普惠险药品准入机制与评估体系研究  

Research on Access Mechanism and Evaluation System of Inclusive Insurance Drugs

作　　者：于保荣[1] 孔维政 王庆 YU Baorong;KONG Weizheng;WANG Qing(School of Insurance and Economics,University of International Business and Economics,Beijing 100029,China;不详)

机构地区：[1]对外经济贸易大学保险学院,北京100029 [2]山东大学公共卫生学院,山东济南250012

出　　处：《卫生经济研究》2022年第8期1-4,共4页

基　　金：国家自然基金面上项目“商业保险公司经营社会医疗保险的实证研究”(71173135/G0308)。

摘　　要：特药责任是普惠险的重要保障内容之一。特药数量不断增加、普惠性质逐渐增强、保障病种以肿瘤为主并向目录外倾斜,是普惠险特药保障的主要趋势。在特药准入方面,应遴选出目前医保目录内覆盖不足的重点疾病,再根据企业填报的产品进行药物经济学评价与基金预算影响分析,最后与药企展开谈判。普惠险特药的评估体系应有前置指标和评价指标两部分,在满足安全性和补充性两个先决条件的基础上,从有效性、创新性、经济性和公平性四个维度进行具体考量。未来普惠险在特药责任的设计上应推动完整、循证、透明的评估体系建设,完善特药责任动态调节机制,合理发挥各参与主体的优势。Special drug liability is an important guarantee content of inclusive insurance.At present,the main development trend of inclusive insurance's expensive drugs is that the number of drugs keeps increasing,the nature of universal benefit gradually increases,and the diseases are guaranteed to be dominated by tumors and tilted out of the basic medical insurance catalog.In terms of the access process of special drugs,key diseases that are not covered in the current clinical medical insurance catalog should be selected,and then pharmaceutical economic evaluation and fund budget impact analysis should be conducted according to the products submitted by enterprises,and finally negotiations should be launched with pharmaceutical enterprises.In addition,the evaluation system of inclusive insurance's special drugs should consist of two parts:pre-index and evaluation index.Among them,special drugs should meet the two prerequisites of safety and supplement.Secondly,it should be considered from four dimensions of effectiveness,innovation,economy and fairness.In the future,the participant of inclusive insurance should promote the construction of a complete,evidence-based and transparent evaluation system,improve the dynamic regulation mechanism of expensive drug liability and give full play to the advantages of each participant.

关 键 词：普惠险 特药保障 药品目录 经济学评价 

分 类 号：F840.684[经济管理—保险] R95[医药卫生—药学]