美国340B药品定价计划下院外药房管理的经验与启示  

Experience and enlightenment of out-of-hospital pharmacy management under the 340B drug pricing program in the United States

作　　者：贾月明 姜来 吕兰婷 JIA Yueming;JIANG Lai;LYU Lanting(Dept.of Pharmacy,OASIS International Hospital,Beijing 100015,China;Center for Health Technology Assessment and Policy Evaluation,Renmin University of China,Beijing 100872,China;School of Public Administration and Policy,Renmin University of China,Beijing 100872,China)

机构地区：[1]北京明德医院药剂科,北京100015 [2]中国人民大学卫生技术评估与医药政策研究中心,北京100872 [3]中国人民大学公共管理学院,北京100872

出　　处：《中国药房》2023年第8期897-901,共5页China Pharmacy

基　　金：国家社科基金重大项目(No.22ZDA096);中国人民大学公共健康与卫生疾控跨学科交叉平台资金项目(No.2021PDPC)。

摘　　要：目的借鉴美国340B药品定价计划(简称340B计划)经验,为优化我国药品“双通道”政策下定点零售药店的运行与管理提供参考。方法通过梳理美国实施340B计划下院外药房的实施现状,总结该计划下院外药房管理的经验,提出我国药品“双通道”政策下定点零售药店的管理思路和可能遇到的问题。结果与结论340B计划下的院外药房相对于医疗机构而言缺乏充分的患者基本信息和医保状态信息,易出现重复折扣和药品转移的问题;同时由于院外药房脱离了医疗机构内药品使用的管理和限制,加上销售药品带来的经济激励,使得美国340B计划面临高额医疗卫生费用支出与院外药房逆向选择风险。建议我国在进行药品“双通道”政策定点零售药店建设时,应该明确定点零售药店遴选标准,增强医疗机构和定点零售药店的财务透明度,建立科学的处方流转机制,加强参保患者与处方的审核以及认证管理,健全监督管理机制,同时将定点零售药店的药品销售情况合理纳入医疗机构用药管理中,从而实现药品可及的同时不滥用,科学控费。OBJECTIVE To learn from 340B drug pricing program(short for 340B program)in the United States,and provide reference for optimizing the operation and management of designated retail pharmacies under the“dual channel”policy in China.METHODS The status quos of the implementation of out-of-hospital pharmacies under the 340B program in the United States was reviewed to summarize the experience of the management of out-of-hospital pharmacies under the program in the United States,and to propose thoughts of management and possible problems for designated retail pharmacies under the“dual channel”policy in China.RESULTS&CONCLUSIONS Out-of-hospital pharmacies under the 340B program lacked sufficient basic information and medical insurance status of patients compared to medical institutions,which easily led to duplicate discounts and drug diversion issues.Due to the separation of out-of-hospital pharmacies from the management and restrictions on the use of drugs in medical institutions,coupled with the economic incentives brought by the sale of drugs,the 340B program in the United States faced high medical expenditure and adverse selection risks for out-of-hospital pharmacies.In this regard,when China is carrying out the construction of designated retail pharmacies under the“dual channel”policy,it is necessary to clarify the selection criteria for designated retail pharmacies,enhance the financial transparency of medical institutions and designated retail pharmacies,establish a scientific prescription circulation mechanism,strengthen the review and certification of insured patients and prescriptions,and improve the supervision and management mechanism.Meanwhile,the drug sales situation of designated retail pharmacies should be reasonably incorporated into the drug use management of medical institutions,so as to achieve the availability of drugs without abuse,and effectively control costs.

关 键 词：340B药品定价计划 双通道 定点零售药店 重复折扣 药品转移 

分 类 号：R95[医药卫生—药学]