建立医保特殊用药谈判机制的实践与思考

Analysis of Establishing a Negotiation Mechanism for Special Medication in Health Care Insurance System

江西省通过建立谈判机制,首批将5种特殊药品纳入城镇重特大疾病保障基金支付范围,一年可为全省重特大疾病参保患者减轻医药费用负担1.2亿元。特殊用药的谈判实施步骤,应在摸清基金存量和需求调查的基础上,坚持基本保障原则,急需适时、稳妥实施和公平公正原则,谈判降价原则。针对特药准入选择难、供需矛盾突出等问题,亟需健全市级统筹、扩大重特大疾病保障的覆盖范围;加大筹资力度;引入市场采购机制,完善竞价谈判机制;加强相关各方的协作与管理。

Through establishing a negotiation system, there are five kind of special medicines had been initially included in the scope of major and very serious medical insurance coverage for urban residents. As a result, it has saved medical expenses of 1.2 billion Yuan RMB each year for the patients of Jiangxi province. To implement the special medication negotiation process, we must have a clear picture of the fund storage and demands; insist on the principle of guarantying basic, urgent and timely needs, implementing reliably, reflecting fairness and justice, and reducing price by negotiation. In order to address difficulties in special medication entry selection and contradiction between supplies and demands, we are in badly need of improving social fund pooling level, expanding the scope of coverage for major and very serious diseases. We should also take more efforts on fund-raising, introduce market procurement system and promote the bidding negotiation system, and intensify coordination and administration among various parties.