我国基本医疗保险对新型口服抗凝药物费用补偿的情况调查

The Coverage of Primary Medical Insurance in Individual Municipalities and Provinces for New Oral Anticoagulants

目的:调查2017年版《国家基本医疗保险、工伤保除和生育保除药品目录》更新之后,各省市自治区基本医疗保险对新型口服抗凝药物(Novel oral anticoagulant,NOAC)费用补偿的情况。方法:在所有实行国家药品目录的省级行政单位选取一家三级甲等医院,分别调查利伐沙班、达比加群、阿哌沙班在省(自治区)职工医保、城镇职工医保、城镇居民医保覆盖范围内的门急诊及住院适应证、支付比例情况。结果:在所调查的31家不同省市自治区的三甲医院中,利伐沙班、达比加群、阿哌沙班进入常规采购品种目录的比例分别为100%、87.1%、61.2%;其中,4家医院所在省市基本医疗保险覆盖的利伐沙班的适应证相较于国家药品目录受到进一步限制。29.7%的省市自治区基本医疗保险覆盖门诊NOAC的使用,报销比例在0.2～0.9,100%的省市自治区基本医疗保险覆盖住院NOAC的使用,报销比例在0.15～0.95。结论:各省市自治区新型口服抗凝药物的基本医疗保险政策与其地区经济水平相适应,但目前大部分省市对非瓣膜性房颤患者使用NOAC的保障较差。

Objective： To study the expense compensation changes of basic health insurance for new oral anticoagulants（NOACs）in individual municipalities and provinces after the update of the National basic health insurance, work insurance and maternity insurance drug catalog, 2017 edition. Methods： Only one first class hospital from every provincial administrative unit which implements basic health insurance had been selected and the coverage of basic health insurance for New oral anticoagulants（NOACs）, including indications and insurance payout ratio of institutions working, enterprise working and non-working urban residents, were investigated. Results： Rivaroxiban was in the purchasing plan of 100% of the 31 investigated hospitals, dabigatrn was in 87.1% and apixaban was in 61.2%.The covered indications of rivaroxiban by basic health insurance in 4 of the provinces and municipalities were further limited than national drug catalogs. Only 29.7% of the provinces and municipalities covered the outpatient use of NOACs, and the payment ratio varies from 0.2 to 0.9. 100% of the provinces and municipalities covered the inpatient use of NOACs, and the payment ratio varies from 0.15 to 0.95. Conclusions： The results showed that the health insurance coverage for NOACs in 31 provinces and municipalities were in accordance with regional economic development level. And in most region, the basic health insurance provided a low level of benefit for non-valvular atrial fibrillation outpatient who had used NOACs.