药品福利管理的发展及应用现状系统评价

Development and application status of pharmacy benefit management: a systematic review

目的系统评价药品福利管理模式(pharmacy benefit management,PBM)的概念、定义、发展、运作机制、功能、效果、优势及挑战等各方面情况,为其在中国的引进和应用推广提供依据。方法计算机检索PubMed、EMbase、Web of Science、CNKI、WanFang Data和CBM数据库,搜集药品福利管理相关研究、政策和应用的文献,检索时限均从2000年1月1日至2017年1月1日。由2名研究者独立筛选文献、提取资料,采用AHRQ评价清单对纳入的观察性研究进行质量评价后,对文献资料进行定性评价。结果共纳入12篇研究,结果显示美国PBM模式能通过与药品生产商的谈判折扣、缩短药品流通环节、制订与管理处方集、监督医生的处方行为、对患者进行健康教育和健康干预、使用高度信息化系统的实时处方赔付、使用邮购药品送货到家等方面,起到降低患者用药费用负担、对患者进行较好的疾病管理。结论中国对PBM模式的尝试不能完全复制美国PBM模式,应结合我国国情,充分考虑我国特有的社会体制、卫生管理体制、医药市场环境及社会文化等各方面的现实问题,探索出适合我国的PBM模式。

Objectives To systematically review the concept, definition, development, operation mechanism,function, efficacy, advantages and challenges of pharmacy benefit management(PBM), in order to provide evidence for its introduction and application in China. Methods PubMed, EMbase, Web of Science, CNKI, WanFang Data and CBM databases were searched to collect literatures on researches, policies, and applications related to PBM from January 1st,2000 to January 1st, 2017. Two researchers independently screened literatures, extracted data and used the AHRQ evaluation list to evaluate the quality of the observational studies, then qualitative method was used to review literature.Results A total of 12 researches were included. The results showed that PBMs had played an important role in negotiation discounts with drug manufacturers, supervising drug circulation and doctors’ prescription behaviors,delivering health management services for patients, prescription payments with highly information-oriented systems, etc.,which, as a result, could reduce the medication burden of patients with superior diseases management. Conclusions China’s attempt to adopt a PBM model must take full account of practical conditions, which involves health management system, pharmaceutical market environment and social culture. It cannot merely emulate the PBM model of the United States. With consideration of local conditions, China can explore a suitable path for its own PBM model.