福利经济学视角下多适应症抗癌药品基本医疗保险定价方式探讨  

Comparison of Basic Medical Insurance Pricing Models on Multi-indication Drugs from the Perspective of Welfare Economics

作　　者：朱圣文 胡宏飞 陈焱秋 唐文熙[1,2] 马爱霞 ZHU Shengwen(School of International Pharmaceutical Business,China Pharmaceutical University,Nanjing,Jiangsu,211198,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]中国药科大学药物经济学评价研究中心,江苏南京211198

出　　处：《医学与社会》2023年第1期80-86,共7页Medicine and Society

基　　金：国家自然科学基金资助项目,编号为71603278。

摘　　要：目的:从福利经济学视角出发,探索不同利益主体对不同基本医疗保险定价方法的偏好,为我国医保谈判准入中多适应症药品的医保支付价格确定提供参考。方法:以A药品为例,在基于价值定价框架下比较3种定价方法:基于市场份额和价值的加权定价、基于市场份额的单一加权定价和单适应症定价对医保基金负担、消费者剩余和生产者剩余的影响。结果:基于市场份额和价值的加权定价计算得A药品价格为4866.90元/100毫克,基于市场份额的单一加权定价为8614.10元/100毫克,单适应症定价A药品的价格为1501.00-21941.50元/100毫克不等。基于市场份额和价值加权定价,产生的医保基金负担、消费者剩余、生产者剩余分别为144.47亿元,5.16亿元和3.25亿元。基于市场份额的单一加权定价产生的医保基金负担、总消费者剩余、生产者剩余分别为255.69亿元,2838.60元和8.41亿元。单适应症定价产生的医保基金负担、总消费者剩余、生产者剩余分别为140.46亿元,0元和8.41亿元。结论:基于市场份额和价值计算多适应症药品价格能够切实减轻医保和患者负担,同时兼顾企业创新,为多适应症药品医保支付价格的制定提供了可行思路。Objective:From the perspective of welfare economics,to explore the preferences of different stakeholders for different basic medical insurance pricing methods,and to provide a reference for the determination of medical insurance payment prices for multi-indication drugs in Chinese medical insurance negotiation access.Methods:Drug A was taken as an example,3 pricing methods were compared under the framework of value-based pricing:weighted pricing based on market share and value,single-weighted pricing based on market share and single-indication pricing on the burden of medical insurance funds,consumer surplus and the effect of producer surplus.Results:Based on the weighted pricing of market share and value,the price of drug A was 4866.9 yuan/100 mg,the single weighted price based on market share was 8614.1 yuan/100 mg,and the price of A drug for single indication was 1501-21941.5 yuan/100 mg.Based on market share and value-weighted pricing,the resulting medical insurance fund burden,consumer surplus,and producer surplus were 14.447 billion yuan,516 million yuan,and 325 million yuan,respectively.The burden of medical insurance funds,total consumer surplus,and producer surplus generated by single-weighted pricing based on market share are 25.569 billion yuan,2838.60 yuan and 841 million yuan,respectively.The burden of medical insurance funds,total consumer surplus,and producer surplus generated by single-indication pricing were 14.046 billion yuan,0 yuan,and 841 million yuan,respectively.Conclusion:Calculating the price of multi-indication drugs based on market share and value can effectively reduce the burden on medical insurance and patients,and at the same time take into account corporate innovation,which provides a feasible idea for the formulation of the payment price of multi-indication drugs for medical insurance.

关 键 词：药品定价 多适应症 基本医疗保险 支付标准 国家基本医疗保险目录 

分 类 号：R197.32[医药卫生—卫生事业管理]