日本“价格带”汇总的医保支付标准调整方式及启示

“Price Ranges” Adjustment of Medical Insurance Payment Standard in Japan and the Enlightenment for China

目的:通过分析日本“价格带”汇总的医保支付标准的调整机制,探讨我国同通用名下医保支付标准的形成路径。方法:检索日本政府历年发布的医保支付标准调整政策及相关文献,梳理总结日本对于医保支付标准调整方式的变迁、现行调整方法及政策效果。同时分析我国的药品医保支付标准制定所处环境和面临问题。结果:我国情况与日本类似,同样面临着仿制药支付标准过度细分的问题,而日本通过引入“价格带”汇总机制,将同品规下仿制药支付标准集中控制在3个以内,并结合替代率、上市时间对长期上市原研药的支付标准逐年下调,实现了从“按厂牌”到“按区间”再到“按通用名”制定药品支付标准的转变,解决了药品支付标准过度细分的问题。结论:我国可以借鉴日本对于药品支付标准调整的经验,针对不同药品应结合分类管理思想,差别选择整合策略,总体上以“三阶段、两路径”循序整合药品支付标准,逐步实现“医保药品支付标准按通用名制定”的改革目标。

Objective: The paper introduces the adjustment mechanism of the Japanese “price ranges”medical insurance payment standard, and discusses the formation path of the medical insurance payment standard by generic name in China. Methods: Using drug price policies issued by government of Japan and related literature,the paper summarizes the changes, current adjustment methods and policy effects of Japan’s adjustment of medical insurance payment standards, and analyzes the environment and problems faced by China’s medical insurance payment standard of drugs. Results: China is similar to Japan, facing the problem of excessive subdivision of generic drug medical insurance payment standards. By introducing the "price ranges" aggregation mechanism,Japan has limited the medical insurance payment standards for generic drugs under the same product regulations to 3. Combined with the replacement rate and time to market, the payment standards for long-term marketed original drugs have been lowered year by year, realizing the transformation from "by brand" "by ranges" to "by generic name" and solving the problem of excessive subdivision of drug payment standards. Conclusion: China can learn from Japan’s experience in adjusting drug payment standards. For different drugs, we should combine the idea of classified management, choose the integration strategy differently, and generally integrate the drug payment standards in a sequential manner with " three stages, two paths", and gradually achieve the reform goal of " medical insurance payment standard by generic name ".