美国医保药品目录管理模式分析及借鉴

Analysis and Insight of US Insurance Drug Formulary System

国家医疗保障局自成立以来,注重医疗保障制度建设及长远布局,全民医保体系下的创新药品谈判制度在增加创新药物可及性的同时实现了药价的合理管控。为进一步提高我国医保药品目录精细化管理水平,完善以循证证据为决策的药品目录动态调整机制,本研究对美国医疗保险及医保药品目录管理模式进行了深入解读及整理,阐述了美国各类医疗保险药品目录管理的共性模式以及医疗照顾计划(Medicare)、医疗援助计划(Medicaid)和商业医疗保险的药品目录管理实例,通过分析美国药品目录管理方式的利弊,在我国制度优势的基础上,提出完善我国药品目录管理可借鉴的经验及应避免的错误。

Since its establishment,the National Healthcare Security Administration has been focusing on the construction of the efficient medical insurance system with a long term viability.The drug negotiation system under the universal health care system in China has achieved reasonable control of drug prices while increased the access of innovative drugs to the broad insured population in China.For the purpose of further implement a more refined national reimbursement drug list(NRDL)management system and to construct an evidence-based dynamic formulary adjustment mechanism in China.This study conducted in-depth analysis of current US insurance formulary system and generate insight to support further policy modification.By examining the current formulary practice of Medicare,Medicaid and commercial medical insurance,analyzing its pros and cons,we can learn the lesson,avoid the mistakes,and build a better NRDL management mechanism based on the political and social system advantages of China.