近4版国家医保目录中降糖药的变化与思考  

Changes and Thinkings of Hypoglycemic Drugs in the Last Four Editions of the National Drug Reimbursement List

作　　者：高悦[1] 杨谊[1] 张艳丽[1] GAO Yue;YANG Yi;ZHANG Yanli(Shanghai Songjiang District Central Hospital,Shanghai,China 201600)

机构地区：[1]上海市松江区中心医院,上海201600

出　　处：《中国药业》2023年第10期20-24,共5页China Pharmaceuticals

基　　金：2018年上海市临床药学重点专科建设项目[沪卫计药政[2018]9号]。

摘　　要：目的为优化临床降糖药的使用提供参考。方法采用Excel软件录入2017年版、2019年版、2020年版、2021年版《国家基本医疗保险、工伤保险和生育保险药品目录》(简称《医保目录》)中降糖药的名称、剂型、医保支付方式及“备注”中的医保限制情况,分析降糖药的基本情况和调整情况。结果4版《医保目录》中,降糖药医保付费支付方式多为乙类(占比均超过60%且变化不大);新增品种以口服复方降糖药(从0种增至8种)、胰高血糖素样肽-1(GLP-1)类似物(从1种增至7种)、钠-葡萄糖协同转运蛋白2(SGLT-2)抑制剂(从0种增至4种)为主;国家谈判药品以GLP-1类似物为主。《医保目录》中SGLT-2抑制剂及GLP-1类似物均为二线用药,而2019年欧洲心脏病学会指南推荐合并动脉粥样硬化性心血管疾病(ASCVD)或处于ASCVD高危、极高危的患者首选SGLT-2抑制剂或GLP-1类似物单药治疗。结论医保目录的更新需紧跟指南,降糖药的医保支付分类有待进一步调整。Objective To provide a reference for optimizing the clinical use of hypoglycemic drugs.Methods Excel software was used to input the names,dosage forms,medical insurance payment methods of hypoglycemic drugs and medical insurance restrictions in the remarks of the last four editions(2017,2019,2020 and 2021)of the List of Drugs for National Basic Medical Insurance,Work-Related Injury Insurance and Maternity Insurance(hereinafter referred to as the National Drug Reimbursement List).The basic information and adjustment of hypoglycemic drugs were analyzed.Results In the four editions of the National Drug Reimbursement List,more than 60%of the hypoglycemic drugs were paid by medical insurance in category B with little changes of the proportion.The new varieties were mainly oral compound hypoglycemic drugs(from zero to eight drugs),glucagon-like peptide-1(GLP-1)analogues(from one to seven drugs)and sodium-dependent glucose transporters 2(SGLT-2)inhibitors(from zero to four drugs).Drugs priced through national negotiation were mainly GLP-1 analogues.In the National Drug Reimbursement List,SGLT-2 inhibitors and GLP-1 analogues were second-line drugs,while the European Society of Cardiology Guideline(2019)recommend that SGLT-2 inhibitors or and monotherapy was priority in the patients with atherosclerotic cardiovascular disease(ASCVD),high-or very high-risk of ASCVD.Conclusion The update of the national drug reimbursement list needs to follow closely the guidelines,and the category of medical insurance payment for hypoglycemic drugs needs further adjustment.

关 键 词：国家医保目录 糖尿病 降糖药 国家谈判药品 政策更新 

分 类 号：R95[医药卫生—药学]