The 2026 National Medical Insurance Drug Catalog Adjustment
achieves full-process parallelism with the Commercial Insurance Innovative Drug Catalog for the first time,
opening up a more strategically flexible
"walking on two legs" pathway.
This article is approximately 2,989 words, with a reading time of about 3 minutes.
On the morning of September 8, the three-and-a-half-day on-site negotiation for the National Basic Medical Insurance Catalog officially concluded. On September 9, price negotiation for the Commercial Health Insurance Innovative Drug Catalog officially launched, with final results expected to be announced in late November.
Just one day before the negotiations began, the State Council Information Office held a press conference in the "Starting the 15th Five-Year Plan" series, at which Li Tao, Deputy Director and Spokesperson of the National Healthcare Security Administration, introduced arrangements related to medical insurance reform and development, pharmaceutical price governance, and support for pharmaceutical innovation during the "15th Five-Year Plan" period.
Li Tao stated that during the "15th Five-Year Plan" period, the medical insurance authorities will, on the basis of adhering to "basic protection," support differentiated innovation, continue to dynamically adjust the basic medical insurance drug catalog every year, and include more eligible innovative drugs in key areas such as tumors, rare diseases, chronic diseases, children, and the elderly into reimbursement coverage; at the same time, optimize and improve the commercial health insurance innovative drug catalog, and for innovative drugs that exceed the scope of basic medical insurance but have a high degree of innovation, significant clinical value, and obvious patient benefits, recommend that commercial health insurance pay first, thereby reducing the family economic burden of patients with severe diseases through the dual protection of "basic medical insurance + commercial health insurance." [1]
This statement places the annual arrangement of "two catalogs, one timetable" from the May work plan into a five-year policy coordinate system—medical insurance and commercial insurance coordination is no longer merely an expedient arrangement within a single negotiation year, but has been explicitly written into the long-term institutional design of the "15th Five-Year Plan." For innovative drug companies, this means that the negotiations currently underway will not only determine whether a drug can obtain an admission ticket this year, but also cast the first vote for the path of value realization over the next five years.
This negotiation, which will affect the next five years, is currently being advanced through a set of specific mechanisms. An innovative therapy with an annual treatment cost of more than one million yuan used to have almost only one path: squeeze onto the medical insurance negotiation table, push the price down to a level the fund can bear, or get nothing at all.
In 2026, this single-choice question has a second option for the first time.
I. Policy Signal: Medical Insurance and Commercial Insurance Coordination Written into the "15th Five-Year Plan" Long-Term Institutional Design
On May 9, 2026, the National Healthcare Security Administration released the "Work Plan for the 2026 Adjustment of the National Basic Medical Insurance, Maternity Insurance, and Work-Related Injury Insurance Drug Catalog and the Commercial Health Insurance Innovative Drug Catalog" and publicly solicited opinions; on May 31, the work plan was officially implemented. This is the ninth annual dynamic catalog adjustment since the establishment of the National Healthcare Security Administration, and also the first time that the basic medical insurance catalog and the commercial insurance innovative drug catalog have achieved full-process synchronization and parallelism—two catalogs, the same timetable, walking side by side for the first time. [6]
For innovative drug companies, this is not just a procedural "merged office," but also means that a new path of value realization is taking shape.
This path did not appear out of thin air. The press conference also mentioned a set of data spanning time: since the establishment of the institution in 2018, the medical insurance drug catalog has undergone multiple dynamic adjustments, cumulatively adding 949 drugs, of which 199 are innovative drugs. This is also the context for understanding the current round of dual-catalog parallel adjustment—it is not an isolated action, but the latest answer delivered by this mechanism that has continued to evolve for eight years. [1]
II. Rule Changes: The Declaration Channel Has Changed from "One-Way" to "Two-Way"
The core of this year's rule changes lies in two keywords: "front-loaded rhythm" and "two-way channel."
From the timetable perspective, this year's rhythm is similar to previous years: preparation (April-May) → declaration (June-July) → review (July-August) → negotiation (August-September) → announcement of results (October-November), with the five stages consistent throughout, and the annual cycle remains compact. [2]
The changes are hidden in the details. This year's "compactness" is not only about rhythm, but also reflected in the front-loading and acceleration within the rhythm—on-site negotiations were advanced by about one and a half months compared with previous years, compressing the waiting windows between various stages.
Supporting this, this year for the first time a "pre-declaration" channel was established, allowing drugs that have completed technical review but have not yet obtained formal approval documents to submit materials in advance; at the same time, three new categories of out-of-catalog drug declaration qualifications were added—the first category is particularly noteworthy: drugs in the 2025 commercial insurance innovative drug catalog can use this as a springboard to declare for the basic medical insurance catalog, and drugs in the commercial insurance catalog can also declare again due to newly added indications.
The other two new qualifications also fill previous policy gaps: one allows drugs that have been converted from conditional approval to regular approval within a specific time period to declare, and the other provides another access opportunity for "new drugs with the same generic name as varieties that failed renewal."
Together, the three constitute a multi-dimensional broadening of this year's declaration channels. In other words, the two catalogs have changed from "each doing its own thing" to "having exchanges."
III. Division of Labor Logic: Medical Insurance Manages "Basic Protection," Commercial Insurance Manages "Sufficient Innovation"
Parallel adjustment does not equal the same set of standards. Medical insurance and commercial insurance are calculated separately, each anchored to different boundaries.
The positioning of the medical insurance catalog has always been clear: adhere to "basic protection," and build the improvement of protection levels on the basis of the fund's payment capacity. The core logic of negotiation price suppression is to find a balance between the medication needs of insured persons and the sustainability of the fund—the implicit threshold commonly referred to in the industry as "no negotiation above 500,000, no entry above 300,000" is an intuitive manifestation of this boundary.
The commercial insurance innovative drug catalog targets a different group of "players": varieties with a high degree of innovation, significant clinical value, and remarkable patient benefits, whose price formation mechanism is more market-oriented—according to industry estimates, the negotiated price reduction range for commercial insurance catalog drugs is roughly 15% to 50%, significantly lower than the price reduction requirements of medical insurance negotiations. The initiative in product design and pricing is also left more to insurance companies themselves. [3]
Unlike previous years, this year the two catalogs are parallel and calculated separately: medical insurance calculation is anchored to the fund's affordable boundary, while commercial insurance negotiation explores a gentler price formation mechanism. For varieties that simultaneously meet the declaration conditions of both catalogs, a two-way linkage mechanism can be seen from the mechanism design—negotiate medical insurance first, and if no agreement is reached, there is still an opportunity to turn to commercial insurance.
This is precisely the access positioning of the commercial insurance catalog: to take on those innovative drugs that "cannot be temporarily included in the basic catalog." That is, even if a drug fails to reach agreement at the medical insurance negotiation table, it does not mean it is completely out—it still has the opportunity to take a more market-oriented path with gentler price constraints through the commercial insurance innovative drug catalog.
In terms of mechanism, this provides a transitional access supplement path for varieties that failed to reach agreement in the current round of medical insurance negotiations. It should be clarified that the medical insurance catalog remains the largest payer and core access channel for innovative drugs, and the commercial insurance catalog is positioned as a supplement rather than a replacement—for varieties that temporarily cannot adapt to the fund's affordability during negotiations, companies can transfer to the commercial insurance channel to seek staged payment coverage, but the actual compensation scale and patient coverage of commercial insurance are still gradually being cultivated, and its payment volume cannot yet be equated with medical insurance.
For some particularly high-value innovative therapies (such as CAR-T), the commercial insurance catalog provides a differentiated early exploration path, but its ultimate volume still depends heavily on medical insurance access or further maturity of commercial insurance products.
The declaration portal itself also leaves flexibility: for eligible exclusive varieties, companies can either declare only for the commercial insurance catalog, or "walk on two legs" by declaring for both medical insurance and commercial insurance simultaneously, rather than only proceeding in a fixed order. This also gives companies more room for strategic maneuvering.
Data also confirms that this channel is opening: according to the "Work Plan for the 2026 Adjustment of the National Basic Medical Insurance, Maternity Insurance, and Work-Related Injury Insurance Drug Catalog and the Commercial Health Insurance Innovative Drug Catalog," the 2026 declaration for adjustment of the basic medical insurance catalog and the commercial insurance innovative drug catalog ended at 20:00 on June 10. During the declaration period, a total of 818 drug declaration materials were received, including 570 out-of-catalog drugs (509 declared separately for the basic catalog, 17 declared separately for the commercial insurance innovative drug catalog, and 44 declared simultaneously for both the basic catalog and the commercial insurance catalog), and 248 in-catalog drugs, with the overall number further increasing compared with 2025. [4]
IV. Competitive Landscape: Four Major Focus Areas—ADC, GLP-1, AD, and CAR-T
Behind hundreds of declaration materials are several high-profile tracks collectively making their bids.
In the ADC field, domestic innovative drugs have entered the review spotlight as a cluster for the first time; in the GLP-1 track, domestic dual-target and innovative-mechanism products are advancing side by side, accelerating benchmarking against the international frontier; in the AD field, there has long been a lack of treatments that truly change the course of the disease; CAR-T and other high-value cell therapy products have declared intensively, becoming a key sample for testing the commercial insurance catalog's payment capacity for ultra-high-priced innovative drugs. In addition, more than 15 rare disease drugs in total have entered different declaration channels, with coverage further expanded compared with previous years. [7]
According to the latest data, Relma-cel, priced at 1.29 million yuan per injection, has become the highest-priced variety under negotiation in the CAR-T category in this year's basic medical insurance catalog negotiations (excluding the commercial insurance innovative drug catalog), and negotiation was completed on September 6, with final results possibly to be announced in November. In addition, Alzheimer's disease disease-modifying therapies, new-generation GLP-1 and other varieties are also focal points of this year's national negotiations, collectively competing for the medical insurance "admission ticket." [5]
It is worth noting that Relma-cel was first included in the inaugural commercial insurance innovative drug catalog in 2025, and this year, through the channel of "already included in the 2025 commercial insurance innovative drug catalog" among the out-of-catalog declaration conditions, it declared in reverse for the basic medical insurance catalog.
In other words, it is taking the path of "commercial insurance first, medical insurance later," which precisely confirms the flexible mechanism of "walking on two legs, with no fixed order," rather than a single-direction progressive relationship—the institutional design of parallel dual catalogs actually provides companies with strategic choice space that varies by variety, allowing them to either enter through medical insurance with commercial insurance as a fallback, or first validate value through commercial insurance and then strive for medical insurance volume. The specific path depends on the dynamic matching of the variety's pricing strategy, clinical data maturity, and the fund's affordability.
V. Operational Path: Medical Insurance as the Foundation, Commercial Insurance as Complement, with No Fixed Order
"Multi-level medical security system" is a direction repeatedly mentioned in the industry in recent years. The parallel adjustment in 2026 has given this direction a more concrete operational path—medical insurance sets the basic foundation, commercial insurance expands new space, two catalogs, one linkage mechanism, and one simultaneous announcement.
For innovative drug companies, this means that planning for commercialization paths needs to add an evaluation dimension: for varieties with clear clinical value but temporarily unable to adapt to the medical insurance fund's affordability in the current round of negotiations, the commercial insurance catalog provides an early access window that can be utilized, but its payment volume and patient coverage are still being gradually improved, and it does not yet have volume capacity equivalent to medical insurance. Companies should take medical insurance access as their core strategic goal, and the commercial insurance path as an auxiliary strategic supplement under specific circumstances.
For investment institutions, when evaluating the valuation of innovative drug companies, the dual-catalog mechanism can be taken into consideration, but it is necessary to distinguish the different impacts of "medical insurance access expectations" and "commercial insurance coverage expectations" on cash flow—the two differ fundamentally in pricing logic and volume pace, and should not be simply equated.
For patients, innovative drugs included in medical insurance through negotiation can enable them to obtain basic protection coverage at a more affordable price; for high-value innovative drugs that have not yet entered medical insurance but have been included in the commercial insurance catalog, patient groups with corresponding commercial health insurance products also have an additional payment option.
The coordination of medical insurance and commercial insurance during the "15th Five-Year Plan" period is not an abstract planning statement, but is being turned step by step into visible operational details through the dual-catalog parallelism in May, the declaration review in July, and the negotiations from August to September. Negotiation is never the endpoint, but a process in which value is repriced and seen anew.
As the "repricing" mechanism extends from a single medical insurance negotiation table to "dual-catalog" coordinated evaluation, the value verification of innovative drugs has also entered a more three-dimensional coordinate system. Under the "dual-catalog" mechanism, Yifeng will pay more attention to source innovation projects that can truly solve unmet clinical needs and possess global competitiveness—products that can simultaneously withstand the dual tests of the medical insurance "basic protection" benchmark and the commercial insurance "sufficient innovation" benchmark will undoubtedly have more imaginative space for commercialization certainty and sustainability.
Data sources:
1、
https://www.chinanews.com.cn/gn/2026/09-04/10690115.shtml
2、
https://mp.weixin.qq.com/s/qXA4LkJoCeD096SV66itGw
3、
https://mp.weixin.qq.com/s/76MAfar9BSWlsua2B0DTyA
4、
https://mp.weixin.qq.com/s/S5Z8V35i1DrPjFbO67qhYQ
5、
https://mp.weixin.qq.com/s/o7VRhaZVQXZJXX51IKQfNw
6、
https://mp.weixin.qq.com/s/kbblg4KSabAx0nQidJMG0w
7、
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