China's commercial health insurance list for innovative drugs
China has a second national drug list beside the list for basic medical insurance. The Commercial Health Insurance Innovative Drug List took effect on 1 January 2026 with 19 drugs.1 The basic medical insurance fund does not pay for a drug on it.2 The list is recommended to commercial health insurers and mutual aid schemes for reference, and it leaves listed drugs out of two hospital indicators.3
Where the list comes from
The National Healthcare Security Administration and the National Health Commission issued measures in support of innovative drugs on 30 June 2025, with the agreement of the State Council. Item 7 adds the list.3
The list is for innovative drugs that are highly innovative, of great clinical value and of clear benefit to patients. They must also go beyond the scope of basic medical insurance.3 The work plan for 2025 describes them as drugs that cannot enter the basic list for the time being.4
Which drugs could apply in 2025
An application to the commercial list was open to an exclusive drug in one of two groups.4
- a drug with a new generic name approved between 1 January 2020 and 30 June 2025
- a rare disease drug approved by 30 June 2025
The enterprise could apply to the commercial list alone, or to both lists at once.4
How a drug is chosen
The commercial list is drawn up in step with the adjustment of the basic list, through the same five stages.4
| Stage | What happens for the commercial list |
|---|---|
| Filing | A formal check against the conditions for the commercial list |
| Expert review | Experts propose drugs, and a panel of commercial insurance experts reviews them again |
| Assessment | Commercial insurance and pharmacoeconomic experts give an opinion on price |
| Price consultation | The enterprise and the panel consult on site |
| Result | A drug that succeeds enters the list and an agreement is signed |
The panel for price consultation is made up of commercial insurance experts and representatives of the insurance administration.4 Experts are recommended by the departments concerned, industry associations, commercial insurers and provincial administrations.4
Where experts find a drug suited to either list, negotiation for the basic list comes first. A drug that fails there goes on to price consultation.4
The price is reached by consultation, where the basic list uses negotiation. The measures call it a settlement price and provide for a stricter mechanism of price confidentiality.3
What listing gives
The measures and the notice issuing the lists give a listed drug the following treatment.32
- It is left out of the indicator for the share of costs that patients pay themselves at designated medical institutions.
- It is left out of the monitoring of drugs that can be replaced by products selected in centralised procurement.
- A case using it under commercial health insurance may be left out of payment by disease group, and is paid after review.
- It may be listed directly on procurement platforms, under the rules for negotiated drugs.
- It may be left outside the limit of two products for one generic name in a hospital.
Hospitals may not cite the number of drugs on their formulary or the share of drug costs as a reason to limit innovative drugs.3 Designated medical institutions are encouraged to hold their pharmacy committee within three months after a list is published.3
Provinces may explore letting designated retail pharmacies stock listed drugs.2 They monitor the prices at which institutions and pharmacies sell them.2
What listing does not give
Listing makes no payment of its own. The basic medical insurance fund does not pay for a drug on the commercial list.2 The list is recommended to commercial health insurance and medical mutual aid for reference.3 Insurers are supported in designing new products from the list, updating their scope of cover and adjusting their methods of payment.2
The first list
| Figure | |
|---|---|
| Drugs in on-site price consultation in 2025 | 24 |
| Drugs on the first list | 19 |
| In force from | 1 January 2026 |
The administration’s release names three kinds of drug on the first list.1
- tumour treatments, including CAR-T products
- treatments for rare diseases, including neuroblastoma and Gaucher disease
- treatment for Alzheimer’s disease
The figure of 24 is given in a press report carried on the administration’s site, which cites the administration’s notice of 4 November 2025.5
Other support in the same measures
The measures of 30 June 2025 contain 16 items. Several concern a drug before and after it is listed.3
| Item | What it provides |
|---|---|
| 3 | An innovative drug whose marketing application has been accepted may ask for guidance on entry to the list |
| 6 | An enterprise may supply institutions outside the insurance network free of the payment standard |
| 9 | The enterprise chooses the province where an innovative drug is first listed and sets its own price |
| 12 | A case that does not fit payment by disease group may be reviewed on its own |
| 14 | Commercial insurers that qualify receive data sharing and help with settlement |
Questions people also ask
Does basic medical insurance pay for a drug on the commercial list?
The basic medical insurance fund does not pay for drugs on the commercial list.2
Can a drug apply to both lists in the same year?
In 2025 an enterprise could apply to the commercial list alone or to both lists at once.4
What happens if a drug fails negotiation for the basic list?
Where experts found the drug suited to either list, it goes on to price consultation for the commercial list.4
How many drugs are on the first commercial list?
The first list holds 19 drugs and took effect on 1 January 2026.1
Is the price of a drug on the commercial list published?
The measures provide for a stricter mechanism of price confidentiality for the settlement price.3
Footnotes
-
National Healthcare Security Administration, release on the 2025 drug lists, 7 December 2025. https://www.nhsa.gov.cn/art/2025/12/7/art_14_18972.html ↩ ↩2 ↩3
-
National Healthcare Security Administration and Ministry of Human Resources and Social Security, notice issuing the drug lists for 2025, Yi Bao Fa [2025] No. 33, 5 December 2025. https://www.nhsa.gov.cn/art/2025/12/7/art_104_18970.html ↩ ↩2 ↩3 ↩4 ↩5 ↩6 ↩7
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National Healthcare Security Administration and National Health Commission, Several Measures to Support the High-Quality Development of Innovative Drugs, Yi Bao Fa [2025] No. 16, 30 June 2025. https://www.nhsa.gov.cn/art/2025/7/1/art_104_17058.html ↩ ↩2 ↩3 ↩4 ↩5 ↩6 ↩7 ↩8 ↩9 ↩10
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National Healthcare Security Administration, announcement of 10 July 2025 and Work Plan for the 2025 Adjustment of the Drug List for National Basic Medical Insurance and the Commercial Health Insurance Innovative Drug List. https://www.nhsa.gov.cn/art/2025/7/10/art_109_17198.html ↩ ↩2 ↩3 ↩4 ↩5 ↩6 ↩7 ↩8 ↩9
-
People’s Daily Health, report on the close of the 2025 negotiation, carried by the National Healthcare Security Administration on 7 November 2025. https://www.nhsa.gov.cn/art/2025/11/7/art_14_18559.html ↩
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