By Fineline Cube 
The National Healthcare Security Administration (NHSA) this week issued the finalized “2025 National Basic Medical Insurance, Maternity Insurance, and Work Injury Insurance Drug Catalog Adjustment Work Plan” and related documents, with minimal changes from the draft released earlier this month. The application period for both medical insurance and commercial health insurance listings will run from July 11 to 20.
Commercial Health Insurance (CHI) Drug List
The CHI drug list focuses on highly innovative drugs with significant clinical value and patient benefits that currently exceed the “basic coverage” mandate of the national formulary. Eligible drugs include those with new generic names approved within the last five years or orphan drugs for rare diseases with exclusive market rights. The CHI list is recommended for reference by commercial health insurers and other multi-tier healthcare security systems, but will not be reimbursed by basic medical insurance (BMI).
NHSA Oversight and Process
The NHSA oversees the CHI drug list development, aligning with the BMI list adjustment timeline. While the process mirrors BMI adjustments, CHI experts hold key decision-making power on inclusion and pricing negotiations. Companies may choose to apply for BMI listing only, CHI listing only, or both simultaneously. Evaluations for both lists proceed in parallel. Drugs recommended by the comprehensive expert panel for CHI inclusion will undergo specialized commercial health insurance expert review for final approval.
Policy Optimization and Implementation
The NHSA will explore optimized payment policies, such as excluding CHI-listed drugs from basic insurance self-payment rate calculations and volume-based procurement (VBP) substitution monitoring. It will also exempt eligible CHI-covered drug cases from diagnosis-related group (DRG) payment caps after review.-Fineline Info & Tech