With the official nationwide implementation of the new National Reimbursement Drug List (NRDL) and the Commercial Health Insurance Innovative Drug List starting January 1, 2026, multiple innovative drugs newly included in the lists, such as Tebotuzumab N01 Injection, Lucatumumab, and Tirzepatide Injection, have had their first reimbursed prescriptions issued in hospitals across various regions. The beneficial effects of the new drug catalogs are beginning to materialize.
In this adjustment, the new NRDL added a total of 114 drugs, while the Commercial Health Insurance Innovative Drug List incorporated 19 drugs, further optimizing the level of medication coverage for the public.
To ensure the genuine implementation of the new catalogs, healthcare security departments have explicitly required designated medical institutions to convene pharmacy and therapeutics committees by the end of February this year, to promptly include newly added drugs in their internal procurement catalogs. They have reiterated that negotiated drugs are not subject to administrative restrictions such as the "one drug, two specifications" rule, drug proportion targets, or total healthcare insurance budget caps. For cases involving high-value innovative drugs unsuitable for diagnosis-related group bundled payments, medical institutions are permitted to apply for "special case individual negotiation," ensuring that new and effective drugs benefit patients more quickly and effectively.
Multiple innovative drugs have seen their first reimbursed prescriptions issued in hospitals. Recently, Ms. Zhang, who is suffering from triple-negative breast cancer, received the first box of Lucatumumab for Injection reimbursed by health insurance in Hubei province at the pharmacy window of the Enshi Tujia and Miao Autonomous Prefecture Central Hospital. Professor Li Dongmei from the Oculoplastic Department of Beijing Tongren Hospital, affiliated with Capital Medical University, issued the first prescription in Beijing for Tebotuzumab N01 Injection (brand name: Xinbimin) after its inclusion in the reimbursement catalog, for a patient named Mr. Zhang (pseudonym) troubled by thyroid eye disease. The first prescription for Tirzepatide Injection for Type 2 diabetes in Shanghai was issued by the Department of Endocrinology and Metabolism at Shanghai Tenth People's Hospital, bringing new hope for many Type 2 diabetes patients to efficiently achieve their blood glucose management goals...
The newly adjusted NRDL and Commercial Health Insurance Innovative Drug List have been successively implemented across provinces and municipalities. Regions including Zhejiang, Jiangsu, Shaanxi, Shandong, Hebei, Beijing, and Shanghai have issued notices to formally execute the "National Basic Medical Insurance, Maternity Insurance, and Work-Related Injury Insurance Drug List (2025)" and simultaneously implement the "Commercial Health Insurance Innovative Drug List (2025)". With the formal execution of the new catalogs, hundreds of thousands of patients nationwide have gained access to new medications.
The new NRDL represents the 8th adjustment since the establishment of the National Healthcare Security Administration (NHSA), adding 114 drugs, 50 of which are Category 1 innovative drugs. Both the number of new additions and the proportion of innovative drugs hit record highs. The newly included drugs exhibit three significant characteristics: filling clinical treatment gaps, offering superior profiles within their class, or providing higher cost-effectiveness. The level of coverage has seen marked improvement in key areas such as oncology, chronic diseases, mental illnesses, rare diseases, and pediatric medications.
It is worth noting that, to support the high-quality development of innovative drugs and promote the construction of a multi-tiered healthcare security system, the NHSA, in conjunction with relevant departments, formulated the Commercial Health Insurance Innovative Drug List. This list focuses on incorporating drugs with high innovation, significant clinical value, and substantial patient benefits that fall outside the scope of basic medical insurance coverage, recommending their reference for use by commercial health insurance, medical mutual aid, and other security systems, while basic medical insurance does not reimburse them. It is understood that the first national edition of the Commercial Health Insurance Innovative Drug List includes 19 drugs, encompassing not only oncology treatments like CAR-T therapies but also rare disease treatments for conditions like neuroblastoma and Gaucher disease, as well as two Alzheimer's disease treatments that have garnered significant public attention.
This Commercial Health Insurance Innovative Drug List prominently reflects three characteristics: First, it demonstrates a pro-innovation orientation, as the included drugs represent excellent achievements in recent pharmaceutical technological progress, covering popular target drugs such as CAR-T, TCE therapies, and bispecific antibodies. Second, it reflects a focus on key areas, including drugs addressing population aging trends like Alzheimer's disease, and rare disease medications often affecting children, such as those for Gaucher disease and neuroblastoma. Third, it clarifies the boundaries between basic medical insurance and commercial insurance coverage. Basic medical insurance adheres to a "basic coverage"定位, primarily considering drugs that are safe, reliable, efficacious, and with relatively mature targets and mechanisms, while commercial insurance leans more towards innovative and cutting-edge pharmaceuticals.
After the implementation of the NRDL and the Commercial Health Insurance Innovative Drug List, the public can query information on drugs within the catalogs via the "National Healthcare Security Administration" WeChat official account. The specific steps are: enter the official account, click on the "Micro Services" menu, select "National Reimbursement Drug List Query" or "Commercial Health Insurance Innovative Drug List Query"; input the drug's generic name to search, enabling you to check if the drug is in the catalog and view related classification information; you can also filter searches by "Drug Classification" or "Reimbursement Category."
How are the "dual catalogs" of medical insurance and commercial insurance being implemented? Including new drugs in the reimbursement catalog is only the first step towards benefiting patients; the truly critical aspect is whether prescriptions can be issued promptly in hospitals, allowing patients to access the medication. With the formal implementation of the new catalogs, facilitating the smooth entry of newly added drugs into hospital formularies has become a vital link for the policy to take effect.
According to the latest information from the NHSA, newly added drugs are rapidly being supplied and used in medical institutions across the country, benefiting many insured individuals. As of January 20, 99 newly added drugs from the basic medical insurance catalog were available for sale in 12,198 designated medical institutions, and 14 drugs from the Commercial Health Insurance Innovative Drug List were available in 223 designated institutions. Currently, local healthcare security departments and designated institutions are continuously working on the supply guarantee and cost settlement for these new drugs, ensuring the public can timely and conveniently enjoy the benefits brought by the policy. From a local perspective, regions are primarily focusing efforts in the following directions:
First, updating the medical insurance information system's drug database and broadening medication access paths through the "dual channel" system. For instance, Zhejiang province has uniformly activated the new national drug catalog, strictly adhering to the nationally stipulated drug varieties, usage restrictions, and classification (Category A/B), without independently adjusting the core content, ensuring national policy implementation in Zhejiang remains faithful to the original intent. To guarantee a smooth policy rollout, Zhejiang completed the update of its medical insurance information system's drug database in advance and guided medical institutions to synchronously adjust their internal formularies, ensuring insured individuals can settle accounts according to the new policy. Shandong province has also simultaneously completed the online listing of new drugs and maintained information in the insurance settlement system. It has collaborated with health departments to guide hospitals in procuring and supplying new drugs as required. For negotiated drugs within the catalog, a "dual channel" guarantee between hospitals and pharmacies is implemented, ensuring medications are available, accessible, and reimbursable for the public.
Second, convening specialized pharmacy and therapeutics committees to promptly include new drugs in the internal hospital procurement catalog. For example, Shaanxi province's notice requires all designated medical institutions to hold specialized pharmacy and therapeutics committees by the end of February 2026, prioritizing the supply of negotiated drugs without being limited by the "one drug, two specifications" rule, and strictly prohibiting restrictions on rational use based on total budget controls or drug proportion targets. Zhejiang province has established a platform for communication between healthcare providers and enterprises, organizing promotion meetings for drugs within the catalog to facilitate precise connections between pharmaceutical companies and medical institutions, helping institutions quickly understand core information like drug indications and efficacy. Additionally, Zhejiang has strengthened supervision of medical institutions, urging them to supply drugs listed in the catalog in a timely manner based on clinical needs, thereby guaranteeing clinical medication demand.
Third, standardizing external prescriptions through "electronization," achieving standardized and electronic management of externally dispensed medical insurance prescriptions. For instance, the Anhui Provincial Healthcare Security Bureau, jointly with the Provincial Health Commission and the Provincial Medical Products Administration, issued the "Notice on Further Regulating the Management of Externally Dispensed Medical Insurance Drug Prescriptions" to standardize the use of external prescriptions by designated institutions. Shaanxi, aligning with the practical management of special drugs, dynamically adjusted the scope of its provincial special drug management based on the national NRDL adjustments. After adding 59 and removing 6 drugs, the province now manages 337 special drug varieties, simultaneously strengthening the supervision of external prescription flows for these drugs. Furthermore, for cases involving high-value innovative drugs unsuitable for DRG bundled payments, medical institutions are allowed to apply for "special case individual negotiation." This measure has been implemented in multiple regions like Anhui and Zhejiang, providing payment security for the clinical application of innovative drugs.
Regarding the implementation of Commercial Health Insurance Innovative Drugs, provinces and cities like Shandong, Hebei, and Zhejiang原则上 handle the online listing and supply of drugs within the Commercial Health Insurance Innovative Drug List by参照 the procedures for medical insurance negotiated drugs. Notably, drugs in the Commercial Health Insurance Innovative Drug List are not paid for by the basic medical insurance fund, and their costs are not included in the indicators for basic medical insurance self-pay rates at designated institutions or in the monitoring scope of substitutable品种 under centralized procurement. Cases involving the application of innovative drugs from this catalog that fall within the coverage of relevant commercial health insurance may be excluded from the basic medical insurance's DRG payment scope, with payment processed after review and evaluation procedures. Currently, Shandong province has included some Commercial Health Insurance Innovative Drugs, such as the CAR-T cell therapy drug Axicabtagene Ciloleucel, in its provincial customized commercial health insurance guidance catalog list.
Additionally, the Commercial Health Insurance Innovative Drug List is encouraged to be used as a reference by commercial health insurance, medical mutual aid, and other multi-tiered healthcare security systems. Healthcare security departments in regions like Hebei and Zhejiang will collaborate with relevant departments to promote the construction of a multi-tiered security system, actively support the development of inclusive commercial health insurance, and recommend the list for reference by these systems. Support is given to commercial insurance institutions to design new products, update coverage ranges, and adjust reimbursement methods based on this list, aiming to better meet patient medication needs and effectively reduce the burden of medical expenses. Regions with the capacity are encouraged to explore the implementation of "one-stop" settlement integrating medical insurance, work-related injury insurance, and commercial insurance.
Conclusion From the past concern over "expensive medication" to the current reality of "saving on drug costs," the emergence of these "first reimbursed prescriptions" reflects the warmth and strength of national healthcare security policies. This marks the 8th consecutive year of dynamic adjustment to the basic medical insurance drug catalog by the healthcare security authorities. Through this dynamic "weeding out the old and bringing in the new" mechanism, more new and effective drugs that are clinically urgent and proven efficacious are incorporated into the reimbursement scope, while drugs that have been clinically phased out or have not been supplied for a long time are removed. This not only optimizes the efficiency of healthcare fund usage but also enhances the public's level of medication coverage. As more new drugs enter the catalog, the standard of clinical medication will steadily improve, and patient access barriers will be further lowered.