This year's government work report highlighted the introduction of a commercial health insurance catalog for innovative drugs. In 2025, the National Healthcare Security Administration and other departments issued policies to support the high-quality development of innovative medicines. By the end of the year, the Commercial Health Insurance Innovative Drug Catalog was released, including 19 high-value innovative drugs not covered by basic medical insurance. This initiative promotes a dual-track payment system where basic insurance covers essential needs, while commercial insurance covers high-value and innovative treatments.
This measure offers a new approach to addressing the challenge of paying for high-cost innovative drugs and positions commercial health insurance as a key support for the development of innovative drugs and medical devices. However, even after the catalog's implementation, innovative drugs still face multiple obstacles in clinical application. Overcoming these "final hurdles" to ensure patients truly benefit from high-value innovative medicines remains a critical issue for the industry.
Driven by both policy support and market demand, commercial health insurance has achieved an average annual growth rate of over 20% in the past decade, with more than 11,000 medical insurance products currently available.
In recent years, commercial health insurance has continuously expanded its coverage and enhanced health protection services. Industry experts note that a decade ago, the sector began including CAR-T therapies costing over one million yuan in coverage lists. Today, most mainstream medical insurance products cover new technologies, drugs, and devices, including high-value treatments like targeted cancer therapies and proton and heavy ion therapies.
Preliminary estimates indicate that in 2025, total reimbursements for innovative drugs and devices by commercial health insurance reached approximately 14.7 billion yuan, marking four consecutive years of rapid growth with a compound annual growth rate of 70%.
For 2026, the government work report proposes accelerating the development of commercial health insurance, promoting the high-quality development of innovative drugs and medical devices, and better meeting the public's diverse healthcare and medication needs.
AXA Tianping CEO Zuo Weihao believes this opens new growth opportunities for the insurance industry, encouraging market participants like AXA to speed up the development of commercial health insurance and facilitate the adoption of medical innovations. By incorporating innovative drugs and devices, providing high-quality medical resources, and offering full-cycle health management, commercial insurance can complement basic medical insurance to safeguard public health.
Magnesium Health Senior Vice President and Chief Commercial Officer Lang Liliang stated that this year's government work report clearly emphasizes accelerating the development of commercial health insurance and closely links it with promoting high-quality innovative drugs. This not only reflects a precise plan for building a multi-level healthcare security system but also charts a course for the high-quality development of the health industry. Commercial health insurance is a vital pillar of China's multi-level healthcare security system, serving as an effective supplement to basic insurance and a bridge connecting patients with quality medical resources.
In Lang's view, commercial health insurance acts as both an accelerator and a stabilizer for the high-quality development of innovative drugs and devices. By establishing market-based payment guarantees, broadening coverage for innovative treatments, and improving diverse payment ecosystems, commercial health insurance can significantly enhance the accessibility and affordability of innovative therapies. This stabilizes returns for pharmaceutical companies, encouraging more R&D investment and creating a positive cycle of expanded coverage, drug and device innovation, and patient benefits.
With rapid advances in biomedical technology, China ranks second globally in the number of innovative drugs approved for market. However, challenges such as "difficult hospital access and payment barriers" for high-value innovative drugs persist.
At the 2025 Innovative Drug High-Quality Development Conference, the industry's first commercial insurance catalog for innovative drugs was officially released. Despite this progress, innovative drugs still encounter "last-mile" issues in clinical application: insufficient prescription guidelines for doctors, limited risk control measures by insurers, and weak perceived benefits for patients.
During this year's Two Sessions, Sun Jie, a member of the National Committee of the Chinese People's Political Consultative Conference and Vice Dean of the School of Insurance at the University of International Business and Economics, recommended granting commercial health insurers the authority to develop usage guidelines and clinical pathways for high-value innovative drugs. This would create a collaborative governance model where basic insurance sets the direction, commercial insurance establishes standards, and hospitals implement them. This approach would empower specialized health insurers not only as strategic purchasers and payers with negotiation and pricing rights but also as developers of usage guidelines and clinical pathways, genuinely improving the accessibility and affordability of catalog drugs.
The first commercial insurance catalog includes 19 high-value innovative drugs, covering five CAR-T therapies for precise cancer treatment, various malignant tumor treatments, and rare disease medications, focusing on areas not yet covered by basic medical insurance.
Seventeen of the 19 drugs are injectables, requiring administration by medical professionals in hospitals. However, some hospitals, following their management protocols, refuse to allow externally purchased injectables to be administered on-site. Sun Jie emphasized that ensuring hospital availability of commercial insurance catalog drugs is a key step in overcoming the final hurdles for innovative drug adoption.
To address hospital-side barriers, Sun proposed three recommendations across performance evaluation, funding access, and payment mechanisms to comprehensively alleviate hospitals' concerns and institutional constraints, smoothing the path for catalog drugs into hospitals.
Specifically, the suggestions include: optimizing performance monitoring indicators for tertiary public hospitals by excluding commercial insurance catalog drugs from cost metrics and adding indicators for innovative drug application ratios; allowing public hospitals to accept commercial insurance funds beyond government allocations, basic insurance, and patient out-of-pocket payments, while establishing a shared payment mechanism for pharmaceutical services involving basic insurance, commercial insurance, and patients; and creating a markup payment mechanism for the 19 catalog drugs, building on existing DRG/DIP (diagnosis-related group/diagnosis-intervention packet) payment exemptions.
Zhou Yanfang, a deputy to the National People's Congress and Director of China Taiping's Strategic Research Center, suggested incorporating the availability of commercial insurance catalog drugs into performance assessments for national key clinical specialties and leading hospitals, incentivizing medical institutions to ensure these drugs are accessible and prescribable. Streamlining pharmacy committee approval processes would also encourage hospitals to adopt these drugs willingly and quickly.
Additionally, promoting full integration between the commercial insurance catalog and the "dual-channel" pharmacy settlement system, leveraging the national medical insurance information platform, could establish a one-stop instant settlement mechanism for innovative drugs. This would allow patients to purchase drugs from outside pharmacies without advance payment or post-purchase reimbursement, ensuring "data moves more, people move less."
Due to their low premiums and broad coverage, inclusive health insurance products have played an increasingly important supplementary role in recent years, alleviating high medical costs and preventing poverty due to illness. Special drug coverage is a core innovative feature of these products, directly addressing the commercialization needs of innovative drugs.
According to the 2025 City-Specific Commercial Medical Insurance Knowledge Graph, 137 of the 169 basic traditional inclusive insurance products include special drug coverage, accounting for over 80% of products. On average, each product covers 41 special drugs across 28 indications. While expanding rapidly, the industry widely acknowledges that inclusive insurance's coverage capacity for innovative drugs still has significant gaps, struggling to keep pace with the development of innovative drug industries and patient clinical needs.
Sun Jie noted that current inclusive insurance drug catalogs are limited, typically covering dozens of drugs, which is narrow compared to the hundreds of approved innovative drugs on the market. This leaves many clinically needed innovative drugs uncovered, failing to meet insured individuals' demands for diverse, personalized treatment options. Constraints on fund size and premiums also limit the inclusion of high-value innovative drugs.
To address this, Sun recommended optimizing and upgrading inclusive insurance to enhance coverage of innovative drugs. She suggested that local governments expand the range of innovative drugs covered by inclusive insurance, increasing the number of drugs outside basic insurance. Encouraging commercial insurers to develop innovative drug insurance products that complement inclusive insurance, such as special drug insurance for non-catalog drugs or upgraded versions of inclusive insurance with higher coverage, was also proposed.
She further advised learning from the innovative drug catalog experience by implementing joint price negotiations and co-payment mechanisms. Inclusive insurance underwriters could lead negotiations with pharmaceutical companies, discussing not only settlement prices but also payment terms and coverage scope. Exploring volume-based or outcomes-based payment agreements could create data-driven dynamic adjustment mechanisms, ensuring efficient use of insurance funds while incentivizing drug companies to provide ongoing clinical evidence for a virtuous cycle.
Notably, local governments have taken the lead in integrating inclusive insurance with the national commercial insurance innovative drug catalog, offering practical models for the widespread adoption of innovative drugs across the country.
On March 3, the Shanghai municipal government held the 2026 Shanghai Health and Medical Security Work Conference, guiding the optimization and upgrade of the 2026 "Shanghai Hui Bao" inclusive insurance. Efforts include promoting exemplary group commercial insurance products, improving policies for purchasing commercial health insurance with personal accounts, and aligning with the national commercial insurance innovative drug catalog to enhance support for innovative drugs and devices. Policies supporting the listing, inclusion, hospital access, and payment of innovative treatments will be refined to accelerate clinical application. New models for cross-border drug and device transactions and regular "insurance-enterprise" dialogues will also be explored.