创新生物制品新增适应症医保支付标准调整机制研究  

Adjustment Mechanism on Medical Insurance Payment Standard of Innovative Biologics after Increasing New Indications

作　　者：丁锦希[1] 郝丽 陈烨[1] 郑艺 Ding Jinxi;Hao Li;Chen Ye;Zheng Yi(China Pharmaceutical University,Nanjing,211198)

机构地区：[1]中国药科大学

出　　处：《中国医疗保险》2020年第3期37-43,共7页China Health Insurance

基　　金：2017年国家人力资源和社会保障部项目：基本医疗保险药品支付标准制定及实施有关问题研究、基本医疗保险药品目录谈判准入方式设计;2020年国家医疗保障局项目：药品医保支付标准制定规则研究

摘　　要：2017年、2018年国家医保准入谈判协议到期后,部分创新生物制品有新的适应症被批准上市。本文分析域外创新生物制品新增适应症准入后医保支付标准的调整模式,结合我国现状,建议现阶段按通用名调降支付标准,有效均衡医保基金控费和企业新适应症研发激励,未来探索按适应症管理模式。按适应症管理可促进“价值导向型”医保支付模式形成,激发企业开发小适应症的积极性,进而减少标签外用药行为,增强患者用药的安全性和可及性,是未来全球主流的医保管理方式。After the expiration of the National Health Insurance Access Negotiation Agreement in 2017 and 2018,some innovative biologics are approved for new indications.By analyzing the adjustment mode of the medical insurance payment standard after the admission of new indications for innovative biologics,combined with China's current situation,it is suggested to reduce the payment standard based on the generic name,to eff ectively balance fees control of medical insurance fund and incentives for enterprises to develop new indications,and gradually explore to adjust the payment standard based on the indication.According to indication management,it can promote the formation of"value oriented"medical insurance payment mode,stimulate the enthusiasm of enterprises to develop small indications,reduce the behavior of external use of drugs,and enhance the safety and accessibility of patients'medication.It is the global mainstream medical insurance management mode in the future.

关 键 词：新适应症 创新生物制品 医保支付标准 

分 类 号：F840.684[经济管理—保险]