嵌合抗原受体T细胞产品医保创新支付模式研究  

Research on innovative payment mode of medical insurance for chimeric antigen receptor T cell products

作　　者：刘丹妮 丁锦希[1,2] 李佳明 李伟[1,2] LIU Danni;DING Jinxi;LI Jiaming;LI Wei(School of International Pharmaceutical Business,China Pharmaceutical University,Nanjing 211198,Jiangsu Province,China;Pharmaceutical Market Access Policy Research Center,China Pharmaceutical University,Nanjing 211198,Jiangsu Province,China)

机构地区：[1]中国药科大学国际医药商学院,江苏南京211198 [2]中国药科大学医药市场准入政策研究中心,江苏南京211198

出　　处：《世界临床药物》2022年第4期369-376,共8页World Clinical Drug

基　　金：中国药科大学“双一流”学科创新团队建设项目(CPU2018GY4)。

摘　　要：作为新型肿瘤免疫治疗药品,嵌合抗原受体T细胞(chimeric antigen receptor T cell,CAR-T)上市时间短、定价高,临床用量难以精准预测,目前尚未纳入我国医保目录。该文在分析CAR-T产品医保支付难点的基础上,结合我国医保管理体制,构建创新支付4步走结算模式,并从实操层面提出“量价挂钩—商保协同—先行谈判”3项操作要点,确保创新支付落地应用,降低医保基金支出风险,提高CAR-T产品可及性。As a novel cancer immunotherapy with high market price,chimeric antigen receptor T cell(CAR-T) has not been marketed for a long time,and its clinical usage is difficult to predict precisely.Currently it has not been included in the National Reimbursement Drug List (NRDL).Based on the analysis of the difficulties in reimbursing CAR-T products,combining the medical insurance management system in China,the paper proposed to establish a four-step settlement mode for CAR-T products,and brought forward three key points of “coordination between price and volume-collaborating with commercial health insurance-advance negotiation” from the practical side,to ensure the implementation of the innovative payment mode,reduce the risk of medical insurance fund expenditure,and improve the accessibility of CAR-T products.

关 键 词：嵌合抗原受体T细胞(CAR-T) 创新支付 量价协议 

分 类 号：R197.1[医药卫生—卫生事业管理]