我国仿制药品医疗保险支付标准的实证探索:基于参考定价方法  

The Exploration of Healthcare Payment Standard for Generic Drugs in China:An Empirical Study Using Reference Pricing

作　　者：张玉丽 谢诗桐 吴晶[1] ZHANG Yu-li;XIE Shi-tong;WU Jing

机构地区：[1]天津大学药物科学与技术学院,天津300072

出　　处：《中国药物经济学》2018年第11期30-35,共6页China Journal of Pharmaceutical Economics

摘　　要：中国于2015年开启了新一轮药品价格改革,主要内容为取消绝大部分药品,特别是医疗保险目录内药品的政府定价,改为由医疗保险管理部门制定医疗保险支付标准。因此,如何科学制定医疗保险支付标准成为药品价格形成机制的关键内容。目前,我国尚未形成针对过期专利药品及其仿制药品支付标准的制定体系,而随着仿制药品质量与疗效一致性评价的持续开展和通过一致性评价药品数量的不断增加,使得以药品通用名为基础制定支付标准成为学术探讨热点。本研究选取了三个用于治疗常见疾病(血脂异常、高血压和骨质疏松)且已有部分产品通过一致性评价的药品,借鉴德国参考价格的制定方法,利用真实世界医疗保险数据库,以通用名为基础进行支付标准的实证测算,以期为我国制定过期专利药品及其仿制药品的医疗保险支付标准提供参考依据。结果显示,使用德国参考价格定价方法制定过期专利药品及其仿制药品医疗保险支付标准是基本可行和值得探索的,但我国医药市场有其独特之处,实际实施时需要根据具体情况对测算方法进行相应调整。A new round of drug price reform has been launched in China from 2015, which mainly aims to abolish the government pricing system and to set out the payment rate calculation rules by the healthcare insurance department, especially for the drugs in National drug reimbursement list. Therefore, it is the key point to conduct the payment rate efficiently for the reform. While the system of payment rates for expired patented drugs and their generic drugs have not been developed in China yet, it has been a hot issue to investigate the calculation methods of the payment rates based on the generic names, given the continuous development of the consistency evaluations of the quality and efficacy for generic drugs and the rapid increase of the number of drugs passed evaluations. Three drugs(treatment for dyslipidemia, hypertension and osteoporosis), of which some of products have passed the consistency evaluation, were selected in this study, and an empirical calculation of the payment rate using German reference price method based on the real-world healthcare insurance database was conducted, in order to provide a reference for the development of healthcare payment rates for expired patented drugs and their generic drugs. The results showed that it is feasible and worth exploring to use the reference pricing method to conduct the healthcare payment rates for expired patented drugs and their generic drugs. While there are some own unique features in China pharmaceutical market, it is necessary to adjust these methods according to specific conditions in practice.

关 键 词：仿制药品 支付标准 参考价格 通用名 实证测算 

分 类 号：R95[医药卫生—药学]