国家医疗保险准入谈判政策对抗癌新药使用的影响

Influence of National Medical Insurance Admittance Negotiated Policy on the Utilization of Innovative Anticancer Drugs

目的评价国家医疗保险(医保)准入谈判政策实施对南京地区抗癌新药药物利用及医保支付费用的影响。方法基于南京地区2016—2019年药品采购数据,计算药物利用频度(DDDs)、用药金额、限定日费用、排序比、医保支付金额,对比分析纳入医保前后药物利用及医保基金支出情况。结果纳入医保后,国家医保准入谈判的抗癌新药DDDs与用药金额显著增加,纳入医保之后B/A总体上升,药物同步性转好,但部分药品出现用药金额与DDDs分离现象,国家医保准入谈判的抗癌新药占全部抗癌药物医保支付金额比例较高,但其占全部药物医保支付金额的比例较低。结论医保准入谈判覆盖政策有效地推动了抗癌新药使用,提高了抗癌新药的可及性,同时并未对医保基金支付产生较大的影响。

Objective To evaluate the effect of the implementation of national medical insurance admittance negotiation policy on the utilization of innovative anticancer drugs and the medical insurance payment in Nanjing city.Methods Based on the purchase data by medical insurance in Nanjing city from 2016 to 2019.To compared and analyzed the drug utilization and expenditure of medical insurance fund by calculating the frequency of drug utilization,consumption amount,defined daily dose consumption,ranking ratio and amount of medical insurance payment.Results After being included in the medical insurance,the innovative anticancer drug DDDs and the consumption amount increased significantly,the overall B/A increased,and the synchronization of drugs were becoming better.However,the consumption amount was separated from DDDs for some drugs.Innovative anticancer drugs in the medical insurance account for a higher proportion of the total amount of anticancer drugs paid,but their proportion in the total drugs amount of medical insurance payment was low.Conclusion National medical negotiation and medical reimbursement effectively promote the utilization and availability of innovative anticancer drugs and it didn’t have a great impact on the medical insurance fund.