医保药品目录调整之退出机制的国际经验借鉴  

Review of the International Experiences in Drug Delisting Policies

作　　者：岳晓萌[1] 李钰翔 赵绯丽 贾方红 吴久鸿 YUE Xiaomeng;LI Yuxiang;ZHAO Feili;JIA Fanghong;WU Jiuhong(College of Pharmacy,University of Cincinnati,Cincinnati,OH 45267,USA;College of Medicine,University of Cincinnati,Cincinnati,OH 45267,USA;The University of Newcastle,University Drive,Callaghan 2308,Australia;Beijing Health Economics Association Pharmacoeconomics Professional Committee,Beijing 100101,China)

机构地区：[1]辛辛那提大学药学院,美国俄亥俄州辛辛那提45267 [2]辛辛那提大学医学院,美国俄亥俄州辛辛那提45267 [3]纽卡斯尔大学,澳大利亚新南威尔士州,纽卡斯尔2308 [4]北京市卫生经济学会药物经济学专业委员会,北京100101

出　　处：《医药导报》2021年第2期158-162,共5页Herald of Medicine

摘　　要：近期国家医保局发布的《基本医疗保险用药管理暂行办法》和《2020年国家医保药品目录调整工作方案》中将拟调整的药品分为新增纳入、直接调出、可以调出及调整限定支付范围四类,并首次明确支付标准调整和调出药品的条件。医保目录动态调整、有进有出体现中国医保管理水平的进一步提升,但目前调整退出机制和具体操作办法尚有待健全完善。该研究对欧洲部分有代表性的国家和美国医保目录调整,特别是退出机制进行梳理,从决策机制、调整频次和路径、评审方法和标准、以及实施效果和影响等多个维度展开分析论述,对退出机制关键步骤和主要考虑因素进行归纳总结。在对国际经验和操作模式分析总结的基础上,进一步提出针对中国医保目录药品调整和退出机制建立健全的政策建议,以期为优化医保管理、提高医保运行效率提供参考。Two main policy documents:“Interim Measures for the Administration of Drugs Used in Basic Medical Insurance”and“Work Plan for the Adjustment of the National List of Drugs For Medical Insurance in 2020”that were recently issued by the National Healthcare Security Administration recently for the first time clarified the conditions of adjusting payment criteria and delisting medicines from the national reimbursement drug list(NRDL).The adjustment of drug listing was classified into four categories:newly added items,direct delisting,ready for delisting and payment criteria adjustment.The establishment of dynamic adjustment of NRDL reflects the further advancement of China's medical insurance management.This study reviewed the international experiences and procedure of dynamic adjustment of drug reimbursement formulary,in particular the delisting procedure.The focus of this study is the representative countries in Europe and the United State of America.The domains that were analyzed include decision-making mechanism,the frequency and procedure of adjustment,evaluation method and criteria,as well as the impact and result of the adjustment.Based on the analyses and summary of the international experiences,we further provided the policy recommendations on the establishment of adjustment and delisting mechanism in China with the aim of facilitating the management of NRDL and improving the efficiency of medicine insurance scheme in China.

关 键 词：退出机制 药品报销 医疗保险目录 动态调整机制 药物经济学 

分 类 号：R956[医药卫生—药学]