摘要
2022年6月,国家医疗保障局在《非独家药品竞价规则》中提出,非独家药品若通过竞价成功纳入药品目录,则按规则确定该通用名药品的医保支付标准。价格低于支付标准的药品以实际价格为基础支付;价格高于支付标准的药品,高出部分由参保人承担。这一医保支付标准制定方法将定价与补偿相结合,在2022年国家医保目录调整工作过程中取得了一定成效,对我国医药市场将产生深远的影响。德国是最早建立参考定价制度的国家,其经验值得借鉴。本文旨在总结德国参考价格体系的设计和实施经验,为完善我国相关政策提出建议。
Abstract
In June 2022, China’s National Healthcare Security Administration proposed in the Non-exclusive Drug Bidding Rules that if non-exclusive drugs were successfully included in the drug catalogue through bidding, the medical insurance payment standard for the generic name drug would be set according to the rules. Drugs with prices lower than the payment standard shall be reimbursed based on the actual price while drugs with prices higher than the payment standard, the part exceeding the standard would be paid out of pocket. This method for formulating medical insurance payment standard integrates pricing and payment, with initial practice in the 2022 adjustment of national medical insurance catalogue and far-reaching impact on China's pharmaceutical market. Internationally, Germany was the first country to establish the fixed reference price (FRP) system and may provide key learning for others. This article summarizes the design and implementation experience of the FRP system in Germany, and provides suggestions for improving relevant policies in China.
关键词
国家医保目录调整 /
非独家药品竞价 /
医保支付标准 /
德国 /
参考定价制度
Key words
adjustment of national medical insurance catalogue /
non-exclusive drug bidding /
medical insurance payment standard /
Germany /
fixed price system
李孜, 刘宇刚, 陈偲演, 彭珊.
德国参考定价制度对我国非独家药品医保支付标准的启示[J]. 中国医疗保险. 2023, 0(3): 48-52 https://doi.org/10.19546/j.issn.1674-3830.2023.3.007
Enlightenment of the Fixed Reference Price System in Germany on the Medical Insurance Payment Standard for Non-exclusive Drugs in China[J]. China Health Insurance. 2023, 0(3): 48-52 https://doi.org/10.19546/j.issn.1674-3830.2023.3.007
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参考文献
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