商业健康保险在创新药物支付体系中的角色重构与路径探析OA

Commercial health insurance,as an important component of a multi-level medical security system,is undergoing a transition in its role within pharmaceutical payment systems from a supplementary payer to a partner in risk sharing and value creation.Based on the current development status and practical challenges of commercial health insurance in China,this study systematically reviews international models of commercial health insurance participation in innovative drug payment and integrates evidence from domestic practices.It further analyzes the evolving functional positioning of commercial health insurance in innovative drug payment systems in the new development stage and explores future pathways for its participation.In the future,efforts should be made to further improve the value-based drug formulary management mechanisms and explore the potential role of commercial health insurance as an initiator of real-world evidence generation.These approaches may provide a reference for promoting coordinated development between basic medical insurance and commercial health insurance and fostering a new ecosystem in the pharmaceutical sector.