The new edition of the National Basic Medical Insurance, Maternity Insurance, and Work-Related Injury Insurance Drug List (2025) (hereinafter referred to as the "Basic Medical Insurance List") and the inaugural Commercial Health Insurance Innovative Drug List (2025) (hereinafter referred to as the "Commercial Innovative Drug List") will be officially implemented nationwide starting January 1, 2026. As the first-ever "dual directories," this update successfully added 114 new drugs to the Basic Medical Insurance List and incorporated 19 drugs into the Commercial Innovative Drug List.
Experts noted in interviews that the adjustment of the National Medical Insurance List consistently adheres to the principles of "genuinely supporting innovation, supporting genuine innovation, and supporting differentiated innovation." The coordinated release of these dual directories will help meet the public's diverse and multi-level medication needs, address the accessibility challenges of high-value innovative drugs, and inject strong momentum into the research and development efforts of pharmaceutical companies.
The expansion of drug coverage focuses on key therapeutic areas. Among the 114 drugs newly included in the medical insurance list are 36 oncology drugs, 12 drugs for chronic diseases such as diabetes, 13 anti-infective drugs, and 10 drugs for rare diseases, while 29 drugs that are clinically unnecessary or have superior alternatives were removed. Following this adjustment, the total number of drugs in the National Medical Insurance Drug List has increased to 3,253, comprising 1,857 Western medicines and 1,396 traditional Chinese medicines.
"From oncology to metabolic diseases, from autoimmune disorders to rare diseases, the coverage of disease areas in this update to the medical insurance list is very comprehensive," stated Liu Linna, Chief Pharmacist at Tangdu Hospital of the Air Force Medical University. She emphasized that the rapid inclusion of innovative and specialized drugs addresses many clinical challenges; for instance, patients with triple-negative breast cancer or pancreatic cancer, who previously had no treatment options, can now afford and access effective medications.
Zhang Ke, Party Secretary and Director of the National Healthcare Security Administration (NHSA), reported that the NHSA has adjusted the medical insurance drug list for eight consecutive years. Cumulatively, including the 2025 update, 949 new drugs have been added. Expenditures by the medical insurance fund for negotiated drugs during their agreement periods have exceeded 460 billion yuan, driving sales of over 600 billion yuan, thereby powerfully promoting the iterative upgrade and "replacing the old with the new" in the pharmaceutical market.
A common public concern is when drugs included in the medical insurance list will actually become available in hospitals, often referred to as the problem of "making the list but not the hospital." To address this long-standing issue, the new policy introduces a combination of measures. On one hand, it requires all designated medical institutions to convene their Pharmacy and Therapeutics Committees by the end of February 2026 to promptly include newly added drugs in their hospital procurement lists, establishing temporary green channels if necessary. On the other hand, it reiterates that negotiated drugs are not subject to administrative restrictions such as the "one product, two specifications" rule, drug proportion targets, or overall medical insurance budget caps. Furthermore, for cases involving high-value innovative drugs unsuitable for Diagnosis-Intervention Packet (DIP) payment, the policy allows medical institutions to apply for "special case individual negotiation."
The inclusion of high-value innovative drugs is accelerating. It is understood that among the newly added drugs in the Basic Medical Insurance List, 50 are Category 1 innovative drugs, many of which were approved in recent years. The overall success rate for inclusion reached 88%, a significant increase from 76% in 2024. This not only demonstrates clear support for "genuine innovation" and "differentiated innovation" but also reflects a shift in medical insurance payment from "passive reimbursement" towards "strategic purchasing" and "value-based purchasing." This approach involves using medical insurance negotiations and price guidance to direct limited insurance funds precisely towards clinically urgent, efficacious, and cost-effective drugs, thereby enhancing the overall efficiency of healthcare resource allocation.
An analysis reveals that alongside numerous innovative products from domestic companies, the 2025 National Medical Insurance List also features prominent original-research drugs from multinational corporations. Examples include Novartis's Inclisiran sodium injection and Brolucizumab injection, and Johnson & Johnson's Guselkumab injection. "In 2025, Novartis successfully had 2 new products and 4 new indications included in the National Medical Insurance Drug List, which affirms our relentless efforts to promote access to innovative medicines," said Li Yao, President and Managing Director of Novartis China. He added that to date, the company has over 40 drugs included in the National Medical Insurance List.
"The newly included drugs in the 2025 medical insurance list exhibit three significant characteristics: they either fill clinical treatment gaps, are superior to existing alternatives, or offer higher cost-effectiveness," explained Huang Xinyu, Director of the Medical Service Management Department at the NHSA. For instance, all three domestically marketed KRAS G12C targeted therapies for KRAS-mutant non-small cell lung cancer—Fuzereisai Tablets, Gesuoreisai Tablets, and Juyuansuan Gelaireisai Tablets—were included in the new list, effectively filling a critical clinical void.
During the expert review phase of the 2025 medical insurance list adjustments, more than 10 Category 1 innovative drugs failed to pass the expert review, drawing industry attention. Regarding this, Huang Xinyu stated that some Category 1 new drugs were duplicative of existing drugs in the list without demonstrating enhanced clinical value. Additionally, drugs whose prices exceeded the "basic coverage" functional positioning of the insurance, or where the price did not match the perceived value, also could not pass the review.
Efforts are underway to resolve the dilemma of accessing drugs beyond basic medical insurance coverage. In recent years, some life-saving innovative drugs have been priced very high upon initial market launch, making them difficult to cover under the basic medical insurance list, and thus remaining unaffordable for many patients. To address this, the NHSA, focusing on highly innovative drugs with significant clinical value and patient benefits that fall outside the scope of basic medical insurance, has established the Commercial Innovative Drug List for the first time. This initiative is guided by the goal of meeting the public's diverse medication needs and aims to fill the gaps in clinical drug coverage.
A review of the inaugural Commercial Innovative Drug List shows that the included drugs encompass both热门靶点药物 like CAR-T cell therapies, TCE therapies, and bispecific antibodies, as well as drugs for rare diseases that predominantly affect children, such as those for relapsed or refractory neuroblastoma and Gaucher's disease. "The first Commercial Innovative Drug List includes a total of 19 drugs, a result that aligns with expectations and forms a good complementary connection with the basic medical insurance," Huang Xinyu explained.
Wang Pingyang, Vice President of the Zhejiang Medical Security Research Association, commented that most drugs in the Commercial Innovative Drug List were launched between 2021 and 2025. These drugs are not only highly innovative and clinically valuable, providing significant benefits to patients, but they also effectively differentiate themselves from basic medical insurance coverage, possessing both strong insurability and market appeal. Some of these drugs have already been gradually included in various commercial insurance products in recent years, with a few even covered by over 100 inclusive commercial health insurance (Huimin Bao) projects. Through the Commercial Innovative Drug List, pharmaceutical companies can expand their market reach, patient medication burdens can be reduced, and commercial insurance can enhance its appeal to enrollees, creating a virtuous cycle of multi-stakeholder benefits.
"The policy sends a very clear signal to the entire industry: the state supports independent innovation and is willing to ensure value return for innovation through institutional design. This will greatly encourage pharmaceutical companies to invest more resources in pioneering and differentiated R&D," said Lü Lulu, CEO of Heyuan Bio. She highlighted that Naijiolunsai Injection, the first fully independently developed CD19-targeted CAR-T cell therapy product in China, developed by Heyuan Bio, has been included in this inaugural Commercial Innovative Drug List.
A responsible official from the NHSA stated that as more new drugs enter the directories, the level of clinical medication will steadily improve. In the next steps, the NHSA and the Ministry of Human Resources and Social Security will further refine policies, strengthen management, and ensure the effective implementation of the directories. This will better guarantee reasonable clinical medication needs for insured individuals and continuously enhance the public's sense of gain, happiness, and security.