多适应症药物上市数量快速增长,设计适合其特征的准入评估方法,是国家医保目录调整面临的新挑战。本文认为,多适应症药物按通用名管理仍是现阶段我国医保管理的主流模式,并构建“简易调算法为主、完整精算法为辅”的方法体系。当多适应症药物适应症呈现“一大多小”特征时,适用简易调算法,即“一个参照药物、一次测算、按人群用量调整”,其操作简明,可有效控制基金支出,契合我国现行医保管理架构。当多适应症药物各适应症人群大体相当时,可适用完整精算法,即“多个参照药物、多次测算、加权平均”,以充分体现价值导向。

With the rapid growth of multi-indication drugs on the market, designing access assessment methods for multi-indication drugs is a new challenge for the adjustment of the National Catalog of Drugs Covered by Basic Medical Insurance. This paper believes that the management of multi-indication drug by generic name is still the mainstream mode of medical insurance management in China at present. The assessment method system of “simple adjustment calculation method” as the main and “complete actuarial method” as the supplement should be built. When the indications of drug meet the standard of "one indication with large population and multiple indications with small population", simple adjustment calculation method is applied. The simple adjustment calculation method means "one reference drug, one measurement, and adjustment by population", which can control the fund expenditure effectively and fit into the current medical insurance management structure. When the indications of drugs are roughly equal in population, the complete actuarial method is applied. The complete actuarial method means "multiple reference drugs, multiple measurements, weighted average", fully reflecting the value orientation.