创新多元支付体系支持高值创新药准入和落地实施研究  

Research on Innovative Multi-Payment System Supporting High-Value Innovative Drug Access and Implementation

作　　者：陈丽萍 张志娟 赵汪洋 彭步焯 罗川朝 冯岚 宋瑞霖 宣建伟 

机构地区：[1]中山大学药学院医药经济研究所,广州511400 [2]中国医药创新促进会,北京100007

出　　处：《中国医疗保险》2025年第1期5-10,共6页China Health Insurance

摘　　要：目的:为进一步提高高值创新药的患者可及性、保障医保基金安全性和支持产业创新可持续,探索创新多元支付体系以补充完善国家现有谈判规则,寻求科学合理的患者支付价(A部分)、医保支付(B部分)和多层次保障(C部分)的确定方法及实施途径。方法:采用文献综述、专家访谈与小型研讨会等方法,结合卫生管理和卫生经济学等学科理论,以完善创新多元支付方案及细化落地方式。结果:A部分应建立在患者可负担的基础上,并结合替代治疗方案的实际费用及国际患者支付情况来设定。B部分为医保实际支付部分,延续现行NRDL规则,通过药物经济学方法测算、谈判得到医保支付价。医保通过平衡患者的可负担性与医保基金承受能力,确定A部分和B部分的水平。药品价格减去A、B部分即为C部分。C部分可由创新企业牵头提供部分资金,通过杠杆作用撬动社会各方资源,实现资源的叠加,共建多元支付体系。同时,政府通过组织协调、政策引导和资金支持,确保A、B、C各部分共同发挥作用,以提升整体保障能力和效果。结论:本研究针对高临床获益且价格昂贵的药品,探索以患者支付价和医保支付价相结合的社会多元支付体系,是平衡高值创新药的患者可及性、保障医保基金安全和产业创新可持续的其中一种可行的创新支付方案。未来将通过地方试点,根据地方实际情况具体设计A、B、C部分,总结实践经验,以完善工作方案和推广示范点经验。Objective:To enhance the accessibility of high-value innovative drugs for patients,to guarantee the sustainability of medical insurance funds,and to support industrial innovation,this study aims to explore an innovative multi-payment system that supplements and refines the existing national negotiation framework.Specifically,it seeks to identify scientific and reasonable methodologies and implementation pathways for determining(Component A)the patient payment price,(Component B)the medical insurance payment,and(Component C)the muti-layer security.Methods:This study adopts a multi-disciplinary approach such as literature review,expert interviews,and small-group workshops,integrating theories from health management and health economics to refine proposals for the innovative multi-payment system and its implementation strategies.Results:The Component A should be based on patients’affordability,actual costs of alternative therapies,and international benchmarks.The Component B should follow the existing National Insurance Drug List(NRDL)rules and the medical insurance price is calculated and negotiated by pharmacoeconomic methods.Medical insurance determines the levels of Component A and B by balancing the affordability of patients with medical insurance funds.Subtracting Component A and B from the drug price is Component C.For Component C,innovative pharmaceutical companies play a leading role by providing part of the funds,leveraging various social resources to build a collaborative,resource-sharing multi-stakeholder payment system.Simultaneously,the government ensures the effective functioning of Component A,B,and C through organizational coordination,policy guidance,and financial support,enhancing the overall security capacity and effectiveness of the payment system.Conclusion:This study explores a social diversified payment system that combines patient payment price and medical insurance payment price for expensive drugs with high clinical benefits.This approach provides a viable pathway for balancing patients�

关 键 词：高值创新药 患者可及性 创新多元支付体系 

分 类 号：F840.684[经济管理—保险]