Objective: To clarify the current status and development trend of the security of drugs for rare diseases by inclusive commercial medical insurance. Method: Quantitative and qualitative methods were conducted on the inclusive commercial medical in- surance programs and specific drug lists covering various cities all over the country during 2021-2022. Results: From 2021 to 2022, the number of GSP schemes covering medicines for rare diseases increases, and the number of rare disease specialty medicines cov- ered by GSP increases. 2022 sees more GSP schemes setting separate coverage levels for rare disease specialty medicines, which are lower than general specialty medicines coverage. Conclusion: Rare disease drug coverage under universal commercial insurance con- tinues to be optimized, but improving the level of rare disease drug coverage still requires the concerted efforts of all parties in the multi-level coverage system