德国创新药品医保准入机制

Innovative Medical Insurance Access Mechanism for Pharmaceuticals in Germany

德国通过一系列政策规范了创新药品医保准入流程,在提升患者创新药品的可及性的同时,也降低了医保基金的支付压力,在这一过程中有诸多值得我国学习的地方。而我国创新药品准入机制一直处于探索发展阶段,基于创新药品医保准入的全流程,总结了德国的医保准入机制,包括监管的组织架构、医保准入及支付流程、新增适应症的价格调整机制等,同时结合我国创新药品准入现状,建议我国可引入创新药品谈判仲裁机制、支付模式过渡机制、新增适应症量价加权平均算法机制,为我国现行创新药品准入与支付制度提供国际实践借鉴经验。

Germany has standardized the access process of innovative drugs to medical insurance through a series of policies,which not only improves the accessibility of innovative drugs for patients,but also reduces the payment pressure of medical insurance funds.There are many aspects worth learning from in this process for China.The access mechanism for innovative drugs in China has always been in the exploration and development stage.Based on the entire process of medical insurance access for innovative drugs,it summarizes its medical insurance access mechanism in Germany,including regulatory organizational structure,medical insurance ac-cess and payment process,and price adjustment mechanism for new indications.At the same time,considering the national conditions of innovative drug access in China,it is recommended that China introduce innovative drug negotiation and arbitration mechanism,payment mode transition mechanism,add a weighted average algorithm mechanism for indication prices to provide international practi-cal experience for China’s current innovative drug access and payment system.