多适应证药物医保准入和定价策略境外经验及启示

Multi-indication Drug Medical Insurance Access and Pricing Strategy Study

文章对境外国家或地区多适应证药物在医保准入和定价策略进行综述,为我国多适应证药物医保准入路径模式、医保支付标准测算方法提出建议。从境外经验来看,医保准入模式包括所有适应证同时准入、单个适应证序贯准入。医保评估模式包括准入前评估、准入后评估。医保定价方法包括签订价格协议、基于每种适应证的价值制定的加权平均价格、基于首个适应证制定初始价格,后续根据预算影响调整价格等。我国应基于目前的医保准入体系,进一步探索和细化多适应证药物的医保准入路径和相应的医保支付标准测算方法,促进医保精细化管理。

The strategies of foreign countries or regions for the access and pricing of multi-indication drugs are reviewed to put forward suggestions for the path model of medical insurance access and the calculation method of medical insurance payment standards for multi-indication drugs in China.From overseas experiences,the medical insurance access model includes simultaneous access for all indications and sequential access for a single indication.The medical insurance evaluation model includes pre-admission evaluation and post-admission evaluation.The medical insurance pricing method includes signing a price agreement,setting a weighted average price based on the value of each indication,setting an initial price based on the first indication,and adjusting the price based on budgetary influences.Based on the current medical insurance access system,it needed to further explore and refine the medical insurance access path of multi-indication drugs and the corresponding calculation methods of medical insurance payment standards to promote the refined management of medical insurance.