典型国家和地区原研药医保支付标准设计对我国的启示

The enlightenment of the design of original drug medical insurance payment standard system in typical countries and regions for China

目的:为国家药品集中采购政策背景下的药品医保支付标准管理提供参考。方法:对典型国家和地区的药品医保支付标准管理经验进行研究。结果:选取的典型国家和地区具有较为完备的药品医保支付标准管理体系,参考市场实际交易价格等多重因素,仿制药与原研药医保支付标准存在差异。建议:完善相关政策文件,建立科学的药品医保支付标准管理体系,通过药品市场价格交易监测机制,构建以市场为导向的医保支付标准形成机制,根据仿制药与原研药等不同药品的不同属性进行精细化分类管理;同时,在当前国家药品集中采购品种同通用名实行同一医保支付标准的政策前提下,继续推进并优化仿制药一致性评价工作,实现仿制药与原研药临床疗效一致,以符合当前仿制药与原研药实行同一医保支付标准的政策导向。

Objective:To provide reference for the management of drug medical insurance payment standard under the background of the national drug centralized procurement policy.Method:Research on the management experience of drug and medical insurance payment standard in typical countries and regions.Result:There is a relatively complete drug medical insurance payment standard management system in the typical countries and regions of studied,refer to multiple factors such as the actual trading price in the market,and there are differences in drug medical insurance payment standard between generic and original drug.Recommendation:It is recommended to improve relevant policy documents,and establish a scientific management system for drug medical insurance payment standards,establish a market-oriented mechanism for forming drug medical insurance payment standards through drug market price transactions,and refine classification management based on different attributes of different drugs such as generic drugs and original drugs.At the same time,under the current policy of implementing the same drug medical insurance payment standard for drugs with the same generic name of national drug centralized procurement,it is recommended to continue promoting and optimizing the consistency evaluation of generic drugs,achieving consistency in clinical efficacy between generic drugs and original drugs,in line with the current policy orientation of implementing the same drug medical insurance payment standard for generic drugs and original drugs.