编者按： 长期以来，我国创新药商业化面临着"进院难、支付难"的结构性困境，尤其是高值创新药，常常受限于 基本医保"保基本"的定位而难以纳入报销范围。此次政策组合拳的核心逻辑，在于通过明确的分工，厘 清了政府与市场的支付边界。 对外经济贸易大学创新与风险管理研究中心副主任龙格在接受采访时指出，《商保创新药目录》聚焦超 出基本医保保障范围，但临床价值显著的创新药，作为基本医保目录的补充。两者形成了"医保保基 本、商保接高端"的分工：基本医保覆盖基础药品，商保目录则满足多元化、高层次需求，并为创新药 提供"先商保后医保"的梯度准入路径。 具体而言，新版基本医保目录继续发挥"压舱石"作用。2025年医保目录新增114种药品，谈判/竞价成功 率高达88.19%，创下近七年新高。新增药品中，50种为1类创新药，重点覆盖肿瘤、慢性病、罕见病等 领域。调整后的目录内药品总数增至3253种，其中西药1857种、中成药1396种，极大地提升了重点领域 的用药保障水平。 与此同时，首版《商保创新药目录》则精准承接了基本医保"溢出"的高端需求。首批商保目录共纳入19 种药品，涵盖了CAR-T疗法、神经母细胞瘤和戈谢病等罕见病特效药以 ...

南方财经全媒体记者 孙诗卉 实习生 徐若萱 2025年12月7日，国家医保局与人力资源社会保障部联合发布了《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 2025年医保目录）及首版《商业健康保险创新药品目录》（以下简称《商保创新药目录》），两份目录均将于2026年1月1日起正式实施。 作为构建多层次医疗保障体系的里程碑事件，业内人士表示，此次"双目录"的同步发布，意味着我国医药支付体系正式进入"基本医保+商业健 康险"双轮驱动的新阶段。 长期以来，商业健康险在特药责任设计上存在"专业性不足"的痛点。资深从业者迈伦向21世纪经济报道记者指出，保险公司缺乏药物经济学专 家，自行制定目录难度极大。此次《商保创新药目录》的制定相当于为保险行业提供了一份官方背书的、高质量的"药品池"，极大地降低了产 品开发的准入门槛和信息不对称风险。 对于消费者而言，这一政策不仅夯实了基础用药的保障底线，更使得此前因价格高昂而难以企及的百万级CAR-T疗法、前沿阿尔茨海默病药物 等高值创新药，有了实质性的支付解决方案。 承接医保"溢出"创新药支付需求 长期以来，我国创新药商业化面临着"进院难、支付难"的结构性 ...

Core Insights - The 2025 National Medical Insurance Drug List has been officially released, adding 114 new drugs, including 50 innovative Class 1 drugs, with a negotiation success rate of 88%, the highest in seven years [1][3] - The first version of the commercial insurance innovative drug list has been introduced, featuring 5 CAR-T cell therapies and 19 high-priced innovative drugs, marking a significant expansion in coverage [1][5] - The adjustment reflects a strategic upgrade in China's medical insurance from "basic coverage" to "basic + high-end coverage," addressing the demand for accessible and affordable innovative drugs [1][9] Drug Additions and Market Impact - The new drug list includes 114 drugs, with 44% being Class 1 innovative drugs, and a total of 3,253 drugs now covered under the insurance [3] - Notable winners include Heng Rui Pharma, which secured 20 new drug approvals, and Eli Lilly, whose drug Tirzepatide has entered the Chinese market, benefiting 140 million diabetes patients [3][4] - The inclusion of CAR-T therapies in the commercial insurance list allows for reimbursement of high-cost treatments, which were previously inaccessible to many patients [5][7] Innovations in Treatment - The new list includes significant advancements in treatments for Alzheimer's disease, with two new drugs targeting amyloid beta accumulation, providing options for over 10 million patients in China [7] - The addition of 13 rare disease drugs fills coverage gaps in four rare disease areas, expanding the total number of rare disease drugs covered to approximately 100 [8] - The adjustment also emphasizes pediatric medications, with a separate review channel for children's formulations, indicating a positive shift in addressing children's healthcare needs [9] Strategic Implications - The 2025 adjustment signifies a shift towards a dual-track medical payment system in China, combining basic medical insurance with commercial insurance to meet both fundamental and advanced healthcare needs [9] - The rapid inclusion of innovative drugs into the insurance system reflects a decade of progress in China's pharmaceutical landscape, transitioning from rare domestic innovations to a robust pipeline of new therapies [9]

Core Viewpoint - The first version of the commercial insurance innovative drug directory in China has been released, including 19 drugs, and will be implemented starting January 1, 2026 [1][3]. Group 1: Overview of the Innovative Drug Directory - The directory aims to fill gaps in clinical medication coverage by including innovative drugs that are not reimbursed by basic medical insurance [3][4]. - The drugs included are primarily those with significant clinical value and patient benefits, exceeding the coverage of basic medical insurance [3][4]. - Notable drugs in the directory include CAR-T cell therapies and treatments for rare diseases prevalent in children [3][4]. Group 2: Market Impact and Growth - The commercial health insurance market in China has been rapidly growing, with premium income reaching 977.3 billion yuan in 2024 [4]. - The innovative drug directory is expected to enhance the efficiency of insurance coverage by reducing overlaps with basic medical insurance [4][5]. - Experts believe that the directory will create a win-win situation for pharmaceutical companies, patients, and insurance providers, encouraging innovation and market expansion [5][6]. Group 3: Policy Support and Implementation - The National Medical Insurance Administration has provided "three exclusions" to support the implementation of the directory, allowing for easier access to innovative drugs in hospitals [5][7]. - Although the drugs in the directory are not reimbursed by basic medical insurance, patients can still benefit from commercial insurance products that cover these medications [7][8]. - The directory is expected to facilitate the use of high-value drugs and expand the coverage of commercial health insurance products [7][8]. Group 4: Challenges and Recommendations - There are concerns about the sustainability and accessibility of the innovative drug directory, with suggestions for establishing a comprehensive payment control and pricing mechanism [9][10]. - Insurance companies face challenges in managing the introduction of innovative drugs due to the lack of historical claims data, which complicates cost predictions [10]. - Recommendations include enhancing risk management capabilities and integrating data to improve the overall service and coverage of innovative drugs [10].

Core Viewpoint - The first version of the commercial insurance innovative drug directory in China has been released, including 19 drugs, and will be implemented on January 1, 2026, aiming to fill gaps in clinical medication coverage and enhance patient access to innovative treatments [1][2]. Group 1: Innovative Drug Directory - The directory includes drugs that are clinically valuable and significantly benefit patients, exceeding the coverage of basic medical insurance [2]. - Notable inclusions are CAR-T cell therapies and treatments for rare diseases prevalent in children, such as neuroblastoma and Gaucher disease [2]. - The directory is designed to complement the basic medical insurance system, addressing the limitations of existing coverage [2]. Group 2: Market Impact - The commercial health insurance market in China is rapidly growing, with premiums reaching 977.3 billion yuan in 2024, nearing the total funding level of resident medical insurance [3]. - The innovative drug directory is expected to enhance the efficiency of insurance coverage by reducing overlaps with basic medical insurance [3]. - Experts believe that the directory will create a win-win situation for pharmaceutical companies, patients, and insurance providers, encouraging investment in innovative drug development [4]. Group 3: Policy Support - The National Healthcare Security Administration has introduced a "three exclusions" policy to support the implementation of the innovative drug directory, allowing for more flexible use of innovative drugs in hospitals [5][6]. - This policy aims to alleviate the burden on hospitals and improve patient access to necessary medications [6]. Group 4: Future Considerations - The directory's introduction may lead to a slight increase in insurance premiums in the short term, but long-term stability is expected [7]. - The estimated market size for innovative drug sales in China is projected to reach 162 billion yuan in 2024, with commercial health insurance covering approximately 12.4 billion yuan [8]. - There are concerns regarding the effective implementation of the directory, as it is not mandatory and lacks a clear pricing mechanism [9]. Group 5: Challenges for Insurance Companies - The introduction of innovative drugs poses challenges for insurance companies in terms of precise cost prediction due to limited historical claims data [10]. - Recommendations for insurance companies include adjusting product strategies, enhancing risk management capabilities, and integrating into the broader health ecosystem [10].

Core Viewpoint - CAR-T therapy, a cutting-edge cancer immunotherapy, offers significant potential for treating blood cancers but faces challenges due to high costs and limited accessibility [1][2][8] Group 1: CAR-T Therapy Overview - CAR-T therapy utilizes genetically modified T-cells to target and destroy cancer cells, showing promising results in treating certain blood cancers like B-cell acute lymphoblastic leukemia and lymphoma [2][5] - The therapy is highly personalized, requiring individual production for each patient, which contributes to its high cost, typically ranging from 999,000 to 1,290,000 RMB [6][9] Group 2: Market Dynamics - The global CAR-T market is projected to reach $21.8 billion by 2030, with a compound annual growth rate of 22.1% from 2024 to 2030 [6][7] - China has emerged as a significant player in the CAR-T market, with eight out of fifteen globally approved CAR-T products originating from Chinese companies [6][7] Group 3: Challenges and Innovations - High production costs and limited insurance coverage are major barriers to the widespread adoption of CAR-T therapy [9][10] - Companies are exploring innovative payment models and cost control strategies, such as partnerships with commercial health insurance and sourcing materials from domestic suppliers [10][11] Group 4: Regulatory Environment - The upcoming regulatory framework in China aims to enhance the oversight of CAR-T therapies, which may lead to improved quality and safety standards in the industry [13][15] - The introduction of new CAR-T therapies targeting solid tumors and autoimmune diseases is expected to expand the market significantly [8][15] Group 5: Future Outlook - With advancements in technology and payment systems, CAR-T therapy may transition from a last-resort option to a standard treatment for various cancers [11][16] - The potential for cost reduction through innovations like in vivo CAR-T therapy could make these treatments more accessible to a broader patient population [11][16]

Market Performance - The pharmaceutical and biotechnology index declined by 2.62% from November 3 to November 7, underperforming the Shanghai Composite Index by 2.37 percentage points, marking seven consecutive weeks of underperformance [1] - The innovative drug sector (BK1106) fell by 3.51% during the week, while the Hang Seng Healthcare Index dropped by 2.39% and the Hong Kong innovative drug ETF (513120) decreased by 3.92% [1] Industry Commentary - After a strong rally, the innovative drug industry has entered a bubble-popping phase, with a return to rational investment not necessarily being negative for the sector. However, the current market adjustment appears excessive, with leading companies like Kangfang Biotech, Zai Lab, and Kelun-Biotech experiencing declines exceeding 30% [2] - Zai Lab's recent performance has been impacted by two public announcements: disappointing clinical data for its gastric cancer drug Bemarituzumab and a Q3 report showing total revenue of $116 million, a 14% year-on-year increase, but a net loss of $35.96 million, which is a narrowing of losses compared to the previous year. Revenue growth was primarily driven by sales of "Nusinersan" and "Dingyoule," offset by a slowdown in "Zele" sales [2] Short-term Outlook - In the short term, the innovative drug industry is undergoing emotional recovery and valuation reconstruction, with stock volatility heavily influenced by clinical data and earnings guidance. Zai Lab faces short-term emotional pressure due to the termination of a key clinical trial and downward adjustments in performance expectations. However, from a medium to long-term perspective, the innovative logic of the industry remains unchanged, with globally competitive pipeline assets being the core support for company valuations [3] IPO Developments - Nanjing Haina Pharmaceutical Technology Co., Ltd. has submitted an IPO application to the Hong Kong Stock Exchange, with CICC as the sole sponsor. This follows the termination of a major asset restructuring plan in June 2023, where Haina was to be acquired by Chengdu Xian Dao [4] - Haina Pharmaceutical, established in 2001, integrates drug research and manufacturing, providing CXO services and proprietary product pipelines. The company's revenue primarily comes from CXO services, with 398 ongoing CXO projects as of mid-2025 [4] Financial Performance - For 2024, Haina Pharmaceutical projects revenue of 425 million yuan, a year-on-year increase of 3.65%, but a net profit of 53.295 million yuan, reflecting a 27% decline, indicating a situation of "increased revenue but decreased profit." In the first half of the year, both revenue and net profit saw declines of 16.97% and 25.82%, respectively, attributed to a decrease in CRO service income and a 45.8% drop in sales of proprietary drugs [5] Clinical Trial Updates - From November 3 to November 7, the National Medical Products Administration disclosed 110 new clinical trial registrations, with 33 of these being innovative drugs in Phase II or above, primarily covering oncology, immunology, cardiovascular, and psychiatric fields [6] - Four innovative drugs were approved during the week [7] Notable Approvals - The first CAR-T therapy in China, Pucalunase injection (pCAR-19B), was approved for treating pediatric acute B lymphoblastic leukemia patients aged 3 to 21. This drug was previously included in breakthrough therapy and priority review categories [8] - Pucalunase is the fifth CD19 CAR-T product approved in China, following four others from various companies [9]

Core Insights - The article emphasizes the need to resolve the contradiction between the high costs of CAR-T therapy and the payment system, which relies on both technological cost reduction and the expansion of research pipelines to access a broader patient market [1] - The focus is on the potential market growth in the solid tumor sector, which could significantly alter the CAR-T market landscape [1] Industry Trends - The global CAR-T research initially focused on hematological tumors, with existing products targeting CD19 and BCMA, covering conditions like non-Hodgkin lymphoma (NHL) and multiple myeloma (MM). The research is now expanding towards solid tumors, with the proportion of clinical trials for solid tumors expected to rise from 15% in 2020 to 30% by 2025 [2][3] - The incidence of solid tumors is significantly higher than that of hematological cancers, indicating a potential exponential growth in the patient population. This growth can help distribute costs through economies of scale and enhance market competitiveness [2] Patient Population Insights - In China, the annual incidence rates for NHL and MM are 6.97 and 1-2 per 100,000 respectively, with approximately 40,000 new cases of DLBCL and 14,000-28,000 new cases of MM each year [2] - For solid tumors, the annual incidence of gastric cancer is between 10-20 per 100,000, with 140,000-280,000 new cases annually, and liver cancer has a similar incidence rate with a potential treatable population of 98,000-196,000 patients per year [3] Technical Challenges - Solid tumors present unique challenges for CAR-T therapies, including tumor microenvironment suppression, antigen heterogeneity, infiltration barriers, and T cell exhaustion [4] Domestic Trends - In China, all six approved CAR-T therapies target hematological tumors, but the proportion of clinical trials for solid tumors is expected to reach 42% by 2024. Key drivers for this shift include technological advancements, policy support, and a large patient base for solid tumors [5] Company Pipeline Analysis - Companies are focusing on expanding their CAR-T pipelines to include solid tumors, with several firms reporting promising clinical trial results and plans for future submissions [6][10][15][20][23][35] - For instance, Kexing Biopharm's Claudin18.2 CAR-T for gastric cancer has shown a 22% objective response rate in Phase II trials, while another company, Yuanqi Bio, reported a 56.5% response rate for GPC3 CAR-T in liver cancer [5][10] Market Potential - The potential market for CAR-T therapies in solid tumors is vast, with estimates suggesting that the annual patient population for gastric and liver cancers alone could reach between 126,000 and 280,000, far exceeding the total for hematological cancers [3][5]

Core Insights - The article discusses the transformative impact of CAR-T therapy in cancer treatment, highlighting its shift from a laboratory concept to a viable treatment option for patients with relapsed/refractory tumors [1] - The Chinese biopharmaceutical sector, particularly in cell therapy, is gaining significant attention from both domestic and international investors, with over $5 billion in business development (BD) transactions in 2024 alone [2] - The analysis aims to decode the investment logic in innovative drugs, focusing on the challenges and opportunities within the cell therapy landscape, particularly CAR-T [3] Industry Overview - The CAR-T market is characterized by a critical contradiction: while the therapy shows significant efficacy, its high costs (often exceeding 1 million yuan per treatment) limit patient access [5][6] - The demand for CAR-T therapy is substantial, with approximately 25,000 new cases of multiple myeloma and 60,000 new cases of non-Hodgkin lymphoma annually in China, yet many patients are deterred by the high costs [5] Payment System Challenges - Commercial health insurance currently supports CAR-T therapy, but only 42% of the available plans explicitly cover CAR-T treatments, with reimbursement rates for pre-existing condition patients being particularly low [6] - For widespread adoption, the cost of CAR-T treatments must drop below 300,000 yuan, which would allow for basic medical insurance coverage [6] Cost Reduction Strategies - The high costs of CAR-T therapy stem from its personalized and high-tech production model, but technological advancements are expected to reduce these costs significantly [9][10] - Key factors influencing cost reduction include: 1. **Vector Technology**: Transitioning from viral to non-viral vectors can reduce costs by 30%-50% [9] 2. **Autologous vs. Allogeneic**: Allogeneic CAR-T can lower costs to one-third or half of autologous CAR-T by enabling batch production [10] 3. **Production Processes**: Automation can reduce production time from over 14 days to about 30 hours, cutting costs by over 40% [11] Investment Analysis Framework - The analysis will evaluate nine CAR-T companies based on several dimensions, including: 1. **Technology Iteration and Cost Control**: Assessing the core technology routes and potential for cost reduction [13] 2. **Market Potential**: Estimating the patient population for various indications [14] 3. **Economic Viability and Market Access**: Identifying which companies are likely to secure market access based on cost control and pipeline potential [15] 4. **International Expansion Opportunities**: Evaluating the potential for products in international markets [16] 5. **Commercialization Capabilities**: Analyzing sales figures, production capacity, and investment relationships [17] Company-Specific Insights - The analysis focuses on nine leading CAR-T companies in China, which are at the forefront of CAR-T development, including those with approved products and those in critical clinical stages [18] - Each company's technology route and cost assessment will be detailed, highlighting their strategies for cost reduction and market positioning [26][30] Future Directions - The article anticipates that the adoption of allogeneic CAR-T technology will significantly reduce costs in the mid-term (2025-2028) and further advancements in non-viral vector technology will continue to drive down costs in the long term [24][25]

Core Insights - The article highlights the revolutionary impact of CAR-T therapy in treating adult relapsed acute B lymphoblastic leukemia (B-ALL), showcasing a successful case where a patient achieved complete remission after treatment [1][4][7] Group 1: CAR-T Therapy Development - The first CAR-T therapy for adult relapsed B-ALL in China, "Nakiolun", was approved in 2023, filling a significant gap in immunotherapy options for this patient population [2][4] - CAR-T therapy has shown high efficacy, with a reported objective response rate (ORR) of 82.1% and a minimal residual disease (MRD) negative rate of 100% within three months of treatment [4][6] Group 2: Patient Outcomes and Survival Rates - Adult patients with relapsed B-ALL have a median overall survival of only 2-6 months, with a 5-year survival rate below 10% [3][6] - CAR-T therapy offers a promising alternative, as evidenced by a patient who, after traditional treatments failed, achieved long-term remission through CAR-T, highlighting its potential to improve survival outcomes significantly [3][7] Group 3: Challenges and Future Directions - Despite its effectiveness, CAR-T therapy faces challenges such as being used only as a last resort after exhausting other treatment options and its high cost, approximately 1.2 million yuan (around 120,000 USD) [6][7] - There is a clinical ambition to reposition CAR-T therapy from a last-line treatment to an earlier intervention for patients with first relapse or MRD positivity, which could potentially replace traditional stem cell transplants [7]