除了"吐故纳新"，65种药品的支付范围也迎来新变化。 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）》正式落地实施。这是医 保部门连续第8年对基本医保药品目录进行优化，通过"有进有出"的动态调整机制，让更多临床急需、 疗效确切的新药好药纳入报销范围，同时将已被临床淘汰或长期未生产供应的药品调出目录，以实现医 保基金使用效率与群众用药保障水平的双提升。 这份事关参保人用药权益的"药品清单"发生了哪些变化？如何更好地满足百姓的用药需求？ 本次目录新增114种药品，其中50种为一类创新药，同时调出29种临床价值较低的药品。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，涵盖肿瘤、罕见病、慢性病、儿童用药 等重点领域。 "新纳入医保目录的药品有3个显著特点：或是填补临床治疗空白，或是同类更优，或是拥有更高的 性价比。"国家医保局医药服务管理司司长黄心宇介绍说。截至目前，医保药品目录已累计调入949种新 药。 具体而言，以肿瘤治疗为例，治疗三阴性乳腺癌的芦康沙妥珠、胰腺癌用药伊立替康脂质体等新 药"入保"，让患者买得起、用得上。在慢性病领域，一年两针的降血脂药英克司 ...

Core Insights - The recent adjustment to the National Medical Insurance Drug List has significantly reduced the costs of long-acting growth hormone treatments, benefiting many families [1] - The new drug list includes a high proportion of innovative drugs and aims to enhance drug accessibility for patients in urgent clinical need [2] Group 1: New Drug Additions - A total of 114 new drugs have been added to the insurance list, covering critical areas such as oncology, chronic diseases, and rare diseases [2] - The average price reduction for newly added drugs exceeds 60%, significantly alleviating the financial burden on patients [2] - Notable new drugs include innovative treatments for triple-negative breast cancer and pancreatic cancer, as well as long-acting growth hormone for children [2] Group 2: Optimization of Existing Drugs - The payment scope for 65 existing drugs has been optimized, including expanded indications for certain medications [3] - Adjustments have been made to ensure that the descriptions of drug payment scopes align more closely with clinical realities [3] Group 3: Policy Measures - The government has implemented a series of policies to ensure that negotiated drugs are effectively integrated into hospitals and accessible to patients [3] - Medical institutions are required to hold pharmacy meetings to incorporate new drugs into their procurement lists by February 2026 [3] Group 4: Industry Impact - The adjustment has led to the removal of 29 drugs that have lower efficacy or better alternatives available, thereby optimizing the use of medical insurance funds [4] - The inclusion of numerous innovative drugs indicates a strengthening of domestic pharmaceutical companies' research and development capabilities [4][5] - Major companies like Heng Rui Medicine and Innovent Biologics have successfully introduced multiple innovative drugs into the new insurance list [5]

Core Insights - The recent adjustment to the National Medical Insurance Drug List has significantly reduced the costs of long-acting growth hormone treatments, benefiting many families [1] - The new drug list includes a substantial number of innovative drugs, with an average price reduction of over 60%, aimed at improving patient access to essential medications [2] Group 1: New Drug Additions - A total of 114 new drugs have been added to the insurance list, covering critical areas such as oncology, chronic diseases, and rare diseases [2] - Notable new drugs include innovative treatments for triple-negative breast cancer and pancreatic cancer, as well as long-acting growth hormone for children [2][4] - The new drugs are characterized by either filling clinical treatment gaps, being superior to existing options, or offering better cost-effectiveness [2] Group 2: Existing Drug Adjustments - The payment scope for 65 existing drugs has been optimized, including expanding the target population for certain medications [3] - Adjustments have been made to align drug descriptions more closely with clinical realities, facilitating easier prescription by healthcare providers [3] Group 3: Policy and Industry Impact - The adjustment aims to optimize the use of medical insurance funds, allowing for the introduction of innovative drugs while removing less effective ones [4] - The removal of 29 drugs primarily targets those with lower cost-effectiveness or available alternatives, with minimal impact on most patients [4] - The inclusion of numerous innovative drugs reflects the strengthening of domestic pharmaceutical companies' R&D capabilities [5] Group 4: Financial Implications - The National Medical Insurance Bureau has adjusted the drug list for eight consecutive years, adding a total of 949 new drugs, with significant financial implications for the pharmaceutical market [5] - The insurance fund has spent over 460 billion yuan on negotiated drug expenditures, driving sales growth exceeding 600 billion yuan [5]

聚焦临床急需，1类新药数量创新高——目录新增114种药品，50种为1类新药。 最新版医保药品目录已于2026年1月1日正式落地实施。此次调整有哪些新亮点？为参保人带来哪些利好？国家医保局7日进行了解读。 动态"吐故纳新"，目录结构更合理——调出29种药品，均为已被临床淘汰、或长期未生产供应的药品。 "无论是比例还是数量，均创历年新高。"国家医保局医药服务管理司司长黄心宇说。新增药品涵盖肿瘤、罕见病、慢性病等。 其中包括贝那鲁肽注射液、达诺瑞韦钠片、盐酸拉维达韦片、阿利西尤单抗注射液、度维利塞胶囊、八氟丙烷脂质微球注射液、甘露特钠胶囊、林普利塞 片等8种未成功续约调出目录的谈判药品。 一批备受关注的新药顺利"入保"：如用于治疗三阴性乳腺癌的芦康沙妥珠、胰腺癌用药伊立替康脂质体等；用于改善内源性生长激素缺乏所致儿童生长缓 慢的长效生长激素针；一年两针的降血脂针英克司兰钠、糖尿病用药替尔泊肽等新药；流感用药昂拉地韦片、玛舒拉沙韦片等。 为保障参保人用药连续性，国家医保局设置过渡期政策，此次调整中未成功续约被调出目录的协议期内谈判药品有6个月的过渡期，2026年6月底前，参保 人购买这些药品，仍然可按照原报销标准。 ...

医保药品，牵动万家。 最新版医保药品目录已于2026年1月1日正式落地实施。此次调整有哪些新亮点？为参保人带来哪些利好？国家医保局7日进行了解读。 聚焦临床急需，1类新药数量创新高——目录新增114种药品，50种为1类新药。 "无论是比例还是数量，均创历年新高。"国家医保局医药服务管理司司长黄心宇说。新增药品涵盖肿瘤、罕见病、慢性病等。 为方便临床用药，用于提升白细胞数量的拓培非格司亭注射液等药品，支付范围从"前次化疗"调整为"既往化疗"，更贴近临床实际，还有一些 集采药品取消支付范围标注，根据药品说明书即可。 针对少数药品的滥用风险，目录新增限定条件，如明确烟酰胺仅限烟酰胺缺乏症患者可报销，确保医保基金用在"刀刃上"。 一些药品的支付范围删减非核心限定内容，但并不改变用药要求。如糖尿病用药司美格鲁肽，删除了"在运动和饮食控制基础上"，调整后临床 医生仍需根据药品说明书用药。 国家医保局微信公众号已上线新版基本医保目录查询功能。（图片来自国家医保局） 动态"吐故纳新"，目录结构更合理——调出29种药品，均为已被临床淘汰、或长期未生产供应的药品。 2025年2月20日，一家药企实验人员在检验生物制品蛋白分子量。 ...

医保药品，牵动万家。 最新版医保药品目录已于2026年1月1日正式落地实施。此次调整有哪些新亮点？为参保人带来哪些利 好？国家医保局7日进行了解读。 聚焦临床急需，1类新药数量创新高——目录新增114种药品，50种为1类新药。 "无论是比例还是数量，均创历年新高。"国家医保局医药服务管理司司长黄心宇说。新增药品涵盖肿 瘤、罕见病、慢性病等。 2025年2月 20日，一家药企实验人员在检验生物制品蛋白分子量。新华社记者 孙凡越 摄 一批备受关注的新药顺利"入保"：如用于治疗三阴性乳腺癌的芦康沙妥珠、胰腺癌用药伊立替康脂质体 等；用于改善内源性生长激素缺乏所致儿童生长缓慢的长效生长激素针；一年两针的降血脂针英克司兰 钠、糖尿病用药替尔泊肽等新药；流感用药昂拉地韦片、玛舒拉沙韦片等。 支付范围"再扩围"，"救命药"更快更可及——65种药品的支付范围有了新变化。 梳理可以发现，不少药品的新增适应症被纳入支付范围，如治疗非小细胞肺癌的阿美替尼片新增两个新 靶点、治疗罕见病发作性睡病的盐酸替洛利生片拓展至6岁及以上患者、曲普瑞林新增子宫内膜异位症 等，符合条件的参保人可享受相关待遇。 为方便临床用药，用于提升白细胞数量的 ...

医保药品，牵动万家。 最新版医保药品目录已于2026年1月1日正式落地实施。此次调整有哪些新亮点？为参保人带来哪些利好？国家医保局7日进行了解读。 聚焦临床急需，1类新药数量创新高——目录新增114种药品，50种为1类新药。 "无论是比例还是数量，均创历年新高。"国家医保局医药服务管理司司长黄心宇说。新增药品涵盖肿瘤、罕见病、慢性病等。 2025年2月20日，一家药企实验人员在检验生物制品蛋白分子量。新华社记者 孙凡越 摄 一批备受关注的新药顺利"入保"：如用于治疗三阴性乳腺癌的芦康沙妥珠、胰腺癌用药伊立替康脂质体等；用于改善内源性生长激素缺乏所 致儿童生长缓慢的长效生长激素针；一年两针的降血脂针英克司兰钠、糖尿病用药替尔泊肽等新药；流感用药昂拉地韦片、玛舒拉沙韦片等。 支付范围"再扩围"，"救命药"更快更可及——65种药品的支付范围有了新变化。 梳理可以发现，不少药品的新增适应症被纳入支付范围，如治疗非小细胞肺癌的阿美替尼片新增两个新靶点、治疗罕见病发作性睡病的盐酸 替洛利生片拓展至6岁及以上患者、曲普瑞林新增子宫内膜异位症等，符合条件的参保人可享受相关待遇。 为方便临床用药，用于提升白细胞数量的拓培非格司 ...

专题：新浪健康保险研究院 来源：华夏时报 12月9日，国家医保局召开有关会议，针对医保目录调整工作及首版商业健康保险创新药品目录进行深 度解读。此前12月7日，2025创新药高质量发展大会在广州召开。会议发布2025年《国家基本医疗保 险、生育保险和工伤保险药品目录》以及备受瞩目的首版《商业健康保险创新药品目录》（下称"商保 目录"）。据悉，新版药品目录自2026年1月1日起正式执行。 对此，国家医保局医药服务管理司司长黄心宇表示，双目录的发布标志着我国创新药保障体系迈向"基 本医保+商保"互补的新阶段，参保患者特别是肿瘤、罕见病等患者用药负担将明显减轻。此次调整后 目录内药品总数增至3253种，在"有进有出"的动态调整中，新增114种新药品，29种药品被调出，19种 高价创新药纳入商保目录。 和君咨询高级咨询师史天一接受《华夏时报》记者采访时指出，"这是我国自2018年国家医保局成立以 来进行的8次医保目录调整中最具突破性的创新，首次引入'商保创新药目录'旨在通过制度创新，构建 多赢格局。这一创举打破了我国药品保障体系过去的单一模式，构建了多层次用药保障新格局。那些曾 因价格高昂被挡在医保门外的创新药，如今 ...

Core Insights - The National Healthcare Security Administration (NHSA) has released the 2025 National Medical Insurance Drug List, adding 114 new drugs, including 50 innovative drugs of Class A, and 19 drugs included in the first commercial insurance innovative drug list [1][4] Summary by Sections New Drug Additions - The 2025 National Medical Insurance Drug List primarily adds chemical drugs, with a rapid increase in biological products and some traditional Chinese medicine [1] - Out of the 114 new drugs, 112 were included through negotiation and bidding, while 2 were directly included from national procurement [1] - A total of 111 new drugs were approved in the last five years, with the number of Class A innovative drugs reaching a historical high of 50 [1] Financial Impact - As of October 2023, the NHSA has paid over 460 billion yuan for drugs under agreement, benefiting over 1 billion patients and driving related sales exceeding 670 billion yuan [2] - Basic medical insurance covers approximately 44% of the costs for innovative drugs, while commercial insurance covers about 7% [2] Evaluation and Selection Criteria - The selection process for new drugs has seen a low pass rate during expert reviews, with only 127 out of 311 drugs passing to the negotiation table this year [2] - Some drugs were not favored due to "involutionary innovation," where the clinical value does not significantly improve compared to existing drugs [3][4] - To be included in the list, drugs must meet at least one of three criteria: filling clinical gaps, superior efficacy, or better cost-effectiveness [4] Commercial Insurance Innovations - The newly introduced commercial health insurance innovative drug list emphasizes drug innovation and clinical value, with 19 out of 141 submitted drugs successfully negotiated for inclusion [5] - The drugs in the commercial insurance list include 9 Class A new drugs, addressing gaps in basic medical insurance coverage [5] Future Directions - The NHSA plans to continue annual adjustments to the drug list to meet evolving clinical needs and incorporate advancements in medical technology [6] - The focus will be on supporting domestic and innovative drugs, enhancing collaboration between commercial insurance and innovative pharmaceutical companies [6]

在2025年国家基本药品目录调整中，谈判成功率达到88%，较上一年的76%有明显提升，创近七年新 高。与此同时，在新晋"国谈药"中，有111种为5年内新上市品种，50种为1类新药，无论是比例还是数 量也均创下历年新高。 而与此同时，仍有近百种（98种）药品在形式审查阶段，就被"国谈"拒之门外。近六成目录外药品在专 家评审阶段未过评，过评率连续两年不足50%。15种药在过评后最终谈判/竞价失败。 "一进一拒"，从正反两个维度体现了国家医保局价值购买的方向——在基本医保的保障边界内，支持真 创新，支持差异化创新。 部分业界观点认为，这一方面是因为在申报和形式审查环节，药企申报意愿持续提升，对规则的认知也 更加清晰，形式审查通过数量和通过率不断提升；另一方面，也与目录内药品涵盖适应证不断丰富，创 新药市场上同靶点、同机制、同适应证药品竞争激烈，医保基金紧平衡等多重原因下，国家医保局对创 新要求不断拔高有关。 182种药未过评背后："四不改"、价格与价值不匹配 国家基本药品目录谈判走进第八个年头，已形成了一套成熟的谈判流程：药企自主申报，专家综合评 审，价格谈判/竞价，最终公布谈判结果。 在今年"国谈"中，国家医保局 ...