被医保支付最多的品种及背后药企。

医药财经2025-06-11

从医保支付视角来看，医药行业的核心支付品种集中于慢性病、肿瘤、罕见病及重大疾病创新药，其背后涉及国内外药企的激烈竞争与政策协同。结合最新医保目录及行业数据，重点品种及厂家分析如下：一、糖尿病用药：医保支付规模最大品类市场规模：2024年上半年公立医疗机构口服糖尿病化药销售额超250亿元，同比增长7.75%。核心品种及厂家：1. 达格列净片（SGLT2抑制剂）厂家：阿斯利康（原研）、浙江华海药业、...

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DPP-4抑制剂创新药，部分新纳入医保品种：信立泰“苯甲酸复格列汀片”（1类新药）；海思科“考格列汀片”（全球首个双周口服DPP4抑制剂）；惠升生物“脯氨酸加格列净片”（SGLT2抑制剂）；详见：第11款DPP-4抑制剂在国内获批；DPP-4降糖药“利格列汀”，集采最低价13分二、肿瘤创新药：医保重点支持领域政策导向：2024年新增91种医保药品中，38种为“全球新”创新药，肿瘤药占比最高。核心品种及厂家1. PD-1/PD-L1抑制剂君实生物 特瑞普利单抗：国内首个10项适应症全纳入医保的PD-1，覆盖黑色素瘤、肺癌围手术期等。信达生物 信迪利单抗：2024年全年产品收入82亿元（+40%），其中信迪利单抗因多适应症续约贡献较大份额。详见：国产PD-1销售成绩单：百济神州38亿，信达生物28亿……2. 双特异性抗体康方生物 卡度尼利：全球首款PD-1/CTLA-4双抗，纳入2024年医保，覆盖宫颈癌等适应症。康方生物 依沃西：PD-1/VEGF双抗，首个“免疫+抗血管”机制双抗。详见：不按套路出牌！康方提前泄密两款双抗的医保价3. 口服靶向治疗药物齐鲁制药 伊鲁阿克片：ALK阳性非小细胞肺癌全线适应症纳入医保。武田制药 布格替尼：ALK阳性肺癌靶向药成功续约。三、自身免疫及消化系统疾病用药炎症性疾病赛诺菲 度普利尤单抗：中重度特应性皮炎全年龄用药，2024年成功续约医保。百时美施贵宝 氘可来昔替尼：全球首款TYK2抑制剂，治疗银屑病新纳入医保。消化领域武田制药 伏诺拉生：新增“根除幽门螺杆菌”适应症，提高首次根除率（原医保用于反流性食管炎）。武田制药 维得利珠单抗：炎症性肠病用药续约。四、罕见病药物：医保覆盖加速扩容2024年新增13种罕见病用药，典型案例如下：齐鲁制药 氯苯唑酸葡胺软胶囊：治疗遗传性ATTR-PN（致死性疾病），原研药价格高昂，国产化后纳入医保提升可及性。武田制药拉那利尤单抗：遗传性血管性水肿（HAE）用药续约。赛诺菲 贝舒地尔：全球首个慢性移植物抗宿主病（cGVHD）靶向药，新纳入医保。五、医保支付机制变革：丙类目录推动多元支付2025年将落地丙类医保目录，覆盖因“保基本”定位暂未纳入基本医保的高价值创新药：覆盖范围：CAR-T疗法（如复星凯特阿基仑赛）、ADC药物（如荣昌生物维迪西妥单抗）、阿尔茨海默症Aβ单抗等。支付方式：通过商业健康险覆盖，医保局引导险企将丙类目录纳入保障，不计入患者自费率考核。影响：为单次治疗超百万元的疗法（如CAR-T）提供支付通道，缓解药企价格压力。总结：医保支付结构反映产业与政策协同演进医保基金作为“永续买方”（当然这背后的实际买方是每一位基金缴纳者）其支付重点体现了临床需求、国产替代与创新升级的三重逻辑：慢性病用药（如糖尿病）由外资原研主导转向国产仿制+创新药并存，集采驱动价格下行；肿瘤/罕见病领域以创新药为主，本土企业（康方、信达、齐鲁）与MNC（武田、赛诺菲）共同受益医保放量；支付机制创新：丙类目录补位“保基本”缺口，商保联动为高值疗法提供可持续支付路径。数据来源：米内网公立医疗机构终端数据、2024年国家医保目录调整结果、招银国际/平安证券行业研报。","kind":"news","is_publish_news":true,"is_publish_highlight":false,"is_publish_live":false,"is_publish_wemedia":null,"editions":null,"column":"","sentiment":"0","news_tag":"","news_rank":0,"isVideo":false,"video":null,"symbols":[],"gpt_button":1,"need_auth":false,"need_login_tip":false,"code":"91000000","status":"200"},"commentList":[],"isCommentEnd":true,"newsSizeData":{"likeSize":1,"commentSize":0,"repostSize":0,"favoriteSize":2,"likeStatus":false,"favoriteStatus":false},"APP":{"userAgent":"Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)","isDev":false,"isTTM":false,"tenantId":"TBCN","deviceId":"web-server-community-laohu8-v3","version":"4.43.1","shortVersion":"4.43.1","platform":"web","vendor":"web","appName":"laohu8","isIOS":false,"isAndroid":false,"isTiger":false,"isTHS":false,"isWeiXin":false,"isWeiXinMini":false,"isWeiBo":false,"isQQ":false,"isBaiduSwan":false,"isBaiduBox":false,"isDingTalk":false,"isToutiao":false,"isOnePlus":false,"isHuaWei":false,"isXiaomi":false,"isXiaomiWebView":false,"isOppo":false,"isVivo":false,"isSamsung":false,"isMobile":false},"href":"/m/news/2542537853","isCrawlerRequest":true}