历年国家医保谈判药品概况与分析——抗肿瘤药品专题

Overview and Analysis on the National Medical Insurance Negotiation Drugs over the Years: Taking Anti-cancer Drugs as an Example

目的以抗肿瘤药品为重点,分析自2015年起国家医保谈判药品变化与发展情况。方法系统检索2015年—2020年每年国家医疗保障局等官方发布的国家医保谈判药品相关政策文件,检索时限截至2021年2月5日。重点对比历年《国家基本医疗保险、工伤保险和生育保险药品目录》中国家医保谈判药品中抗肿瘤药品数量、分类、适应症分布、医保支付限定条件及医保支付标准等变化情况。结果 (1)迄今纳入国家医保谈判药品目录的抗肿瘤药品共63个,其中西药57个、中成药6个,覆盖乳腺癌、肺癌、结直肠癌、胃癌及肝癌等多个癌种。(2)有10个药品陆续纳入常规医疗保险目录。(3)国家医保谈判药品价格平均降幅达44%及以上。(4) 2019年、2020年国家医保局对国家医保谈判药品中协议即将到期的25个抗肿瘤西药进行了续约谈判,23个药品续约成功,其中7个药品扩大了支付限定条件范围;2个药品续约失败,其中1个于2020年纳入常规医保目录。结论医保支付标准总体呈降低趋势,为国家医保资金结余、降低患者就医负担创造了有利条件。同时,国家医保谈判药品中抗肿瘤药品逐年丰富,肿瘤患者药物治疗保障水平逐步提升。国家医保谈判工作趋于常态化,药品支付标准、限定条件及报销时限等规定逐步明确;药物经济学理论与实践在国家谈判策略制定中发挥了重要作用。

Objective To analyze the changes and development of Chinese national medical insurance negotiation drugs especially for anticancer drugs since 2015. Methods All the official documents related to the Chinese national medical insurance negotiation drugs issued by the National Healthcare Security Administration and other authorities from 2015 to 2020 were searched systematically with a cut-off date of February 5th, 2021. Changes over the years were compared in quantity, classification, indication distribution, payment limitation and payment standard of anti-cancer drugs in the Medicine Catalogue for National Basic Medical Insurance, Work-Related Injury Insurance and Maternity Insurance. Results(1)A total of 63 anti-cancer drugs have been included in Chinese national medical insurance negotiation drug list over the years, including 57 Western drugs and 6 proprietary Chinese drugs, covering breast cancer, lung cancer, colorectal cancer, stomach cancer, liver cancer and so on.(2) Among these drugs, ten have been moved into the routine medical insurance list successively.(3) The average price reduction of these negotiated drugs was 44% or more in recent years.(4) From 2019 to 2020, the National Medical Insurance Administration conducted contract renewal negotiations for 25 Western anti-cancer drugs whose agreements were about to expire. Of them, 23 were renewed successfully, and 7 out of the 23 had their scopes of payment limitation expanded after renewal negotiation. Two anti-cancer drugs failed to re-enroll in the list, but one of the two has been moved into the routine medical insurance list in 2020. Conclusion There is a general decreasing trend of medical insurance payment standard, and it has created favorable conditions for the national medical insurance fund balance and reduction of patients’ medical burden in China. Anti-tumor drugs are increased year by year in the national medical insurance negotiation drug list, and the level of drug treatment guarantee for cancer patients is gradually improved. The national medical insurance drug negotiation has become a routine work, and the payment standard, limiting conditions and reimbursement time limit of drugs are gradually clarified. The theory and practice of pharmacoeconomics plays an important role in the formulation of national negotiation strategies.