2025年度医保谈判收官：对真创新表达“真支持”-政策解读-医院绩效咨询,医院绩效管理,医院管理咨询 -九鼎医院管理顾问

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行业新闻

2025年度医保谈判收官：对真创新表达“真支持”

提交者：王艾冰邱越发表时间：2025-11-25点击次数：928来源:人民日报健康客户端

11月3日下午，随着最后一家药企谈判代表走出全国人大会议中心，2025年度医保谈判协商正式落幕，这场持续了5天的国家医保谈判，在一家又一家药企的紧张与忐忑中暂时画上了句号。

根据11月4日国家医保局发布的消息，今年医保谈判有120家内外资企业现场参与，其中参与基本医保药品目录谈判竞价的目录外药品127个，参与商保创新药目录价格协商的药品24个。此次医保谈判结果预计12月初公布，新版药品医保目录将于2026年1月1日起实施。

流程更顺畅、可预测，“信封价”依然是核心

10月30日一早，首日参加医保谈判的企业早早地等在了全国人大会议中心门口，不少企业代表手中的文件夹和厚厚的A4纸，这场围绕着“信封价”的“年度大考”对于他们而言重要性可想而知。国家医保目录调整工作自2018年国家医保局成立以来已经持续8年，记者在和多家等待进场企业采访中得知，“随着医保谈判的逐渐成熟，我们能感受到整体的流程更加顺畅和可预测。”

“医保谈判是国家医保局发挥医保战略性购买功能的两大抓手之一，国家医保局成立后一直在整合定价、采购、支付等职能，通过‘以量换价’实现药品价格优化，核心手段就是集采和医保谈判，其中医保谈判以未来用量为承诺，吸引企业降价进入医保，扩大市场覆盖面，提升患者用药可及性。”11月3日，中国药科大学医药价格研究中心主任路云告诉人民日报健康客户端记者，这直接提升了创新药的可及性，保证国内患者能以更低负担获得全球最新疗法。

“终于谈完了，可以短暂休息一下了。”某国内创新药企的谈判代表走出谈判现场向记者透露，医保谈判的“信封价”仍然是核心，没达到就意味着谈判失败。

根据2025年目录调整的工作方案，医保药品目录调整分为企业申报、形式审查、专家评审、谈判竞价等环节，进入“信封价”是谈判阶段的重点。据记者了解，和此前一样，每家企业有2次报价机会，第一次报价后，谈判专家会提示价格是否在信封价的115%，若两次报价均超出信封价的115%，谈判直接失败。

“信封价在谈判开始之前由两组测算专家背对背独立测算形成。专家包括药物经济学测算组和基金测算组，其中，药物经济学专家组依据企业提交的药品的安全性、有效性、经济性、国际价格信息等材料对药品进行价值评估，形成药物经济学上的价格。医保基金测算专家组根据患者疾病负担、临床用药需求、药品临床价值、创新程度、市场竞争等形成医保基金可接受的药品价格，由医保局综合考量两者测算的价格最终形成信封价。”路云解释。

一位多次参与医保谈判的跨国药企谈判代表在完成谈判后向记者坦言，“每年为了这场谈判，都有艰辛的准备过程，医保谈判的流程越来越清晰和成熟，对企业而言，成与不成都是宝贵的经验。”

医院绩效咨询

谈判过程感受到对“真创新”的真支持

“全程可以说笑中带泪，泪中带笑。”一位结束谈判的国内创新药企代表向记者感叹，虽然在谈判过程中有些难熬和焦灼，但明确能感觉到国家对真创新产品的真支持，“我们的产品有一些不可替代性，谈判时，对方明确对我们说，‘你们的产品很好，我们也希望有一个好的结果’，这对我们创新药企来说，是莫大的肯定和鼓舞了。”

“但对于目录内有类似药品的品种，竞价过程仍然是非常紧张的，我个人认为甚至可以称之为最激烈的一次。”另一位药企代表在采访中说道。

复旦大学公共卫生学院卫生经济学教授胡善联解释，专家组会根据目录内药品的可替代性，将药品分为不同类型。评估一款药品创新性药物能否满足目前的临床未满足的需要，也会考虑到企业的利润空间，将价格压缩到合理的范围之内。

“回顾历年的医保药品谈判，谈判成功药品的平均降幅在50~60%左右，个别药物降幅达到80~90%，所以今年的基本医保目录的谈判或许依然会保持着激烈的‘灵魂砍价’风格，尤其是对于可替代性比较强的药品，如已上市多年的‘老产品’，或者是靶点相同、技术路线相似的创新药，多家企业同台竞技，必然导致竞价激烈，使得相关企业在谈判桌上感到压力比较大。”胡善联表示，这也从另一个侧面体现了国家医保谈判对于真正有创新、有突破的药品的支持。

2025年7月1日，国家医保局召开《支持创新药高质量发展的若干措施》新闻发布会，国家医保局医药管理司司长黄心宇介绍，国家医保局通过战略购买、价值购买实现需方牵引，建立了适应新药准入的医保目录动态调整机制，对创新药纳入医保目录给予政策倾斜，完善支持创新药发展的谈判和续约规则。2018—2024年我国1类创新药获批上市数量呈现明显上升趋势。

路云说，“2017年前，医保目录调整缓慢，能看到企业研发动力不足；2018年国家医保局成立后，通过每年动态调整目录，激励制药企业投入真创新、真研发，这也使得近年一类新药占比显著提升。”

今年，不管是跨国药企还是国内创新药企都在和记者的交流中表示：“医保谈判的推进和优化，给了我们很大的创新信心，每年的医保谈判，对我们来说既是压力，也是动力。”

谈判首次引入商保，让各方发展都有出路

11月2日下午，等候在全国人大会议中心的记者和投资代表比前两天稍多些，大家都在等待全国首次商业健康保险创新药品目录协商开启。“我们态度得好。”一位等待进行商保谈判的药企代表说道，商保目录本身就是国家释放的更加重视创新、重视商保的信号。

根据国家医保局发布的工作方案，第一版商业健康保险创新药品目录主要纳入超出“保基本”定位、暂时无法纳入基本目录，但创新程度高、临床价值大、患者获益显著的创新药，供商业健康保险、医疗互助等多层次医疗保障体系参考使用。

国家医保局此前公示显示，2025医保谈判中，有121个品种申报了商保创新药目录，但最终参加谈判的只有24个。“应该是在专家审查中又做了一定的筛选，把一些明显不适合商保目录、不符合‘商保特征’的品种剔除了，这也是为了提升协商效率和谈判成功率。”一位企业代表表示。

“商保协商谈判的过程中，有保险公司的相关人员参与。”据业内人士介绍，商保谈判的主体主要是商保公司以及保险领域专家、学者共同组成的评审组，评审组对申报产品进行评估。医保局在其中扮演组织和协调的角色，谈判的基调更侧重“协商”。

一家参与商保创新药目录谈判的企业代表还告诉记者，商保目录惠及患者的方式不同于基本医保的直接报销，而是通过间接方式减轻患者负担。一方面，药企通过谈判给予一定的价格折让;另一方面，保险公司可能在其现有保险产品的责任基础上进行“扩责”，提高赔付比例。

胡善联推测：“商保协商的降价幅度应该会相对平缓，估计在20%到40%之间。”除了药企直接降价，支付方式的创新本身意义更大，如按疗效付费、患者援助计划、慈善赠药等，都可能成为商保支付组合拳的一部分，共同降低患者的实际负担。

“针对高值药物(如CAR-T疗法)和罕见病药物，设立专项商保目录，主要体现了医保局平衡医保‘保基本’与特殊需求的关系。”路云也强调。

首都医科大学国家医疗保障研究院执行院长、二级研究员应亚珍表示，医保谈判引入商保，更是为了满足多层次医疗服务需求，基本医保保基本，保得更到位，同时，平衡好基本医保、商保、医疗机构、医药企业等各领域的发展与人民群众医疗服务需求之间的关系，保障各方的发展都有出路。

规范、透明、高效，多元支付更好提升患者用药可及

谈及医保谈判的未来趋势，胡善联用三个关键词概括：更规范、更透明、更高效。国家医保谈判经过八年实践，从药品申报、综合评审到价格谈判，各个环节的评审标准和细节要求都越来越完善。未来这些标准甚至可能逐步向社会公开，让企业更清晰地了解规则，从而引导行业开展更有价值的创新。

“现在对于医保谈判的感受除了紧张还有期待，越来越清晰的规则之下，整体的谈判过程也愈加顺利，前些年，谈判经常一个药谈一个小时，今年基本上半个小时都能结束，如今我们都会将更多的关注倾注在如何研发和生产更好的药品，如何更快速的通过评审和谈判，让更多患者获益。”某跨国药企谈判代表说。

随着一年又一年的医保谈判，医保目录的“容量”压力也日益凸显。胡善联认为，未来的目录管理必然是一个“有进有出”的动态调整过程。“对于一些疗效不明确或主要用于辅助治疗的药品，将会逐步调出目录，或转为非处方药，从而为真正有价值的创新药腾出宝贵的基金空间。”

采访中，胡善联多次强调构建多元支付格局的重要性。“未来的方向绝不是把所有支付压力都压在基本医保上，此次商保谈判释放了积极的信号——医保商保‘双通道’保障机制被进一步明确。”他希望，未来能形成“基本医保保基本、商保作补充，医疗救助托底线、慈善捐赠再助力”的多元筹资和支付体系，最终实现患者、基金、企业三方共赢的局面。

武汉九鼎医院管理顾问是一家集医院发展战略、医院文化、医院人力资源、医院绩效管理等咨询模块为一体的医院管理咨询公司。如有咨询需求请拨打热线：027-82444583。

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Build Date	Jan 9 2019 15:05:36
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Architecture	x64
Configure Command	cscript /nologo configure.js "--enable-snapshot-build" "--enable-debug-pack" "--disable-zts" "--disable-isapi" "--disable-nsapi" "--without-mssql" "--without-pdo-mssql" "--without-pi3web" "--with-pdo-oci=c:\php-sdk\oracle\x64\instantclient_12_1\sdk,shared" "--with-oci8-12c=c:\php-sdk\oracle\x64\instantclient_12_1\sdk,shared" "--with-enchant=shared" "--enable-object-out-dir=../obj/" "--enable-com-dotnet=shared" "--with-mcrypt=static" "--without-analyzer" "--with-pgo"
Server API	CGI/FastCGI
Virtual Directory Support	disabled
Configuration File (php.ini) Path	C:\Windows
Loaded Configuration File	D:\PHPWEB\php\php.ini
Scan this dir for additional .ini files	(none)
Additional .ini files parsed	(none)
PHP API	20131106
PHP Extension	20131226
Zend Extension	220131226
Zend Extension Build	API220131226,NTS,VC11
PHP Extension Build	API20131226,NTS,VC11
Debug Build	no
Thread Safety	disabled
Zend Signal Handling	disabled
Zend Memory Manager	enabled
Zend Multibyte Support	provided by mbstring
IPv6 Support	enabled
DTrace Support	disabled
Registered PHP Streams	php, file, glob, data, http, ftp, zip, compress.zlib, compress.bzip2, https, ftps, phar
Registered Stream Socket Transports	tcp, udp, ssl, sslv3, tls, tlsv1.0, tlsv1.1, tlsv1.2
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Features
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CharConv	No
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krb4	No
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NTLM	Yes
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TLS-SRP	No
Protocols	dict, file, ftp, ftps, gopher, http, https, imap, imaps, ldap, pop3, pop3s, rtsp, scp, sftp, smb, smbs, smtp, smtps, telnet, tftp
Host	x86_64-pc-win32
SSL Version	OpenSSL/1.0.2q
ZLib Version	1.2.7.3
libSSH Version	libssh2/1.8.0

date/time support	enabled
"Olson" Timezone Database Version	2016.10
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Default timezone	PRC

DOM/XML	enabled
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libxml Version	2.9.4
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iconv support	enabled
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PCRE Library Version	8.38 2015-11-23

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PostgreSQL Support	enabled
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gzip compression	enabled
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Registered save handlers	files user
Registered serializer handlers	php_serialize php php_binary wddx

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session.auto_start	Off	Off
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ALLUSERSPROFILE	C:\ProgramData
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APP_POOL_CONFIG	C:\inetpub\temp\apppools\wwwroot\wwwroot.config
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CommonProgramFiles(x86)	C:\Program Files (x86)\Common Files
CommonProgramW6432	C:\Program Files\Common Files
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TMP	C:\Windows\TEMP
USERDOMAIN	WORKGROUP
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_SERVER["TEMP"]	C:\Windows\TEMP
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_SERVER["USERDOMAIN"]	WORKGROUP
_SERVER["USERNAME"]	iZ4r4b31413jd2Z$
_SERVER["USERPROFILE"]	C:\Windows\system32\config\systemprofile
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_SERVER["SERVER_PORT"]	443
_SERVER["SERVER_NAME"]	www.yyjg.net
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_SERVER["REMOTE_PORT"]	3859
_SERVER["REMOTE_HOST"]	216.73.216.63
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_SERVER["LOCAL_ADDR"]	172.16.121.93
_SERVER["INSTANCE_META_PATH"]	/LM/W3SVC/1
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_SERVER["INSTANCE_ID"]	1
_SERVER["HTTPS_SERVER_SUBJECT"]	CN=www.yyjg.net
_SERVER["HTTPS_SERVER_ISSUER"]	C=PL, O=Asseco Data Systems S.A., CN=Certum DV TLS G2 R39 CA
_SERVER["HTTPS_SECRETKEYSIZE"]	2048
_SERVER["HTTPS_KEYSIZE"]	256
_SERVER["HTTPS"]	on
_SERVER["GATEWAY_INTERFACE"]	CGI/1.1
_SERVER["DOCUMENT_ROOT"]	D:\wwwroot\yyjg.net\wwwroot
_SERVER["CONTENT_TYPE"]	no value
_SERVER["CONTENT_LENGTH"]	0
_SERVER["CERT_SUBJECT"]	no value
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_SERVER["CERT_FLAGS"]	no value
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_SERVER["AUTH_USER"]	no value
_SERVER["AUTH_PASSWORD"]	no value
_SERVER["AUTH_TYPE"]	no value
_SERVER["APPL_PHYSICAL_PATH"]	D:\wwwroot\yyjg.net\wwwroot\
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_SERVER["IIS_UrlRewriteModule"]	7.1.0871.0
_SERVER["HTTP_USER_AGENT"]	Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)
_SERVER["HTTP_HOST"]	www.yyjg.net
_SERVER["HTTP_ACCEPT_ENCODING"]	gzip, br, zstd, deflate
_SERVER["HTTP_ACCEPT"]	/
_SERVER["HTTP_CONNECTION"]	close
_SERVER["FCGI_ROLE"]	RESPONDER
_SERVER["PHP_SELF"]	/admin.php/index/view/aid/15094.html
_SERVER["REQUEST_TIME_FLOAT"]	1789690733.1869
_SERVER["REQUEST_TIME"]	1789690733

PHP Authors
Contribution	Authors
Zend Scripting Language Engine	Andi Gutmans, Zeev Suraski, Stanislav Malyshev, Marcus Boerger, Dmitry Stogov, Xinchen Hui, Nikita Popov
Extension Module API	Andi Gutmans, Zeev Suraski, Andrei Zmievski
UNIX Build and Modularization	Stig Bakken, Sascha Schumann, Jani Taskinen
Windows Port	Shane Caraveo, Zeev Suraski, Wez Furlong, Pierre-Alain Joye, Anatol Belski
Server API (SAPI) Abstraction Layer	Andi Gutmans, Shane Caraveo, Zeev Suraski
Streams Abstraction Layer	Wez Furlong, Sara Golemon
PHP Data Objects Layer	Wez Furlong, Marcus Boerger, Sterling Hughes, George Schlossnagle, Ilia Alshanetsky
Output Handler	Zeev Suraski, Thies C. Arntzen, Marcus Boerger, Michael Wallner

SAPI Modules
Contribution	Authors
AOLserver	Sascha Schumann
Apache 1.3 (apache_hooks)	Rasmus Lerdorf, Zeev Suraski, Stig Bakken, David Sklar, George Schlossnagle, Lukas Schroeder
Apache 1.3	Rasmus Lerdorf, Zeev Suraski, Stig Bakken, David Sklar
Apache 2.0 Filter	Sascha Schumann, Aaron Bannert
Apache 2.0 Handler	Ian Holsman, Justin Erenkrantz (based on Apache 2.0 Filter code)
Caudium / Roxen	David Hedbor
CGI / FastCGI	Rasmus Lerdorf, Stig Bakken, Shane Caraveo, Dmitry Stogov
CLI	Edin Kadribasic, Marcus Boerger, Johannes Schlueter, Moriyoshi Koizumi, Xinchen Hui
Continuity	Alex Leigh (based on nsapi code)
Embed	Edin Kadribasic
FastCGI Process Manager	Andrei Nigmatulin, dreamcat4, Antony Dovgal, Jerome Loyet
ISAPI	Andi Gutmans, Zeev Suraski
litespeed	George Wang
NSAPI	Jayakumar Muthukumarasamy, Uwe Schindler
phpdbg	Felipe Pena, Joe Watkins, Bob Weinand
phttpd	Thies C. Arntzen
pi3web	Holger Zimmermann
Sendmail Milter	Harald Radi
thttpd	Sascha Schumann
tux	Sascha Schumann
WebJames	Alex Waugh

Module Authors
Module	Authors
BC Math	Andi Gutmans
Bzip2	Sterling Hughes
Calendar	Shane Caraveo, Colin Viebrock, Hartmut Holzgraefe, Wez Furlong
COM and .Net	Wez Furlong
ctype	Hartmut Holzgraefe
cURL	Sterling Hughes
Date/Time Support	Derick Rethans
DB-LIB (MS SQL, Sybase)	Wez Furlong, Frank M. Kromann
DBA	Sascha Schumann, Marcus Boerger
DOM	Christian Stocker, Rob Richards, Marcus Boerger
enchant	Pierre-Alain Joye, Ilia Alshanetsky
ereg	Rasmus Lerdorf, Jim Winstead, Jaakko Hyvätti
EXIF	Rasmus Lerdorf, Marcus Boerger
fileinfo	Ilia Alshanetsky, Pierre Alain Joye, Scott MacVicar, Derick Rethans
Firebird driver for PDO	Ard Biesheuvel
FTP	Stefan Esser, Andrew Skalski
GD imaging	Rasmus Lerdorf, Stig Bakken, Jim Winstead, Jouni Ahto, Ilia Alshanetsky, Pierre-Alain Joye, Marcus Boerger
GetText	Alex Plotnick
GNU GMP support	Stanislav Malyshev
Iconv	Rui Hirokawa, Stig Bakken, Moriyoshi Koizumi
IMAP	Rex Logan, Mark Musone, Brian Wang, Kaj-Michael Lang, Antoni Pamies Olive, Rasmus Lerdorf, Andrew Skalski, Chuck Hagenbuch, Daniel R Kalowsky
Input Filter	Rasmus Lerdorf, Derick Rethans, Pierre-Alain Joye, Ilia Alshanetsky
InterBase	Jouni Ahto, Andrew Avdeev, Ard Biesheuvel
Internationalization	Ed Batutis, Vladimir Iordanov, Dmitry Lakhtyuk, Stanislav Malyshev, Vadim Savchuk, Kirti Velankar
JSON	Omar Kilani, Scott MacVicar
LDAP	Amitay Isaacs, Eric Warnke, Rasmus Lerdorf, Gerrit Thomson, Stig Venaas
LIBXML	Christian Stocker, Rob Richards, Marcus Boerger, Wez Furlong, Shane Caraveo
mcrypt	Sascha Schumann, Derick Rethans
MS SQL	Frank M. Kromann
Multibyte String Functions	Tsukada Takuya, Rui Hirokawa
MySQL driver for PDO	George Schlossnagle, Wez Furlong, Ilia Alshanetsky, Johannes Schlueter
MySQL	Zeev Suraski, Zak Greant, Georg Richter, Andrey Hristov
MySQLi	Zak Greant, Georg Richter, Andrey Hristov, Ulf Wendel
MySQLnd	Andrey Hristov, Ulf Wendel, Georg Richter, Johannes Schlüter
OCI8	Stig Bakken, Thies C. Arntzen, Andy Sautins, David Benson, Maxim Maletsky, Harald Radi, Antony Dovgal, Andi Gutmans, Wez Furlong, Christopher Jones, Oracle Corporation
ODBC driver for PDO	Wez Furlong
ODBC	Stig Bakken, Andreas Karajannis, Frank M. Kromann, Daniel R. Kalowsky
OpenSSL	Stig Venaas, Wez Furlong, Sascha Kettler, Scott MacVicar
Oracle (OCI) driver for PDO	Wez Furlong
pcntl	Jason Greene, Arnaud Le Blanc
Perl Compatible Regexps	Andrei Zmievski
PHP Archive	Gregory Beaver, Marcus Boerger
PHP Data Objects	Wez Furlong, Marcus Boerger, Sterling Hughes, George Schlossnagle, Ilia Alshanetsky
PHP hash	Sara Golemon, Rasmus Lerdorf, Stefan Esser, Michael Wallner, Scott MacVicar
Posix	Kristian Koehntopp
PostgreSQL driver for PDO	Edin Kadribasic, Ilia Alshanetsky
PostgreSQL	Jouni Ahto, Zeev Suraski, Yasuo Ohgaki, Chris Kings-Lynne
Pspell	Vlad Krupin
Readline	Thies C. Arntzen
Recode	Kristian Koehntopp
Reflection	Marcus Boerger, Timm Friebe, George Schlossnagle, Andrei Zmievski, Johannes Schlueter
Sessions	Sascha Schumann, Andrei Zmievski
Shared Memory Operations	Slava Poliakov, Ilia Alshanetsky
SimpleXML	Sterling Hughes, Marcus Boerger, Rob Richards
SNMP	Rasmus Lerdorf, Harrie Hazewinkel, Mike Jackson, Steven Lawrance, Johann Hanne, Boris Lytochkin
SOAP	Brad Lafountain, Shane Caraveo, Dmitry Stogov
Sockets	Chris Vandomelen, Sterling Hughes, Daniel Beulshausen, Jason Greene
SPL	Marcus Boerger, Etienne Kneuss
SQLite 3.x driver for PDO	Wez Furlong
SQLite3	Scott MacVicar, Ilia Alshanetsky, Brad Dewar
Sybase-CT	Zeev Suraski, Tom May, Timm Friebe
System V Message based IPC	Wez Furlong
System V Semaphores	Tom May
System V Shared Memory	Christian Cartus
tidy	John Coggeshall, Ilia Alshanetsky
tokenizer	Andrei Zmievski, Johannes Schlueter
WDDX	Andrei Zmievski
XML	Stig Bakken, Thies C. Arntzen, Sterling Hughes
XMLReader	Rob Richards
xmlrpc	Dan Libby
XMLWriter	Rob Richards, Pierre-Alain Joye
XSL	Christian Stocker, Rob Richards
Zip	Pierre-Alain Joye, Remi Collet
Zlib	Rasmus Lerdorf, Stefan Roehrich, Zeev Suraski, Jade Nicoletti, Michael Wallner

PHP Documentation
Authors	Mehdi Achour, Friedhelm Betz, Antony Dovgal, Nuno Lopes, Hannes Magnusson, Georg Richter, Damien Seguy, Jakub Vrana, Adam Harvey, Peter Cowburn
Editor	Philip Olson
User Note Maintainers	Daniel P. Brown, Thiago Henrique Pojda
Other Contributors	Previously active authors, editors and other contributors are listed in the manual.

Websites and Infrastructure team
PHP Websites Team	Rasmus Lerdorf, Hannes Magnusson, Philip Olson, Lukas Kahwe Smith, Pierre-Alain Joye, Kalle Sommer Nielsen, Peter Cowburn, Adam Harvey, Ferenc Kovacs, Levi Morrison
Event Maintainers	Damien Seguy, Daniel P. Brown
Network Infrastructure	Daniel P. Brown
Windows Infrastructure	Alex Schoenmaker