-value "star drugs" in the commercial health insurance innovative drug directory, which is expected to create new payment channels and benefit a broader patient population [1][2] - The National Healthcare Security Administration (NHSA) has initiated the adjustment of the commercial health insurance innovative drug directory, marking a significant step towards a multi-layered and balanced payment structure in the healthcare industry [1][2] - According to Frost & Sullivan, the share of commercial health insurance payments is projected to reach 16.3% by 2030, more than doubling from 2024, indicating a growing trend in the market [2] Group 2 - The construction of a diversified medical payment system faces challenges, including fragmented reimbursement rules and payment proportions across different payment methods, which complicates the payment process [2][3] - The "Yima Direct Payment" platform by Meixin Health exemplifies how platform companies are effectively addressing these challenges by integrating various payment solutions and streamlining complex claims processes [3] - The importance of ensuring that innovative drugs are accessible post-launch, including prescription transmission and direct payment capabilities, is emphasized as a critical factor for commercial insurance [2][3]

Core Viewpoint - The article discusses the introduction of the commercial insurance innovative drug directory in China, which supplements the basic medical insurance directory and aims to include high-priced innovative drugs that provide significant clinical value and patient benefits [2][10]. Summary by Sections Introduction of the Commercial Insurance Innovative Drug Directory - The National Healthcare Security Administration announced a list of drugs that passed the initial review for the commercial insurance innovative drug directory, with a total of 121 drugs, over half of which are cancer or rare disease medications [2][5]. - The directory is expected to include high-priced drugs, such as CAR-T therapies costing over 1 million yuan per injection and gene therapies priced around 98,000 yuan per injection [2][4]. Drug Approval and Characteristics - To qualify for the commercial insurance innovative drug directory, drugs must either be newly approved from January 1, 2020, to June 30, 2025, or have indications included in the national rare disease directory by June 30, 2025 [5]. - Among the 121 drugs, 57 are imported, accounting for 47%, with notable entries from companies like Pfizer and Johnson & Johnson [5]. Focus on Cancer and Rare Diseases - The majority of drugs that passed the initial review are cancer treatments, with over 40 entries, followed by 35 for rare diseases [5][6]. - The article highlights the potential for the directory to alleviate payment challenges for rare disease medications, with companies actively submitting applications [6]. Pricing and Negotiation Challenges - The pricing negotiation process for drugs in the commercial insurance directory remains uncertain, as it involves collaboration between the National Healthcare Security Administration, commercial insurers, and pharmaceutical companies [12][13]. - The article notes that the commercial insurance directory may serve as a "double insurance" for companies, allowing them to apply for both the basic medical insurance and the commercial insurance directories simultaneously [9]. Future Considerations and Recommendations - The article suggests that the implementation of the commercial insurance innovative drug directory requires further exploration and refinement, with recommendations for pilot programs in specific insurance products [14]. - It emphasizes the need for insurance companies to develop reasonable pricing mechanisms and improve data integration with basic medical insurance to enhance their pricing strategies [13][14].

Core Insights - The National Healthcare Security Administration (NHSA) has released a list of drugs that passed the preliminary review for the commercial insurance innovative drug directory, which is a new supplement to the basic medical insurance directory aimed at covering high-priced drugs [2][3] - A total of 121 drugs have passed the initial review, with over half being cancer or rare disease medications, including several high-cost therapies [2][5] - The final commercial insurance innovative drug directory is expected to be published between October and November 2023, following expert evaluations and price negotiations [2][3] Summary by Category Drug Characteristics - The drugs included in the commercial insurance innovative drug directory are characterized by high innovation, significant clinical value, and substantial patient benefits, exceeding the basic insurance's "basic protection" scope [2] - Among the 121 drugs, 57 are imported, accounting for 47%, with notable entries from companies like Pfizer, Johnson & Johnson, and Merck [5] Pricing and Negotiation - The drugs will undergo price negotiations, which may lead to price reductions, but the extent of these reductions remains uncertain [9][10] - The commercial insurance innovative drug directory allows for simultaneous applications to both the basic medical insurance and the commercial insurance directories, providing a "double insurance" for companies [7] Market Dynamics - The directory includes a variety of drugs, including CAR-T therapies priced around 1 million yuan per injection, which have faced challenges in entering the basic medical insurance directory [6][9] - The directory's implementation may alleviate payment difficulties for rare disease medications, with companies actively submitting applications [6][8] Insurance Industry Considerations - The insurance industry faces challenges in pricing and market growth potential due to the voluntary nature of commercial insurance participation [9][11] - There is a need for better data integration between commercial insurance and basic medical insurance to enhance pricing strategies and product development [11]

Core Insights - The National Healthcare Security Administration (NHSA) has released the initial review list for the "Commercial Insurance Innovative Drug Directory," marking a significant step in integrating commercial insurance with the national medical insurance system [2][3] - The list includes various high-value innovative drugs, such as CAR-T therapies and rare disease medications, which are expected to enhance market confidence and improve patient outcomes [2][6] Group 1: Commercial Insurance Directory - A total of 141 applications were received for the commercial insurance innovative drug directory, with 121 drug names passing the initial review [3] - The directory features expensive high-value innovative drugs, including CAR-T therapies, which have an average price in the million yuan range [3][4] - Some CAR-T products are being submitted for both basic medical insurance and commercial insurance, providing a second chance for reimbursement if they fail in the first round [4][5] Group 2: Rare Disease Medications - The commercial insurance directory includes 51 products for 52 rare diseases, potentially allowing patients to access previously unaffordable "orphan drugs" through commercial insurance [6] - The example of nusinersen for spinal muscular atrophy (SMA) illustrates the significant cost reduction from nearly 700,000 yuan to approximately 33,000 yuan after entering the insurance system [6] - The number of rare disease drugs in China is expected to increase, with 210 drug development pipelines projected for 2024, 38% of which are in Phase III clinical trials [6][7] Group 3: Market Dynamics and Future Outlook - The integration of commercial insurance with the national medical insurance system is seen as a flexible approach to facilitate access to high-value innovative drugs [7] - The expected results from national negotiations on drug pricing will be announced between October and November 2025, while the commercial insurance directory is set to be finalized by the end of September [7] - The evolving landscape indicates a narrowing gap between the availability and affordability of innovative treatments for patients [7]

Core Insights - The article discusses the recent approval of several high-priced innovative drugs for the commercial insurance innovation drug directory, which were previously excluded from the basic medical insurance directory due to high costs [2][5] - Over 60% of the drugs included in the commercial insurance innovation drug directory have also applied for the basic medical insurance directory, indicating a dual strategy by pharmaceutical companies [2][5] - The National Healthcare Security Administration (NHSA) has initiated a new phase of expert reviews for these drugs, which will determine their final inclusion in the insurance directories [10] Group 1: Drug Approval and Market Dynamics - A total of 121 innovative drugs passed the preliminary review for the commercial insurance innovation drug directory, with 141 applications submitted [5] - Approximately 80 drugs applied for both the basic medical insurance and commercial insurance directories, highlighting a trend towards dual applications [5][9] - The article identifies five categories of drugs that were only submitted for the commercial insurance directory, including rare disease treatments and newly approved drugs with limited clinical data [3][4] Group 2: Pricing and Economic Considerations - Some high-priced rare disease treatments have annual costs exceeding 1 million yuan, which have previously failed to meet the basic medical insurance criteria [6] - The NHSA emphasizes that the approval for the basic medical insurance directory does not guarantee inclusion, as drugs must pass rigorous evaluations and negotiations [9] - The article notes that the commercial insurance directory may serve as a transitional option for innovative drugs that exceed the acceptable pricing thresholds for basic medical insurance [5][10] Group 3: Industry Perspectives and Future Implications - Industry experts suggest that the commercial insurance innovation drug directory should focus on new drugs that fill clinical gaps and provide differentiated treatment options [7] - There is a concern among pharmaceutical companies regarding the potential impact of drug inclusion on insurance premiums and patient access [10][11] - The article highlights the need for real-world evidence to support the clinical efficacy of some newly approved drugs, which may influence their acceptance in the basic medical insurance directory in the future [8][9]

Core Viewpoint - The article discusses the recent approval of high-priced innovative drugs for commercial insurance innovation drug directory, highlighting the ongoing negotiations for inclusion in the basic medical insurance directory, which remains the primary goal for most innovative drug companies [3][4][8]. Summary by Sections Approval Process - The National Medical Insurance Administration announced that 121 innovative drugs passed the preliminary formal review for the commercial insurance innovation drug directory, with a significant number also applying for the basic medical insurance directory [3][7]. - The review process assesses whether the drugs meet the criteria for inclusion in the insurance directories and the completeness of their information [7]. Drug Categories - Less than 40% of the drugs approved only for the commercial insurance innovation drug directory fall into five main categories: rare disease medications, newly approved drugs with limited real-world evidence, globally priced drugs that still do not meet basic insurance thresholds, high-priced new drugs for existing treatments, and preventive biological agents restricted by legal regulations [4][5]. Dual Directory Applications - Approximately 80 drugs, or about 60% of those in the commercial insurance innovation drug directory, applied for both directories, indicating a transitional strategy for many innovative drug companies [8]. - Many high-priced innovative drugs that exceed the acceptable value threshold for basic medical insurance are opting for single directory applications [8][10]. Market Dynamics - The competition in the market for cancer drugs and other treatment areas is intensifying, with a focus on "true innovation" and "differentiated innovation" as encouraged by the National Medical Insurance Administration [10]. - The article notes that some innovative drugs are being submitted for commercial insurance first, with the expectation that they may later be evaluated for inclusion in the basic medical insurance directory once sufficient real-world data is available [11]. Insurance Considerations - The decision to include innovative drugs in the commercial insurance directory is influenced by factors such as the drug's appeal to insurance products, potential premium increases, and the risk of excessive claims [14][15]. - The article highlights the differences in coverage and reimbursement capabilities across various regions, which may affect the sales pathways for innovative drugs [15].

今年，曾在历年"国谈"中或因不符合"70万不谈，50万不入"隐形门槛而被基本医保目录谈判拒之门外的 多款高价创新药通过了商保创新药目录初审。 与此同时，超六成纳入商保创新药目录初审名单的药品同时申报并进入基本目录谈判的初审名单，包括 2款阿尔茨海默症治疗药物、3款CAR-T药物等，这些高价"明星药物"能否通过专家评审、进入"谈判 桌"并最终获得医保支付，仍待揭晓。 8月12日，国家医保局发布《关于公示通过2025年国家基本医疗保险、生育保险和工伤保险药品目录及 商保创新药目录调整初步形式审查的药品及相关信息》的公告（下称"形式审查公示"），121款创新药 通过商保创新药目录初步形式审查，第一财经记者梳理得出上述信息。这与记者此前和多家申报企业方 交流情况基本一致，鉴于基本医保目录覆盖人群广、支付和"进院"政策确定性更强，仍是多数创新药企 的首选或最终目的。 此外，根据国家医保局公示的"入围"药品信息，第一财经还发现，在占比不到四成（40余款）的仅申报 并通过商保创新药目录的药品中，主要包含五类：一是适应证人群少但价格高昂的罕见病用药；二是以 海外临床数据或替代终点上市，真实世界证据尚待积累的刚获批新药；三是药 ...

Core Insights - The National Healthcare Security Administration (NHSA) announced the preliminary review results for the 2025 National Basic Medical Insurance, Maternity Insurance, and Work Injury Insurance drug catalog, revealing 534 drugs passed the review, with 121 drugs included in the commercial insurance innovative drug catalog [1][2] - This year marks the first implementation of a "dual-track system" for the drug catalog, focusing on basic insurance for essential drugs and providing supplementary coverage for "exclusive new drugs" or "rare disease medications" through commercial insurance [1][2] - The number of drugs passing the preliminary review has significantly increased compared to last year, with the number of drug names outside the catalog rising from 249 in 2024 to 310 [1] Drug Categories and Highlights - Over 98% of the drugs in the announced list are Western medicines, with only two traditional Chinese medicines included [3] - CAR-T therapies, which are at the forefront of cancer treatment, have gained attention, with several priced over 1 million yuan per injection, including products from Fosun Kite, Kintor Pharmaceutical, and Reindeer Biologics [1][2] - Notable entries in the list include innovative drugs from domestic companies, such as Shanghai Xinnian Pharmaceutical's hemophilia B gene therapy and Hengrui Medicine's PD-1 monoclonal antibody [3] Review and Approval Process - Passing the preliminary review does not guarantee inclusion in the basic medical insurance or commercial insurance innovative drug catalog, as further expert evaluations and price negotiations are required [3] - Approximately 80 drug varieties passed the preliminary review for both the basic medical insurance and commercial insurance catalogs, indicating potential for simultaneous negotiations [3]

Core Insights - The article discusses the announcement by the National Medical Insurance Administration regarding the preliminary review of 534 drugs for the 2025 National Basic Medical Insurance, Maternity Insurance, and Work Injury Insurance drug catalog, along with 121 drugs included in the commercial insurance innovative drug catalog [1][2]. Group 1: Drug Catalog Adjustments - The 2025 drug catalog adjustments implement a "dual-track system," focusing on basic insurance for essential drugs while providing supplementary coverage for "exclusive new drugs" or "rare disease medications" through the commercial insurance innovative drug catalog [1][2]. - A total of 718 applications were received for the basic medical insurance catalog, with 534 approved, while 141 applications were received for the commercial insurance innovative drug catalog, with 121 approved [1][2]. Group 2: CAR-T Therapies - CAR-T therapies, which are personalized cancer treatments, have gained attention due to their high costs, with prices exceeding 1 million yuan per injection for several products [1][2]. - The article highlights that CAR-T therapies are among the first specialty drugs to be included in commercial insurance coverage, with various regions like Jiangsu and Shanghai incorporating them into their insurance plans [2]. Group 3: Drug Composition and Approval Process - The approved drugs are predominantly Western medicines, with over 98% of the list, and only two traditional Chinese medicines included [3]. - The approval of drugs through preliminary review does not guarantee inclusion in the basic medical insurance or commercial insurance catalogs, as further expert evaluations and price negotiations are required [3]. Group 4: Pricing and Negotiation - Approximately 80 drug varieties passed the preliminary review for both the basic medical insurance and commercial insurance catalogs, indicating potential for simultaneous negotiations [3]. - Drugs that exceed the basic insurance pricing limits may still qualify for the next evaluation stage, but their final inclusion depends on successful negotiations [3].

Core Insights - The National Healthcare Security Administration (NHSA) announced the preliminary review results for the 2025 National Basic Medical Insurance, Maternity Insurance, and Work Injury Insurance drug catalog, revealing 534 drugs passed the review, with 121 drugs included in the commercial insurance innovative drug catalog [1][2] Group 1: Drug Catalog Adjustments - The 2025 adjustments mark the first implementation of a "dual-track system," focusing on basic insurance for essential drugs while providing supplementary coverage for "exclusive new drugs" or "rare disease medications" through the commercial insurance innovative drug catalog [1][2] - A total of 718 submissions were received for the basic insurance catalog, with 534 approved, while 141 submissions were made for the commercial insurance catalog, with 121 approved [1][2] - The number of drug names excluded from the catalog increased from 249 in 2024 to 310 [1] Group 2: CAR-T Therapies - CAR-T therapies, which are personalized cancer treatments, have gained attention due to their high costs, with prices exceeding 1 million yuan per injection for several products [1][2] - The commercial insurance catalog will include CAR-T therapies in upgraded coverage plans in various regions, with Shanghai's "Huibao" covering up to 500,000 yuan for patients [2] - Over the past three years, more than 80 lymphoma patients have received treatment through this channel, with total reimbursements exceeding 40 million yuan [2] Group 3: Drug Composition and Approval Process - The approved drugs are predominantly Western medicines, with over 98% representation, and only two traditional Chinese medicines included [3] - Notable cancer drugs include those from major pharmaceutical companies, alongside innovative domestic products like gene therapy for hemophilia B and PD-1 monoclonal antibodies [3] - Passing the preliminary review does not guarantee inclusion in the final catalog, as further expert evaluations and price negotiations are required [3][4] Group 4: Submission Conditions - Unique drugs meeting specific criteria can apply for both the commercial insurance innovative drug catalog and the basic catalog simultaneously [4]