三省(市)医疗保险特殊用药谈判制度比较

Comparison of Special Drug Negotiation Mechanism under Medical Insurance in 3 Provinces

目的:了解山东省青岛市、江苏省和浙江省医疗保险特殊用药谈判制度的基本情况。方法:查阅山东省青岛市、江苏省和浙江省与医疗保险特殊用药谈判制度相关的政策法规,从谈判机制、保障对象、支付范围、筹资机制及补偿水平五个方面进行比较。结果:青岛市筹资来源于财政拨款,谈判涉及药品和医用材料,覆盖重大疾病、罕见病及慢性病;江苏省无进行额外筹资,有针对性地救助乳腺癌和慢性髓性白血病患者,并将仿制药纳入了谈判范围;浙江省建立了财政补贴与个人缴费的分担机制,没有限定医疗保险特殊用药的临床指征,实行按费用分段补偿。结论:为进一步完善制度,可鼓励医疗保险特殊用药赠送谈判;增加罕见病用药,逐步纳入医用材料;建立医疗保险特殊用药保障目录的动态调整机制。

Objective： To learn about the basic situation of special drug negotiation mechanisms under medical insurance in Qingdao, Jiangsu and Zhejiang. Methods： To compare the differences by consulting the relative policies of medical insurance special drugs from the aspects of negotiation mechanism, medical care object, medical coverage, financing mechanism and reimbursement level. Results： The financial source of Qingdao was financial allocation. The negotiation range covered drugs and medical materials of critical diseases, rare diseases and chronic diseases. There was no additional financing mechanism in Jiangsu. The drug negotiation mechanism was specific to breast carcinoma and chronic myelogenous leukemia. In addition, generic drug was introduced in the negotiation range. In Zhejiang, the risk sharing mechanism of fiscal subsidies and individual contribution was set. The clinical medication indication was unlimited, and reimbursements were given by sectional expenses compensation. Conclusion： In order to implement the system, it needed to courage the medical company to donate drugs during negotiation, broaden rare disease coverage and add more medical materials into negotiation range so as to increase the efficiency of drug negotiation. Moreover, the dynamic adjustment mechanism of medical insurance special drug formulary should he built.