2020年国家医保药品目录限定支付情况及变化趋势分析与优化建议  

Reimbursement limits situation and change trend analysis and optimization suggestion of National Medical Insurance Drug List 2020

作　　者：罗芬[1,2] 李一意[1,2] 罗霞 LUO Fen;LI Yi-yi;LUO Xia(Department of Pharmacy,the Second Xiangya Hospital of Central South University,Changsha 410011;Institute of Clinical Pharmacy,Central South University,Changsha 410011)

机构地区：[1]中南大学湘雅二医院药学部,长沙410011 [2]中南大学临床药学研究所,长沙410011

出　　处：《中南药学》2021年第7期1479-1484,共6页Central South Pharmacy

基　　金：湖南省自然科学基金(No.2020JJ5821)。

摘　　要：目的分析2020年版《国家基本医疗保险、工伤保险和生育保险药品目录》(以下简称2020年版《医保药品目录》)限定支付情况,探究其变化趋势和管理思维,同时针对存在的问题提出建议以促进医保政策的优化升级。方法通过归纳和对比分析研究,对2020年版《医保药品目录》限定支付情况进行统计分析。结果2020年版《医保药品目录》中限定支付范围的药品共有847种,占总数22.89%,包括仅限门诊和定点药店使用、二线用药限制、医疗机构限制、特定人群限制、险种限制和适应证限制等。结论2019年版《医保药品目录》相比于2017年版《医保药品目录》,限定支付条件药品数量明显增加,纳入更多基本药物和新药的同时严格限制其使用条件,保障用药合理性;2020年版《医保药品目录》与2019年版《医保药品目录》限制条件变化不大,主要是调出了临床价值不高且可替代或者已无文号品种,再将一些经评估价格明显偏高的老药通过谈判降价后纳入谈判目录以提高其经济性。医保目录限制条件的变化体现了国家医保目录在不断提升医保基金使用效益的同时,也在提升用药合理性。Objective To explore the change in the 2020 Edition of“Medicine List for National Basic Medical Insurance,Employment Injury Insurance and Maternity Insurance”(called“Medical Insurance Drug List 2020”for short),and at the same time provide suggestions for existing problems to optimize and upgrade of medical insurance policies by analyzing the Reimbursement Limits of National Basic Medical Insurance Drug List 2020.Methods The limited payment situations in the Medical Insurance Drug List 2020 were analyzed through induction and comparison.Results There were 847 drugs with limited payment scope in Medical Insurance Drug List 2020,accounting for 22.89%of the total,including those only available for the outpatients and for designated pharmacies,restricted second-line medication,restricted medical institutions,restricted insurance types,specific population groups,and indication restrictions.Conclusion Compared with the Medical Insurance Drug List 2017,List 2019 has a significant increase in the number of drugs with limited payment conditions.While more essential drugs and new drugs are included,the restrictions for use are strictly enforced to ensure the rationality of the medication use.List 2020 and 2019 do not change much in the limited conditions.The drugs with little clinical value,replacable or with outdated approval number have been removed.Some overpried drugs in regular directory are adjusted after price negotiation,to improve the rationality of drug use.

关 键 词：医保药品目录 限定支付 医保基金 

分 类 号：R197.1[医药卫生—卫生事业管理]