CAR-T细胞治疗产品医保支付政策研究——基于美国Medicare的实证分析

Research on the medical insurance payment policy of CAR-T cell therapy products: based on the empirical study of Medicare in the US

嵌合抗原受体T细胞(CAR-T)疗法作为一种新型的肿瘤免疫疗法,在血液肿瘤治疗领域具有突破性的疗效,但是CAR-T细胞治疗产品价格高昂。为减轻患者的医药费用,部分发达国家已将CAR-T细胞治疗产品纳入医保支付。本文基于美国Medicare Part A和Part B,对CAR-T细胞治疗产品的医保支付政策进行实证分析,以期为我国未来CAR-T产品的医保支付提供借鉴,提出未来可探索“产品准入+DRG/DIP医保打包支付”相结合的方式,以及为高值创新药物建立疾病诊断相关分组(DRG)临时分组、临时补偿机制等。

As a new type of tumor immunotherapy, chimeric antigen receptor T cell(CAR-T) has become a breakthrough therapy in the field of hematoma therapy;however, the cost of CAR-T cell therapy products is extremely high. Some developed countries have included CAR-T cell therapy products into medical insurance payment in order to reduce the medical expenses of patients. This article systematically discusses the medical insurance payment policy of CAR-T cell therapy products based on the empirical research of Medicare Part A and Part B in the US, so as to provide a reference for the medical insurance payment of CAR-T products in China in the future. We propose an exploration of the combination of “product access+DRG/DIP medical insurance package payment” and establish DRG temporary grouping and temporary compensation mechanisms for high-value innovative drugs.