创新药品的医保准入策略

Medical Insurance Access Strategies of Innovative Drug

随着国家医保谈判的常态化进行,我国创新药品的医保准入工作已经取得了显著效果。然而,由于起步较晚、发展时间短,创新药品医保准入策略和价值评估机制仍需进一步完善。本研究从创新药品医保准入的不同阶段(形式审查、综合组评审、价格测算、简易续约)进行了系统的分析和思考。为进一步完善医保准入策略,可采取以下措施:需进一步理清不同阶段的价值维度考量,完善药品全面价值评估体系;医保准入中兼顾一般性公平和罕见病、终末期疾病的特殊性公平,以更好地促进医保准入的公平和效率;同时建立多方沟通机制,包括与医药企业和药监部门的沟通,加强对重大创新药品,尤其是国内创新药品的制度性支持;启动国谈创新药品再评估机制,设置价格综合降幅天花板,完善创新药品价值定价的保障机制。

With the normalization of national medical insurance negotiations,the access to medical insurance for innovative drugs in China has achieved remarkable results.However,due to a late start and a short development period,the innovative medicine medical insurance access strategy and value assessment mechanism still need further improvement.This study provides a systematic analysis and reflection on the different stages of innovative drugs'access to medical insurance(formal review,comprehensive review,price calculation,and simple renewal).To further improve the strategy for medical insurance access,it is necessary to further clarify the value dimensions in different stages and improve the comprehensive evaluation system for pharmaceutical value.Secondly,both the general fairness and the specific fairness of rare and terminal diseases should be taken into consideration in medical insurance access,so as to better promote the fairness and efficiency of medical insurance access.At the same time,establish a multi-party communication mechanism,including communication with pharmaceutical enterprises and drug supervision departments,and strengthen institutional support for major innovative drugs,especially domestic innovation.Finally,it is important to launch the National Innovative Drug Revaluation Mechanism,set up a comprehensive ceiling for price reduction and improve the mechanismto guarantee thevalue of innovative drugs.