According to research by Guotai Haitong Securities Co., Ltd. (GTHT), on December 7, the National Healthcare Security Administration (NHSA) released the 2025 National Basic Medical Insurance, Maternity Insurance, and Work Injury Insurance Drug List adjustments, along with the Commercial Health Insurance Innovative Drug List. The updated list added 114 new drugs, significantly improving coverage in key areas such as oncology. Strategic purchasing has successfully established a clear direction for medical insurance to support genuine and differentiated innovation.
GTHT believes that the commercial insurance list complements the basic medical insurance system well, helping to clarify the boundaries of basic medical insurance coverage. This promotes the differential development of commercial health insurance and basic medical insurance, laying the foundation for a multi-tiered healthcare security system.
Key insights from GTHT include:
1. **Strategic Purchasing Supports Innovation** During the 14th Five-Year Plan period, medical insurance funds cumulatively spent over 13 trillion yuan, benefiting nearly 20 billion medical visits. Through centralized procurement, drug list negotiations, payment reforms, and price management, medical costs have been rationalized, reducing unnecessary expenses for patients. Over the past seven years, 835 drugs were newly included in medical insurance coverage, including 149 innovative drugs, with about 80% of new drugs entering the reimbursement list within two years of market launch.
The NHSA has adjusted the drug list for eight consecutive years, adding 949 new drugs in total, including this year. Medical insurance funds have spent over 460 billion yuan on negotiated drugs during agreement periods, driving sales exceeding 600 billion yuan. Annual medical insurance expenditures of trillions of yuan inject momentum into the healthcare sector, optimizing spending priorities to support innovative drugs, medical devices, and service projects.
2. **Higher Negotiation Success Rate & Improved Coverage in Key Areas** The latest adjustment added 114 drugs, including 50 Class 1 innovative drugs. The negotiation success rate reached 88%, up from 76% in 2024. Meanwhile, 29 drugs with limited clinical supply or better alternatives were removed. Post-adjustment, the total number of listed drugs increased to 3,253 (1,857 Western drugs and 1,396 traditional Chinese medicines), significantly enhancing coverage in oncology, chronic diseases, mental health, rare diseases, and pediatric medications.
3. **First Edition of Commercial Health Insurance Innovative Drug List Released** On June 30, the NHSA and the National Health Commission issued measures to support high-quality development of innovative drugs, proposing the creation of a Commercial Health Insurance Innovative Drug List. This list focuses on high-innovation, high-clinical-value drugs that exceed basic medical insurance coverage, encouraging multi-tiered healthcare security systems, including commercial insurance and medical mutual aid, to adopt them.
The first edition includes 19 drugs, covering CAR-T therapies for cancer, treatments for rare diseases like neuroblastoma and Gaucher disease, and high-profile Alzheimer’s medications. GTHT views this as a complementary step to basic medical insurance, helping define coverage boundaries and fostering differential development between commercial and basic insurance.
**Risk Warnings**: Policy implementation delays, slower-than-expected progress in innovative drug R&D, and risks related to medical insurance cost-control policies.
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