普惠险特药目录的制定与管理经验研究

Research on the Design and Management Experience of Special Drug Catalog in Inclusive Health Insurance

普惠险特药目录的制定可根据政府参与程度,分为纯商业运作、政府指导下的商业运作、纯政府承办三种类型。特药遴选应遵循临床价值、药物经济学价值、基金可承担以及城市定制性等原则,并根据投保情况、基金运行情况、与医保目录的紧密性等因素,不断调整普惠险特药目录。整体而言,为促进普惠险特药保障责任,在平衡产品保障效率与可持续性的同时,多方利益主体应加强药品、保险产品以及信息技术等方面的交流与合作。

According to the degree of government participation,the design of the special drug catalog in inclusive health insurance can be divided into three types:commercial operation,commercial operation under the guidance of the government,and government operation.The selection of special drugs should follow the principles of clinical value,economic value,insurance funds affordability,and city-oriented customization.In addition,this catalog should be constantly adjusted according to insurance coverage,fund operation,and closeness to the medical insurance catalog.As a whole,in order to improve the security of special drugs in inclusive health insurance,it is important to bal-ance the efficiency and sustainability of security.In addition,stakeholders should strengthen the exchange and cooperation between medicines,insurance products,and information technology.