浅析超说明书用药医疗保险支付的实施路径

A Preliminary Analysis of the Implementation Path of Reimbursement for Off-Label Drug Use

超说明书用药是患者获得救治的重要途径。目前,《社会保险法》未对超说明书用药的报销进行明确规定,医疗保险经办机构倾向拒绝支付,这可能导致患者用药负担加重而无法接受及时有效的治疗。本文通过梳理我国超说明书用药医疗保险支付立法及实践状况,分析将超说明书用药纳入医疗保险支付范畴存在的挑战及其原因,并提出在立法层面明确将超说明书用药纳入医疗保险支付范畴,以及通过优化医疗保险制度相关内容规范超说明书用药等方面的思考,以期确保医疗保险基金的有效支付。

Off-label drug use is an important way for patients to obtain treatment.However,the current Social Insurance Law does not clearly stipulate the reimbursement of off-label drug use,and medical insurance administrations decline to cover such expenses.This situation may increase patients’financial burden and hinder their ability to receive timely and effective treatment.This paper analyzes the challenges and un-derlying reasons for including off-label drug use within the scope of medical insurance coverage,and proposes measures to explicitly incorporate off-label drug use into the reimbursement framework at the legislative level.It also suggests optimizing relevant aspects of the medical insurance system to ensure effective utilization of medical insurance fund.