关于部分特殊药品医保使用管理办法的研究

Pilot Study on Administrative Measures for Some Special Medicines in Medical Insurance Medicine List

近年来,部分临床上必须使用、疗效确切、价格昂贵的药品被纳入医保药品目录,然而部分定点医疗机构不配备或让病人自费购买这些药品,患者对此投诉较多。本研究对这类医保特殊药品进行了合理界定和分类,分析了这些药品在使用过程中产生矛盾的原因,并初步测算了医保特殊药品的年度费用。最后,结合本市实际提出解决医保特殊药品问题的政策建议。

In recent years, some medicines, which had clinical necessities, curative effectiveness but high price, were included in the medical insurance medicine list. However, some appointed hospital did not provide these medicines or let patients buy them at their own expense, which resulted in many complaints from patients. This study defined and classified these medicines, analyzed the causes of the contradiction in their usage, and initially estimated their annual cost. Finally, based on the actual situation in Shanghai, we put forward some suggestions to solve these problems.