上海市“双通道”药品用药分析及优化管理建议  

Analysis of“dual channel”drug usage and recommendations for optimizing management in Shanghai

作　　者：黄海强 龚波 安大玖 HUANG Hai-qiang;GONG Bo;AN Da-jiu(Shanghai Medical Security Bureau,SHANGHAI 200040,China)

机构地区：[1]上海市医疗保障局,上海200040

出　　处：《中国新药与临床杂志》2024年第7期518-522,共5页Chinese Journal of New Drugs and Clinical Remedies

摘　　要：目的分析定点药店和医疗机构内“双通道”药品的用药情况,为更好地执行国家谈判药品“双通道”管理机制提供依据。方法梳理上海医保“双通道”管理机制相关政策,分析2022年1月至2023年12月上海市医疗保障智能监管系统中“双通道”药品费用增长率、覆盖率和不同类别药品的费用占比及药品费用排名等。结果随着纳入“双通道”管理的药品范围扩大,用药费用增长明显;抗肿瘤药在所有“双通道”药品中费用占比最高。政策执行过程中出现了处方流转困难、纸质处方带来医保基金安全漏洞等问题。结论“双通道”管理制度执行以来,通过医疗机构和定点药店两个不同渠道,有效提升了国家谈判药品供应保障水平。为进一步显现政策效应,建议加强“双通道”药品配备、加大定点药店服务布局、加强药品使用安全监管。AIM To analyze the usage of“dual channel”drugs in designated pharmacies and medical institutions,and to provide a basis for better implementation of the national negotiation drug“dual channel”management mechanism.METHODS The relevant policies of the“dual channel”management mechanism for Shanghai medical insurance were reviewed.The growth rate and coverage of“dual channel”drug costs,the proportion of different types of drug costs,and the ranking of drug costs within the Shanghai medical security intelligent supervision system from January 2022 to December 2023 were analyzed.RESULTS The cost of medication costs have increased significantly with the expansion of the scope of“dual channel”management drugs.Antitumor drugs account for the highest cost proportion among all“dual channel”drugs.There were some problems in the implementation of the policy,such as difficulties in prescription circulation,security vulnerabilities in medical insurance funds caused by paper prescriptions.CONCLUSION Since the implementation of the“dual channel”management mechanism,the supply guarantee level of the national negotiation drug has been effectively improved through two different channels of designated pharmacies and medical institutions.To further demonstrate policy effects,it is recommended to strengthen the allocation of“dual channel”drugs,increase the service layout of designated pharmacies and strengthen the supervision of drug usage.Download(CAJ format)Download(PDF format)

关 键 词：双通道 国家谈判药品 全民医疗保险 医保基金监管 

分 类 号：R95[医药卫生—药学]