Summary of Key Points
Since the launch of the first commercial insurance innovation drug catalog in January 2026, certain progress has been made (such as doubling the number of designated institutions providing these drugs and some affordable health insurance plans covering the listed medications). However, due to the recommendatory nature of the catalog and existing barriers in industry coordination, the actual results still fall short of expectations. Meanwhile, the adjustments to both the medical insurance catalog and the commercial insurance innovation drug catalog have commenced. The formal review process has been completed, and the next step is the evaluation and negotiation phase. A new catalog is expected to be released in November, with the goal of improving the integration between medical and commercial insurance to build a multi-tiered healthcare system.
Detailed Explanation
1. Commercial Insurance Innovation Drug Catalog: A “Supplementary Coverage List” Beyond Basic Medical Insurance
In simple terms, this catalog serves as a guide for commercial insurance companies (such as affordable health insurance plans and million-dollar medical insurance policies) regarding which innovative drugs have high clinical value and are needed by patients but are not covered by basic medical insurance. It has two main purposes: to clarify the boundaries of what basic medical insurance covers (drugs that are too expensive or too new will not be included initially) and to provide space for commercial insurance to cover these valuable, yet non-basic medical expenses.
For example, certain cancer-targeting drugs and medications for rare diseases are effective but costly. Since basic medical insurance cannot afford them, the commercial insurance innovation drug catalog lists them, encouraging insurers to include them in their products so that patients can get reimbursed for these treatments when purchasing such insurance.
2. Progress Over Half a Year: Some Advances, But Not Yet Meeting Expectations
Progress:
- Increased availability of drugs: By the end of May, the drugs on the catalog were available at 1,486 designated hospitals and pharmacies, more than doubling from the beginning of the year, making it easier for patients to access them.
- Commercial insurance companies are starting to adopt the catalog: Over 100 affordable health insurance products have included these drugs in their coverage, meaning that policyholders can get partial reimbursement for using them.
Shortcomings:
- The catalog is recommendatory, not mandatory: Insurers can choose whether to offer the coverage or not, so not all commercial insurance products include these drugs.
- Industry coordination issues: Although some drugs are on the catalog, the reimbursement processes with commercial insurers are complex, and there may not be enough hospitals providing them, making it inconvenient for patients to use these drugs. Therefore, the goal of “easy access to innovative drugs with commercial insurance” is still not fully achieved.
3. Medical Insurance Catalog Adjustments: Annual Reviews, More Active This Year
The basic medical insurance catalog is updated annually, adding new and effective drugs. The 2026 adjustments have already started:
- More applications received: A total of 818 application materials were submitted this year, covering 674 drugs—100 more applications and 41 more drugs than last year, indicating that pharmaceutical companies are eager to have their products included in the medical insurance coverage.
- Formal review completed: The initial check has confirmed that the proposed drugs meet the basic criteria (e.g., being new drugs with clinical data). Experts will now evaluate them, and price negotiations with pharmaceutical companies will follow. A new catalog is expected to be released in November.
The adjustment process still focuses on ensuring that the coverage includes essential drugs at a reasonable cost. Additionally, mechanisms will be established to coordinate with the commercial insurance innovation drug catalog; for example, if certain drugs cannot be included in medical insurance immediately, commercial insurers will be encouraged to provide coverage for them.
4. Are Patients Really Benefiting? Can New Medical Insurance Drugs Be “Used and Afforded?”
Looking at the new drugs included in the medical insurance negotiations since 2025, patients have indeed seen benefits:
- Wide availability: These new drugs are available at 310,000 designated institutions nationwide, covering almost all major hospitals and chain pharmacies.
- High usage: From January to May, 12.25 million people used these new drugs. For instance, the diabetes treatment drug Tiroptide Injection is available at 12,000 institutions, allowing many patients to access previously unaffordable treatments.
- Cost-effective: The medical insurance fund spent 2.64 billion yuan on these drugs, generating sales of 3.95 billion yuan, indicating that medical insurance reimbursement has helped patients save a significant amount of money.
5. Future Directions: Better Collaboration Between Medical and Commercial Insurance
The National Healthcare Security Administration’s focus is to improve the coordination between medical and commercial insurance:
- Strengthening communication with the insurance industry: Guiding insurers to optimize their products, such as including more drugs from the commercial insurance innovation catalog or simplifying reimbursement processes.
- Improving coordination mechanisms: Ensuring that the medical insurance catalog and the commercial insurance innovation catalog complement each other—medical insurance covers essential needs, while commercial insurance fills in gaps. This will ensure that patients can access the necessary treatments, regardless of whether the drugs are covered by medical insurance.
In summary, the commercial insurance innovation drug catalog is a positive start, but further improvements are needed. In the future, the cooperation between medical and commercial insurance will become more closely aligned, providing patients with a wider range of medication options.
(The entire text is written in plain language, making it easy for non-financial professionals to understand.)