转自：北京日报客户端 新版医保目录已进入实质性落地阶段。1月8日，北京商报记者注意到，包括替妥尤单抗N01注射液、夫 那奇珠单抗注射液在内的多款新增创新药，已在多地医院纷纷开出医保首方。这标志着患者使用这些高 价创新药的实际门槛正在快速降低，新版目录的惠民效应开始显现。 本次医保目录调整不仅新增了114种药品，更首次同步推出《商业健康保险创新药品目录（2025 年）》，通过"基本医保+商保"的双重保障，为肿瘤、罕见病等领域19种高值药品开辟了可及的支付通 路，医保支付体系向多层次保障的实质性转型迈出关键一步，创新药企也迎来了加速商业化放量的重要 节点。 从上市到开出医保首方不足一年 创新药迅速落地医保，是新版医保目录对具有高临床价值"真创新"支持力度加大的直接体现。本次调整 中，新版医保目录与商保创新药目录共纳入独家品种124个。 其中，备受关注的替妥尤单抗N01注射液是国内首款用于治疗甲状腺眼病的靶向药物，从2025年3月上 市，到开出医保首方，用时不到一年，填补了我国该领域近70年的治疗空白。 夫那奇珠单抗注射液则是用于治疗银屑病的生物制剂1类创新药，由恒瑞医药自主研发。恒瑞医药在本 次医保目录调整中被视 ...

新版医保目录已进入实质性落地阶段。1月8日，北京商报记者注意到，包括替妥尤单抗N01注射液、夫 那奇珠单抗注射液在内的多款新增创新药，已在多地医院纷纷开出医保首方。这标志着患者使用这些高 价创新药的实际门槛正在快速降低，新版目录的惠民效应开始显现。 倒逼药企研发策略转向真创新 本次医保目录调整不仅新增了114种药品，更首次同步推出《商业健康保险创新药品目录（2025 年）》，通过"基本医保+商保"的双重保障，为肿瘤、罕见病等领域19种高值药品开辟了可及的支付通 路，医保支付体系向多层次保障的实质性转型迈出关键一步，创新药企也迎来了加速商业化放量的重要 节点。 不到一年开出医保首方 创新药迅速落地医保，是新版医保目录对具有高临床价值"真创新"支持力度加大的直接体现。本次调整 中，新版医保目录与商保创新药目录共纳入独家品种124个。 其中，备受关注的替妥尤单抗N01注射液是国内首款用于治疗甲状腺眼病的靶向药物，从2025年3月上 市，到开出医保首方，用时不到一年，填补了我国该领域近70年的治疗空白。 夫那奇珠单抗注射液则是用于治疗银屑病的生物制剂1类创新药，由恒瑞医药自主研发。恒瑞医药在本 次医保目录调整中被视为 ...

新版医保目录已进入实质性落地阶段。1月8日，北京商报记者注意到，包括替妥尤单抗N01注射液、夫那奇珠单抗注射液在内的多款新增创新药，已在多地 医院纷纷开出医保首方。这标志着患者使用这些高价创新药的实际门槛正在快速降低，新版目录的惠民效应开始显现。 本次医保目录调整不仅新增了114种药品，更首次同步推出《商业健康保险创新药品目录（2025年）》，通过"基本医保+商保"的双重保障，为肿瘤、罕见病 等领域19种高值药品开辟了可及的支付通路，医保支付体系向多层次保障的实质性转型迈出关键一步，创新药企也迎来了加速商业化放量的重要节点。 从上市到开出医保首方不足一年 创新药迅速落地医保，是新版医保目录对具有高临床价值"真创新"支持力度加大的直接体现。本次调整中，新版医保目录与商保创新药目录共纳入独家品种 124个。 其中，备受关注的替妥尤单抗N01注射液是国内首款用于治疗甲状腺眼病的靶向药物，从2025年3月上市，到开出医保首方，用时不到一年，填补了我国该 领域近70年的治疗空白。 | | | 基本医保目录"上新"药品定点医药机构销售情况(2026年1月1日至1月6日) | | | | --- | --- | --- | ...

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 ...

来源：长江日报 长江日报记者从武汉市医保局获悉，《国家基本医疗保险、生育保险和工伤保险药品目录（2025年）》 （下称"新版国家医保药品目录"）及《商业健康保险创新药品目录（2025年）》（下称"商保创新药目 录"）于今日（2026年1月1日）起在武汉同步落地。 新版目录以"临床急需、价格亲民、保障多元"为核心，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。 本次新版目录在武汉落地实施后，"双通道"目录同步扩容，武汉通过明确医疗机构配备标准、搭建院企 常态化对接平台等举措，确保谈判药品"买得到、用得上、报得了"。 50 种创新药 " 快进 " 医保 平均降价超六成 据介绍，本次新版国家医保药品目录调整后，共收录药品3253种，其中西药1857种、中成药1396种。此 次新增的114种药品中，50种为一类创新药，纳入成功率高达88%，且90%以上是近5年获批上市的新 药，实现创新药"快进"医保的加速度。 这些新药精准聚焦临床急需，涵盖肿瘤用药36种、罕见病用药10种、慢性病用药12种、儿童用药9种， 既有治疗三阴性乳腺癌的芦康沙妥珠单抗、全身型重症肌无力的艾加 ...

来源：财经五月花 作者：丁艳 杨芮 这种支付与需求的错配正在找到新的解决路径。12月13日，全国医疗保障工作会议在北京召开，明确提 出2026年要支持商业健康保险发展，健全多层次医疗保障体系，并特别强调要"积极落地商保创新药品 目录"，在个人充分授权和确保数据安全基础上，为有需要的商业健康保险产品提供"医保+商保"一站式 清分结算服务。 12月7日，2025年国家基本医保药品目录及首版商保创新药目录在广州正式发布，将于2026年1月1日起 正式实施。此次国家医保局首次在基本医保目录之外增设商保创新药目录，共纳入19种药品，涵盖 CAR-T等肿瘤治疗药品、神经母细胞瘤等罕见病治疗药品，以及社会关注度较高的阿尔茨海默病治疗药 品。 商保创新药目录的出台标志着医保与商保协同进入实质性阶段，开辟了一条市场化的支付通 道，提升了创新药可及性 "当化疗成为唯一选项时，我们需要的不仅是技术，更是支付的勇气。"一位鼻咽癌患者曾在其自述中如 是写道。这句话背后，是无数癌症患者面对天价创新药时的无奈——即便新药能带来生存希望，但高昂 的费用却让希望沦为奢望。这种困境在罕见病领域尤为突出，患者往往需自费承担数十万元甚至上百万 元的 ...

Core Viewpoint - The inclusion of 19 drugs in the first version of the commercial health insurance innovation drug directory marks a significant step towards improving access and affordability of innovative drugs, particularly high-cost CAR-T therapies, while presenting challenges for insurance companies in product development and risk management [1][4][10]. Group 1: Policy and Implementation - The National Medical Security Work Conference emphasized the support for the development of commercial health insurance and the establishment of a multi-tiered medical security system, with a focus on the implementation of the commercial health insurance innovation drug directory by January 1, 2026 [1][2]. - The first version of the commercial health insurance innovation drug directory includes 19 drugs, focusing on high-cost and innovative treatments, including five CAR-T products and drugs for rare diseases [2][4]. Group 2: Challenges for Insurance Companies - Insurance companies face significant challenges in translating the drug directory into viable insurance products, including issues related to pricing, risk control, and compliance [4][5]. - Accurate pricing for insurance products relies on detailed data regarding potential patient populations, disease incidence, treatment cycles, and real-world efficacy, which are primarily held by pharmaceutical companies and hospitals [4][5]. Group 3: Risk Management and Compliance - The inclusion of Alzheimer's disease treatments raises concerns about adverse selection risks, as these drugs have high costs and long treatment durations, necessitating strict eligibility criteria for insurance coverage [5][6]. - Establishing transparent and compliant financial flows between insurance companies and pharmaceutical firms is crucial for effective collaboration [5][6]. Group 4: Data Sharing and Integration - The "医保+商保" one-stop clearing and settlement model aims to break down data silos, enhancing the efficiency of claims processing and improving patient experiences [6][8]. - Successful implementation of data sharing initiatives in regions like Shanghai and Beijing indicates potential for nationwide adoption, which could facilitate better integration of commercial health insurance with innovative drug offerings [8][10]. Group 5: Investment in Innovative Drugs - The policy encourages insurance funds to invest in the upstream of the pharmaceutical industry, positioning them as "patient capital" for innovative drug development [10][11]. - Major insurance companies are already investing in health industry funds, supporting numerous innovative drug companies and enhancing the overall funding environment for drug development [10][11]. Group 6: Future Outlook - Despite the potential for increased investment in innovative drugs, insurance companies remain cautious due to the high risks and costs associated with drug development, which may lead to a preference for established pharmaceutical firms over smaller, innovative companies [12].

Core Insights - The national medical insurance work conference emphasized the support for the development of commercial health insurance by 2026, aiming to establish a multi-tiered medical security system and promote the "医保+商保" one-stop settlement service for innovative drug products [1][4] Group 1: Policy and Implementation - The first edition of the "Commercial Health Insurance Innovative Drug Directory" includes 19 high-value drugs, focusing on advanced therapies and rare diseases, set to be implemented on January 1, 2026 [1][2] - The release of the directory marks a significant step for commercial health insurance in addressing the accessibility and affordability of innovative drugs, although challenges remain in translating the directory into marketable insurance products [2][3] Group 2: Challenges for Insurance Companies - Insurance companies face three main challenges: pricing, risk control, and compliance, particularly in obtaining accurate data from pharmaceutical companies and hospitals for effective pricing models [3][5] - The inclusion of Alzheimer's disease treatments in the directory raises concerns about adverse selection risks, necessitating strict eligibility review mechanisms to mitigate potential high payout risks [3][6] Group 3: Data Sharing and Settlement - The "医保+商保" one-stop settlement aims to break down data silos, facilitating data sharing to enhance claims processing and improve patient experience [4][5] - Concerns exist regarding the transparency of the settlement process, as a "black box" approach could hinder compliance with regulatory data reporting requirements [5][6] Group 4: Investment in Innovative Drugs - The policy encourages insurance funds to invest in the upstream of the pharmaceutical industry, positioning them as "patient capital" for innovative drug development [6][7] - Major insurance companies are already investing in health industry funds, supporting numerous innovative drug companies, although they remain cautious due to the high risks associated with drug development [7][8] Group 5: Future Outlook - There is potential for insurance companies to become shareholders in large pharmaceutical groups to mitigate investment risks, while maintaining a cautious approach towards smaller innovative firms [8]

来源：中新经纬 作者：李自曼 7日，新版国家医保药品目录及首版商保创新药目录(下称商保创新药目录)正式发布。其中，5款CAR-T 产品纳入商保创新药目录，成为业内关注的焦点。 公开信息显示，中国已上市的CAR-T产品价格普遍在百万元左右，被纳入商保目录后，患者能省多少 钱？ 例如，多地惠民保产品覆盖CAR-T用药责任，如龙江惠民保2026版、淄博齐惠保2026、镇江惠民保 2026；不少高端医疗险和特药险，也将CAR-T疗法包含在保障范围内，例如，友邦智选逸生医疗保险； 一些百万医疗险也包含CAR-T相关的特药保障责任，例如众安尊享e生2025版、人保寿险金医保3号等。 今年2月，中再寿险、镁信健康与波士顿咨询公司联合发布的《中国创新药械多元支付白皮书(2025)》 (下称白皮书)显示，据统计，截至2024年12月，奕凯达®已被80余款商业医疗险产品纳入；倍诺达®已 被70余款商业医疗险产品纳入。同样，惠民保也以特药责任或单独的CAR-T责任为其提供保障。据统 计，目前超过60%的惠民保项目提供了CAR-T保障。 此前有患者报销80多万元医疗费 公开信息显示，CAR-T(嵌合抗原受体T细胞)是通过基因修饰使T ...

Core Insights - The newly released National Medical Insurance Drug List and the first Commercial Insurance Innovative Drug List include five CAR-T products, attracting significant industry attention [1][2] Group 1: CAR-T Products and Pricing - The five CAR-T products included in the Commercial Insurance Innovative Drug List are priced around one million yuan each, with specific prices as follows: Fosun Kairui's Acalabrutinib at 1.2 million yuan, WuXi AppTec's Ruxolitinib at 1.29 million yuan, Reindeer Biotech's Ibrutinib at 1.166 million yuan, Huyuan Bio's Naxitamab at 999,000 yuan, and Kexing Life Science's Ziv-aflibercept at 1.15 million yuan [2][4] - Patients previously reported out-of-pocket expenses exceeding 800,000 yuan for CAR-T therapy, highlighting the financial burden before the inclusion in the insurance list [1][4] Group 2: Impact on Patients and Insurance - Following the inclusion of CAR-T products in the insurance list, patients can expect to reduce their out-of-pocket expenses to between 100,000 and 200,000 yuan after insurance reimbursement [2][4] - A case study of a patient who received over 800,000 yuan in reimbursement through a commercial health insurance policy illustrates the potential financial relief for patients undergoing CAR-T therapy [4][6] Group 3: Insurance Market Dynamics - The inclusion of CAR-T products in the insurance list is expected to lead to more health insurance products covering CAR-T therapy, with some existing policies already including partial coverage [5][8] - Current health insurance products that cover CAR-T therapy have varying premium costs, with basic plans starting around 69 yuan annually and more comprehensive plans exceeding 120 yuan [8][9] - The market for commercial health insurance is projected to grow, with estimates indicating that by the end of 2024, commercial medical insurance payouts for CAR-T therapies could exceed 190 million yuan [6][9]