福建省基于医保支付结算标准的药品采购政策“调结构,腾空间”效果分析  

Policy Effect of the Medicines Procurement Based on Health Insurance Reimbursement Standards in Fujian Province

作　　者：李明爽 叶建春 刁一凡 刘美岑 张杰 江梅英[3] 钱捷 富宏羽 耿帅 孙静[1] LI Ming-shuang;YE Jian-chun;DIAO Yi-fan;LIU Mei-cen;ZHANG Jie;JIANG Mei-ying;QIAN Jie;FU Hong-yu;GENG Shuai;SUN Jing(School of Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China;Fujian Pharmaceutical Machinery Joint Purchasing Center, Fuzhou 350011, China;Fujian Cancer Hospital, Affiliated Tumor Hospital, Fujian Medical University, Fuzhou 350014, China;Beijing 306 Hospital, Beijing 100083 , China)

机构地区：[1]中国医学科学院北京协和医学院公共卫生学院,北京100730 [2]福建省药械联合采购中心,福州350011 [3]福建省肿瘤医院福建医科大学附属肿瘤医院,福州350014 [4]北京306医院,北京100083

出　　处：《中国药学杂志》2019年第13期1114-1120,共7页Chinese Pharmaceutical Journal

摘　　要：目的通过比较用药结构,分析基于医保支付结算标准的药品采购政策的"调结构"和"腾空间"效果,为福建省完善基于医保支付结算标准的药品阳光采购和经验推广提供依据和政策建议。方法基于2016年和2017年福建省医保定点医疗机构药品采购数据,运用Excel 2007软件数据透视表等统计功能,对化学药品一级分类、二级分类(福建省化学药品药品采购目录分类方法)和活性物质(福建省药品采购目录名称)的采购金额及占比、原研和仿制采购数量(以标准单位"片/支/瓶"等调整)与采购金额等进行统计分析及比较。对中成药一级分类(福建省中成药采购目录分类方法)的采购金额及占比进行统计分析及比较。结果 2017年,福建省通过调整药品采购目录,节约采购经费近23. 8亿元,相比2016年的用药结构发生了显著变化。辅助和营养性采购金额及占比明显下降。高血压、新型抗肿瘤等治疗慢性病药物采购金额及占比显著上升。仿制药在采购数量上相比原研药显现出竞争力,呈现逐步替代原研药的趋势,但原研药占有绝对市场份额的品种仍普遍存在。原研药和仿制药的单位价格均有不同幅度降低。结论福建省基于医保支付结算标准的药品采购政策的"调结构、腾空间"效果初显。全面实施医保支付结算标准将使"腾空间"的效果更为显著。为进一步促进仿制药与原研药的有效竞争,福建省应对通过一致性评价和美国FDA及欧盟认证的仿制药与原研药设立相同的医保支付标准,促进仿制药替代原研药。OBJECTIVE To analyze the effects of " adjusting structure and vacating space" of the transparent medicines procurement basing health insurance reimbursement standards,through comparing medicines consumption structure of health insurance designated health facilities of Fujian province. And to generate evidence as well as to propose recommendations for policy improvement and experience promotion. METHODS Based on the 2016 and 2017 provincial medicines pooled procurement database,adopting the pivot table statistical functions of EXCEL software,the consumption value and value in proportion of ClassⅠandⅡchemical products( Fujian provincial medicines procurement list therapeutic classification for chemical products),as well as active pharmaceutical ingredients,consumption value and volume( standardized units in tablet/bottle/vial) of originator and generics were analyzed and compared. The consumption value of ClassⅠformulations of traditional Chinese medicines( Fujian provincial medicines procurement list therapeutic classification for formulations of traditional Chinese medicines) was also analyzed and compared. RESULTS Nearly 2. 38 billion yuan procurement budget was saved in 2017 through adjustment of the medicines procurement list in Fujian province. There were a certain changes of the consumption structure of medicines. The procurement value of adjuvant and nutraceutical medicines dramatically reduced. The procurement value of medicines for treatment of chronic diseases like hypertension and cancers significantly increased. The procurement volume of generics started to surpass that of the originator,and showed potential competitiveness of generic substitution. However,the originator still dominated the market of quite a number of medicines. Prices of both generics and originators decreased. CONCLUSION The effect of "adjusting structure and vacating space" has been demonstrated. Fully implementation of the health insurance reimbursement standards will make the above effect more apparent. To promote effective

关 键 词：药品采购 医保支付结算标准 原研药 仿制药 福建省 

分 类 号：R951[医药卫生—药学]