国外新药医疗保险准入机制研究与启示

Research and enlightenment of new drug medical insurance access mechanism in developed countries

目的:选取国外医疗保障体系健全的发达国家,研究其新药医保准入机制,为国内医保新药准入机制提供参考。方法:主要采用专家访谈法总结提炼国外先进经验与机制。结果:英国、德国和日本的新药医保准入机制各具特点,均形成了高效、经济的准入机制。结论:国内可以从4方面完善新药准入机制:建立多方参与的新药医保准入机制;建立基于技术评审的价格谈判和支付标准动态调整机制;建立公开透明的准入规则和客观的评价标准;参考药物经济学评估综合评定新药价值。

Objective:To select developed countries with a sound medical security system to study their new drug medical insurance access mechanism and provide a reference for the domestic medical insurance new drug access mechanism.Methods:Mainly use expert interview method to summarize and refine foreign advanced experience and mechanism.Results:The new medicine and medical insurance access mechanisms of the United Kingdom,Germany and Japan have their own characteristics,and they all have formed an efficient and economical access mechanism.Conclusion:The new drug access mechanism can be improved in China from four aspects:establish a multi-party new drug medical insurance access mechanism;establish a price negotiation and payment standard dynamic adjustment mechanism based on technical reviews;establish open and transparent access rules and objective evaluation standards;Comprehensively evaluate the value of new drugs with reference to pharmacoeconomic evaluation.