12月13日，全国医疗保障工作会议在北京召开。会议明确提出，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。 而在稍早前的12月7日，国家医保局与人力资源社会保障部联合发布《国家基本医疗保险、生育保险和工伤保险药品目录》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》），并宣布将于2026年1月1日起正式实施。 然而，政策落地对保险赔付来说并非坦途。对于商业保险机构而言，仍然面临着如何将《商保创新药目录》转化为具体的产品责任？如何解决 定价数据匮乏、医院准入壁垒及资金合规流转等现实难题？ 5款百万元国产C A R -T均入选 首版《商保创新药目录》共纳入19种药品，精准聚焦于"高精尖"与"高价"领域。 包括5款国产CAR-T产品、神经母细胞瘤和戈谢病等罕见病特 效药，以及阿尔茨海默病治疗药物。 | 药品 | 药企 | 中国上市 | 适应证 | 创新性、公平性等 | | --- | --- | --- | --- | --- | | 1 伊匹 ...

首版商保创新药目录已于近日揭晓，最终有19个药品成功纳入，这里面就包括了6款罕见病用药，后者 共覆盖神经母细胞瘤、戈谢病、短肠综合征等5种疾病。 该目录纳入的药品具有创新程度高、临床价值大、患者获益显著且超出基本医保保障范围等特征，旨在 为商业健康保险、医疗互助等多层次医疗保障体系提供参考。 不过，随着目录落地，如何吸引到更多的商业保险来承接？这仍有待观察。虽然惠民保在探索罕见病创 新药用药保障上迈出了重要一步，但也面临保障扩面、待遇提升的现实困境。 6款罕见病药物纳入 在罕见病用药保障上，惠民保仍面临挑战。 罕见病大多具有病理复杂、病症危害大、相关治疗药品研发难度大、成本高、售价高的特点，极易导致 患者因病返贫、致贫。 这次纳入罕见病药物短肠综合征创新药注射用替度格鲁肽，该药于2024年2月在中国获批，成为中国首 个治疗短肠综合征的人胰高血糖素样肽2（GLP-2）类似物，填补了短肠综合征治疗领域长期无可使用 的肠康复治疗药物的空白。 短肠综合征是指因各种原因引起广泛小肠切除或旷置后，肠道有效吸收面积显著减少，残存的功能性肠 管不能维持患者的营养或儿童生长需求，出现以腹泻、酸碱/水/电解质紊乱、以及营养吸收和 ...

Core Insights - The first national commercial insurance innovative drug directory for 2025 has been released, including 19 high-value innovative drugs covering key treatment areas such as oncology, rare diseases, and neurodegenerative diseases [1][3][4] - Shenzhen's "Shenzhen Huiminbao" has proactively included all 19 innovative drugs in its coverage for 2025, significantly reducing out-of-pocket expenses for insured residents when using these drugs [1][2][3] Summary by Sections National Drug Directory - The newly published commercial insurance innovative drug directory serves as a supplement to basic medical insurance, focusing on drugs with high innovation, significant clinical value, and substantial patient benefits that exceed the coverage of basic medical insurance [1][4] - Included drugs feature CAR-T therapies for cancer treatment, medications for rare diseases like Gaucher disease, and drugs for Alzheimer's disease, which has garnered significant public attention [1][4] Shenzhen Huiminbao - "Shenzhen Huiminbao" has achieved full coverage of the 19 innovative drugs, providing a crucial supplement to the existing medical insurance framework in Shenzhen [1][4] - The insurance plan supports a "one-stop settlement" service, alleviating the financial burden on insured individuals when seeking medical treatment [2][4] - The program has been operational for three years, maintaining a public welfare characteristic with no restrictions on age, occupation, or health status, allowing for an annual premium of 88 yuan for coverage exceeding 4 million yuan [5] - As of 2025, the number of insured individuals has surpassed 6.15 million, with a total of over 18 million insured instances in three years [5]

备受创新药产业界关注的首版商保创新药目录清单终于"出炉"，共计纳入18家创新药企的19种新药。 另据国家医保局此前披露信息，今年共有121个药品通用名通过商保创新药目录的形式审查，参与商保创新药目录价格协商的药品共24个。 也就是说，从通过形式审查到最终入选，首版商保创新药目录"宽进严出"，入选率约16%。 这大致符合业界预期。曾有多名地方医保部门和商保公司人士对第一财经表示，对于最可能率先衔接商保创新药目录的商保产品——惠民保，特药清单俨 然成为标配，大部分地方惠民保特药目录已涵盖50~100种药品，部分城市还会单独设置CAR-T药品保障清单。在此背景下，一旦商保创新药目录发布， 地方或需要对已完成精算的惠民保产品再度调整特药目录。 与此同时，每年进入基本医保目录的创新药数量保持增势，"国谈药"进院压力仍较大。按照国家医保局政策，谈判药品和商保创新药目录内药品均可不 受"一品两规"限制，不得以医保总额限制、医疗机构用药目录数量限制、药占比等为由影响药品落地，且均有望被医保支付方式改革中的特例单议政策所 惠及。 在此背景下，如果商保创新药目录涵盖药品数量过多，反而不易于落地。更不要说在原先地方惠民保的特药使用 ...

Core Insights - The first version of the commercial health insurance innovative drug directory has been released, including 19 new drugs from 18 innovative pharmaceutical companies, with a roughly equal share of domestic and imported drugs [3][4] - Approximately 70% of the drugs included are oncology treatments, featuring five high-cost CAR-T products, indicating a significant focus on cancer therapies [3][4] - The inclusion of rare disease medications and Alzheimer's treatments in the directory is expected to enhance commercial insurance payment options and facilitate hospital access [3] Summary by Sections Inclusion Criteria - A total of 121 drug names passed the review for the commercial health insurance innovative drug directory, with only 19 ultimately included, resulting in an acceptance rate of about 16% [6] - The directory aims to balance the number of drugs included to ensure effective implementation and avoid overwhelming the system [8] Drug Characteristics - The drugs in the directory generally have a small patient base or clear indications, minimizing the risk of clinical misuse [10] - High innovation and the ability to fill clinical gaps are common traits among the selected drugs, particularly in rare diseases and pediatric treatments [11] - The directory includes a significant number of oncology drugs, with 14 out of 19 being cancer treatments, primarily targeting niche patient populations [11][12] Market Dynamics - The CAR-T products included represent over half of the CAR-T therapies available in China, highlighting their importance in the market [12] - The directory's structure allows for multiple similar drugs to coexist, enhancing patient choice and supporting real-world evidence accumulation [13][14] - The focus on rare disease treatments is evident, with at least five rare diseases represented in the directory, including neuroblastoma and Gaucher disease [14] Future Implications - The directory is expected to influence local health insurance products, prompting adjustments to existing special drug lists in various regions [16][17] - The commercial health insurance sector is encouraged to design new products and adjust reimbursement strategies based on the directory to better meet patient needs [17]

12月7日，2025年国家首版商保创新药目录在广州发布，首批纳入19种高价值创新药，涵盖肿瘤、罕见病、神经退行性疾病等多 个关键治疗领域。记者从"深圳惠民保"承保机构获悉，作为深圳本土普惠型商业健康保险，"深圳惠民保"已率先在2025年度保 障中将这19种创新药全部纳入保障范围。 | 19款药品 | | | --- | --- | | 纳入首批商保目录 | | | 约能名称 | 1541 | | 甲苯磷酰胺注射液 | 天津红日健达康医药科技有限公司 | | 复过的他漫司他片 | 和记黄埔医药(上海)有限公司 | | 注射用户 上一起 | 南京绿叶制药有限公司 | | 那西妥单抗注射液 | 赛生医药江苏有限公司 | | 盐酸沙丙蝶哈片 | 山东新时代药业有限公司 | | 仑卡奈单抗注射液 | 卫材(中国)药业有限公司 | | 多奈单抗法射液 | 礼来贸易有限公司 | | 达妥昔单抗B法射液 | 百济神州(北京)生物科技有限公司 | | 注射用泽尼达妥单抗 | 百济神州(北京)生物科技有限公司 | | 注射用替度格鲁肽 | 武田(中国)国际贸易有限公司 | | 瑞基奥仑赛注射液 | 上海药明巨诺生物科技有限公司 ...