国家医保谈判新型抗肿瘤药物的发展变化  

Changes of novel anti-tumor drugs in national medical insurance negotiation

作　　者：谢杏梅 高悦[1] XIE Xing-mei;GAO Yue(Department of Pharmacy,Shanghai Songjiang District Central Hospital,Shanghai 201600)

机构地区：[1]上海市松江区中心医院药剂科,上海201600

出　　处：《中南药学》2023年第5期1393-1398,共6页Central South Pharmacy

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

摘　　要：目的以新型抗肿瘤药物为重点,分析2018年起《新型抗肿瘤药物临床应用指导原则》(简称《指导原则》)中纳入国家医保谈判药品的发展变化情况。方法对比历年《指导原则》和上一年份或对应年份《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》)中新型抗肿瘤药物数量、系统分布、靶点检测及医保支付限定适应证等方面的发展变化。结果2018年版《指导原则》中纳入33个新型抗肿瘤药物,2019、2020、2021年分别增加了13、27、44个;2018年《指导原则》纳入国家谈判药品26个,2019、2020、2021年分别增至31、39、48个。历年《指导原则》中新型抗肿瘤药物主要分布在呼吸系统、消化系统、血液系统。《指导原则》需靶点检测药品从17个发展至40个,从EGFR、HER2、VEGFR传统靶点发展到作用于PD-L1、BRCA、ALK等新兴靶点。国谈医保目录中新型抗肿瘤药物医保支付限定适应证覆盖范围扩大。结论《指导原则》纳入国家医保谈判新型抗肿瘤药物数量逐年丰富,靶点检测逐步纳入医保,医保支付限定适应证覆盖范围不断扩大,提升了肿瘤患者享受公平可及的医保资源。《指导原则》适应证更新存在滞后性;在后续《指导原则》和《医保目录》更新中应关注我国发病率较高但缺乏药物治疗的肿瘤类型以满足不同肿瘤治疗的需求。Objective To determine the changes of Chinese national medical insurance negotiation drugs(especially novel anti-tumor drugs)in the Guiding Principles of Clinical Application of Novel Anti-tumor Drugs(the Guiding Principles)since 2018.Methods The number,distribution,target detection and limited indications for medical insurance payment of novel anti-tumor drugs were compared between the Guiding Principles and the Medicine Catalogues for National Basic Medical Insurance,Work-related Injury Insurance and Maternity Insurance(the“Medical Insurance Catalogues”)in the preceding year or corresponding years.Results Totally 33 new anti-tumor drugs were included in the 2018 edition of the Guiding Principles,which increased by 13,27 and 44 in 2019,2020 and 2021,respectively.In 2018,26 drugs were included in the Guiding Principles,which were increased to 31,39 and 48 in 2019,2020 and 2021,respectively.Novel anti-tumor drugs in the Guiding Principles over the years mainly covered respiratory system,the digestive system and the blood system.According to the Guiding Principles,the number of drugs required for target detection increased from 17 to 40,and from traditional targets of EGFR,HER2 and VEGFR to emerging targets such as PD-L1,BRCA,and ALK.The medical insurance payment limitation indications of the novel anti-tumor drug in the national medical insurance catalogue were expanded.Conclusion The number of novel anti-tumor drugs included in the national medical insurance negotiation increases year by year.Target detection is gradually included in the medical insurance,and the coverage of medical insurance payment is expanding.Cancer patients have fairer and more accessible medical insurance resources.Delay exists in the update of indications in the Guiding Principles.Attention should be paid to the tumor types with high incidence with few drug treatments in China.

关 键 词：新型抗肿瘤药物 指导原则 国家医保谈判药品 

分 类 号：R95[医药卫生—药学]