高值药品医保支付管理实践比较研究

A Comparative Study on the Practice of Medical Insurance Payment Management for High-value Drugs

许多创新药物研发过程存在高风险、长周期的特点,药企使得在专利期内选择高定价策略,以获得收益回报。对各国医疗卫生及医疗保险管理部门而言,此类高值药品产生的卫生费用支出与患者用药可及性等问题,始终是重要的研究议题。本文研究发现我国大部分地区主要以特药保障或大病保险等形式对高值药品进行管理,而澳大利亚和新西兰通过建立高值药品的独立目录,以促进药品的可及性。本文研究结论揭示:随着新药上市速度加快、患者用药需求加大,对高值药品开展科学评估与管理是必然趋势。

The high-risk, long-cycle R&D process has enabled many innovative drugs to choose high pricing strategies during the patent period to generate a return on their income. For national health and medical insurance management departments, the issue of health expenditures and accessibility of patients with such high-value drugs has always been an important issue. This paper finds that in most parts of China, high-value drugs are mainly managed in the form of special drug protection or major illness insurance, while Australia and New Zealand promote the accessibility of drugs by establishing an independent catalogue of high-value drugs. With the speed of new drug marketing and the increasing demand for patients, it is an inevitable trend to carry out scientific evaluation and management of high-value drugs.