Seven innovative drugs currently listed in the 2025 commercial health insurance catalog have passed the preliminary formal review for inclusion in the upcoming national reimbursement drug list.

The National Healthcare Security Administration recently announced the drugs and related information that have passed the initial formal review for the 2026 National Basic Medical Insurance, Maternity Insurance, and Work-Related Injury Insurance Drug List, as well as the Commercial Health Insurance Innovative Drug List.

Passing this initial review does not guarantee a spot on the final 2026 national reimbursement list. The drugs must still undergo a rigorous expert evaluation process, followed by exclusive negotiations or non-exclusive price bidding before final inclusion.

The seven drugs in question are Donanemab Injection, Lecanemab Injection, Naxituximab Injection, Naxiocel Injection, Ruijiaocel Injection, Sapropterin Dihydrochloride Tablets, and Zenidatuximab for Injection.

Donanemab and Lecanemab are treatments for Alzheimer's disease. Naxituximab and Sapropterin Dihydrochloride are for rare diseases, specifically neuroblastoma and hyperphenylalaninemia, respectively. Naxiocel and Ruijiaocel are CAR-T cell therapies. Zenidatuximab is used to treat biliary tract cancer.

This move to seek national reimbursement coverage highlights the new criteria for the 2026 list adjustment, which includes drugs already in the 2025 commercial health insurance catalog. This linkage aims to better coordinate the two systems and maintain pharmaceutical companies' motivation to participate in the commercial insurance program.

The fundamental medical insurance scheme, constrained by fund capacity and focused on providing basic coverage, typically caps annual treatment costs for included drugs at around 300,000 yuan. This creates a natural tension with the high prices of many innovative therapies.

Experts note that the commercial insurance catalog serves as a supplement and transitional pool for the national list. It allows innovative drugs to accumulate real-world data and validate their clinical value and cost-effectiveness through the commercial insurance channel before potential inclusion in the national reimbursement scheme.

A significant challenge for drugs in the commercial catalog is that commercial insurance covers a limited population, and there are often hurdles in getting these drugs into hospitals. This makes it difficult to rapidly achieve the volume-based price reductions typically seen with national reimbursement, presenting a commercialization dilemma for these innovative treatments.

For innovative drugs already in the commercial catalog to successfully enter the national reimbursement list, they often must accept substantial price reductions, testing the resolve of pharmaceutical companies to gain broader coverage.

The process for adjusting the national drug list, as outlined in relevant regulations and the 2026 adjustment work plan, involves several stages: enterprise application, formal review, expert evaluation, and negotiation/price bidding or consultation.