Industry experts believe that the implementation of multiple drug lists, such as commercial insurance catalogs, essential medicine lists, and insurance association catalogs, essentially relies on different funding entities. The goal is to ultimately define boundaries and establish tiers on the payment side, thereby unlocking the value of innovative drugs. The commercial insurance innovative drug list is about to see its first expansion. Meanwhile, another "commercial insurance drug list" promoted by the China Insurance行业协会 under the National Financial Regulatory Administration has quietly made progress alongside the national price negotiation period. Both are recommended lists. A health insurance industry insider explained that, unlike the commercial insurance innovative drug list led by the National Healthcare Security Administration, this drug coverage list led by the insurance industry association is likely to connect not with the integrated social-commercial insurance, such as city-level supplementary insurance, but with various types of pure commercial health insurance, like million-dollar medical insurance. According to this source, the long-dormant unofficial drug coverage list has preliminarily completed drug selection work and is awaiting release. Recent media reports suggest the list is expected to include over 100 drugs. However, as both public insurance and commercial insurance define the "insurability" of innovative drugs from different perspectives, one interviewed innovative drug company representative expressed greater concern about how to transition from "suitability for insurance" to "actual insurability." Additionally, there remains a significant gap between being listed on a catalog and truly alleviating patients' out-of-pocket burdens. Another health insurance expert pointed out that the current challenges in implementing the commercial insurance innovative drug list reveal unresolved coordination mechanisms among various parties. If the relationship between the two commercial insurance drug lists is not clarified, it could increase coordination difficulties and deepen the wait-and-see attitude of insurance companies and drug companies. The expert called for national-level top-level design to form cross-departmental policy synergy, rather than fragmented progress, to better leverage commercial insurance in the innovative drug payment system.

The relay race for commercial insurance payment of innovative drugs has not truly begun, as stated by the head of a health insurance department at one insurance company. He explained that the commercial insurance innovative drug list was once seen as the "last mile" for innovative drug payments, but in reality, this "last mile" contains countless obstacles. Drug companies, hospitals, public insurance, financial regulators, commercial insurers, and payment platforms each hold a baton in this relay. The race hasn't fully started not because of unwillingness, but due to each entity's distinct positions, interests, and bottlenecks. Until these blockages are resolved, the "last mile" cannot run smoothly. For instance, city-level supplementary insurance is crucial as the primary carrier connecting with the commercial insurance innovative drug list, as any relay handoff failures ultimately affect it. An insurance company representative involved in operating a city-level supplementary insurance plan in a central Chinese city noted that since last year, many innovative drugs were included in local supplementary insurance special drug lists before national price negotiations. However, after last year's negotiations concluded, he realized that the overly broad discount range (15%-50%) in the commercial insurance innovative drug list, the yet-to-be-established discount rebate channels, and supportive clinical usage policies had created a subtle dilemma. While patient numbers increased, drug company discounts corresponding to each claim did not actually flow into insurance company accounts, making the already tight actuarial models of these supplementary insurance plans even more risky. Meanwhile, insurance companies face pressure from both sides. An industry insider familiar with Zhejiang's supplementary insurance operations explained that after the commercial insurance innovative drug list was implemented and discount settlement mechanisms introduced, drug companies offered discounts, leading consumers to expect higher compensation. This expectation is reasonable, but insurers are caught in the middle, squeezed between drug company pricing negotiations and patient coverage expectations. Listing in the catalog is just the first step in the claims process, as noted by Zeng Xudong, head of the Insurance Department at Shanghai University of Finance and Economics' School of Finance. He emphasized that any break in the chain from drug supply, clinical diagnosis and treatment, drug company discounts, to final product claims means the catalog cannot translate into actual patient reimbursements. The aforementioned health insurance expert stressed that cross-sector barriers must be broken. As the National Healthcare Security Administration's commercial insurance innovative drug list prepares for its first expansion, a survey of innovative drug companies participating in the initial list revealed widespread belief that long-term success depends on stronger cross-departmental policy coordination. Currently, there is an urgent need for smooth collaboration among healthcare security, financial regulation, and health authorities.

Policy suitability for insurance does not equal commercial insurability. According to public information, the number of drugs applying for this year's commercial insurance innovative drug list is less than half of the 2025 applicants. In July and August, expert reviews for national negotiations are underway. A drug company representative involved in last year's inaugural commercial insurance innovative drug list negotiations revealed that the review criteria last year still offered limited responses to "commercial insurance payment characteristics." The list's comprehensive review adopted the basic medical insurance's four-dimensional framework of "effectiveness, safety, innovativeness, and fairness." However, commercial insurance and public insurance differ in their protection attributes and operational mechanisms. To address this, the National Healthcare Security Administration this year added a new requirement that innovative drugs included in the commercial insurance list must demonstrate "strong suitability for insurance." Policy suitability and insurance insurability intersect but are not identical, as Zeng Xudong explained. For example, the first commercial insurance innovative drug list included drugs with conditional approval or newly launched products. Zeng believes these drugs have uncertain clinical efficacy, directly impacting insurance companies' underwriting and claims assessment. He further clarified that suitability answers whether a drug is worth covering. During national negotiations, expert panels evaluate a drug's innovation level, clinical value, and patient benefits to determine if it exceeds the basic insurance scope and is worth including, while also assessing whether commercial insurers can identify and manage such risks. Insurability, on the other hand, answers whether coverage is affordable. Under insurance principles, insurers evaluate whether risks can be calculated: whether sufficient homogeneous risks can be pooled, whether losses are accidental and measurable, whether probabilities can be quantified, whether risk concentration is excessive, and whether premiums are economically feasible for insured individuals. Due to the conflict between public governance logic and commercial business logic, the commercial insurance innovative drug list is almost incompatible with health insurance individual products other than city-level supplementary insurance. Even supplementary insurance, being a commercial product, must follow commercial risk pricing logic. For example, drugs for Alzheimer's disease treatment, which have large potential patient populations and lack real-world data for risk assessment, typically require more cautious underwriting by insurers. Zeng Xudong recently presented data at the Ninth Multilevel Healthcare Security System Innovation Conference showing that as of July, among the first commercial insurance innovative drug list's two AD drugs, Lecanemab injection had been included in at least 12 local supplementary insurance products, while Donanemab injection entered at least five products. AD drug coverage in supplementary insurance has generally expanded, but reimbursement rules remain highly fragmented. This year, after a year in the commercial insurance catalog, both AD drugs have turned to the public insurance list. Notably, this year's formal review list for the commercial insurance innovative drug catalog includes four other AD-related drugs, but none have been explicitly included in local supplementary insurance plans, Zeng said.

An industry-wide commercial insurance drug list appears imminent. As China's pharmaceutical innovation accelerates, innovative drug companies have unprecedented expectations for commercial health insurance as a channel to realize domestic market value. After recognizing the capacity limits of supplementary insurance and the commercial insurance innovative drug list, stakeholders have shifted their expectations for innovative drug payments to the broader commercial insurance landscape. However, in recent years, the individual insurance track has been mired in price competition, with some insurers blindly expanding list lengths and even covering innovative drugs immediately upon launch. This seemingly generous concession hides risks, leading to frequent situations where coverage is claimed but claims are denied, and some products may be discontinued due to out-of-control loss ratios. In the absence of a transparent, scientific, standardized, and predictable value screening mechanism, insured individuals and the pharmaceutical industry's recognition of health insurance may decline. The commercial insurance innovative drug list provides a reference, but for most health insurance products, its reference value is limited. With this year's national negotiations underway, the insurance industry association is accelerating its push for an industry-wide commercial insurance drug list. According to media reports, in June, the association convened discussions with multiple drug companies, with commercial insurers like PICC, China Life, and Ping An participating. The aforementioned health insurance insider stated that this list is now largely finalized. Industry expectations for such a list date back to 2021, when the former China Banking and Insurance Regulatory Commission issued guidelines on enriching personal insurance product supply, explicitly proposing the exploration of a commercial health insurance drug list and diagnosis and treatment item list. A year later, the insurance industry association initiated a research project on standard-setting and long-term development of commercial health insurance catalogs. In 2025, the National Healthcare Security Administration announced the first commercial insurance innovative drug list would be released within the year. That same year, the insurance industry association resumed pushing for the commercial insurance drug list. An insurance company insider familiar with the list said that the two lists are not contradictory; both aim to alleviate patients' out-of-pocket pressure from high-value innovative drugs. The difference lies in the number of drugs included, with the industry list being larger. This list includes drugs that people urgently need, with clear clinical efficacy, but relatively high prices and patient financial pressure. The health insurance insider views the commercial insurance innovative drug list as providing a channel for innovative drug companies to connect public and commercial insurance, focusing more on drug innovation. The insurance industry association's list, compiled from historical claims data, summarizes frequently covered drugs, offering insurers a reference for connecting insurance products with target customer medication needs, promoting standardization. Its role can be likened to critical illness disease lists or standardized vehicle insurance clauses, the source said. Compared to the commercial insurance innovative drug list with supporting policies, this industry list's support may involve opening underlying data, allowing for shared data to help insurers more efficiently design market-responsive, risk-controlled products. From the perspective of innovative drug pricing systems, the implementation of multiple lists—commercial insurance catalogs, essential medicine lists, and insurance association lists—essentially relies on different funding sources to define boundaries and tiers at the payment end, realizing innovative drug value, a public insurance expert concluded.