基于医保控费的新型口服抗凝药物专项处方点评的建立和效果评价

Establishment and Effect Evaluation of New Oral Anticoagulants Special Prescription Comments Based on Medical Insurance Fee Control

目的:评估新型口服抗凝药物(new oral anticoagulants,NOACs)专项处方点评在医保管理的干预效果。方法:临床药师根据处方点评管理规范对NOACs的处方适宜性进行点评,并制定NOACs处方专项点评制度和细则来实施点评,医保部门将点评结果反馈给处方医师。结果:2018年10月至2019年7月共点评了200份NOACs处方,不合格处方占51.5%,其中不适宜处方占7.5%,均为无适应证用药,不符合医保报销范畴处方占44%。经过临床药师的点评和医保部门的反馈沟通,同比2018年8月,2019年7月的达比加群酯和利伐沙班医保用量分别降低了28.3%和2.5%,且每月达比加群酯用量逐渐下降,利伐沙班每月用量基本保持平衡。结论:临床药师通过NOACs专项处方点评工作,不仅规范了医师的处方行为,也协助医保部门减轻了总额控制条件下的NOACs支付压力,体现了药师在医院药学中的专业价值。

Objective:To evaluate the intervention effect of special prescription comments on new oral anticoagulants(NOACs)in medical insurance management.Methods:Clinical pharmacists evaluated the rationality of NOACs prescriptions according to the management norms of prescription review,implemented special prescription comments and detailed rules for prescription of NOACs.The medical insurance department fed back the results to prescribers.Results:During the period from October 2018 to July 2019,a total of 200 prescriptions of NOACs were reviewed,of which 51.5%were unqualified,7.5%were without anticoagulation indications,and 44%were not eligible for medical insurance reimbursement.Through the prescription comments of clinical pharmacists and the feedback and communication of medical insurance department,the total amounts of dabigatran and rivaroxaban decreased by 28.3%and 2.5%,respectively in July 2019 compared with those in August 2018.The total amounts of dabigatran gradually decreased monthly,while those of rivaroxaban remained steady monthly.Conclusion:Through the special prescription comment of NOACs,clinical pharmacists not only regulate the prescribing behavior of doctors,but also help the medical insurance department to reduce the medicare payment pressure of NOACs under the condition of total insurance coverage control,showing their professional value in hospital pharmacy.