国家医保谈判药品省级落地管理典型模式研究

Research on the Typical Model of Provincial Management Concerning National Medical Insurance Negotiation Drugs

目的:通过系统梳理国家医保谈判药品各省落地的现状、典型问题及典型模式,为后续国家医保谈判药品省级落地提供参考和借鉴。方法:检索全国31个省份医疗保障局、卫生健康委及药品采购平台等网站,收集、比较国家医保谈判药品落地相关的文件及具体内容。结果:各省积极落实国家谈判药品落地的相关要求,并且为了进一步保障谈判药品落地中的供应、使用和支付问题,有针对性地出台了3种管理模式,但各地管理模式间也存在较大的地区性差异。结论:国家医保谈判药品省级落地是一项系统性工程,需要各部门形成政策合力,也需要各省、各统筹区结合自身情况做好支付待遇和供药机制的制度安排。

Objective:Through systematically sorting out the status quo,typical problems and typical models of the national medi⁃cal insurance negotiating drugs in various provinces,it aims to provide references for the follow-up medical insurance negotiation drugs at the provincial level.Methods:To research the websites of the Healthcare Security Administration,the Health Commission and the Drug Purchasing Platform of 31 provinces,relevant documents and specific contents concerning national medical insurance negotiation are collected and compared.Results:All provinces has implemented the requirements of national medical insurance nego⁃tiations.Three typical management modes of special drug,outpatient special disease mode and dual track mode are introduced so as to further ensure the supply,use and payment of negotiating drugs.Meanwhile,these modes are different concerning regional situa⁃tions.Conclusion:The national medical insurance negotiation is a systematic project.It requires the joint efforts of all departments and also requires the provinces and the co-ordination areas to make arrangements for the payment and supply of relevant drugs.