在创新药新上市即将面临医保国谈的背景下,哪些因素可能影响创新药的价格形成和医保准入,成为决策者和社会各界广泛关注的问题。本研究从创新药价格形成的经济学原理、医保谈判的中国实践、医保准入的不同模式、现有研究的主要发现四个方面进行分析。研究发现,从微观上,价值和成本是创新药价格的上下限,临床价值是最重要的价值维度,需要持续评估。从宏观上,国家经济发展水平对支付方和供给侧都会带来复杂和深远的影响。医保基于“战略购买”思路,需要遴选“性价比”更高的药品,药物经济学评价是必要的工具之一,其有助于降低决策风险,促进“有效市场”和“有为政府”更好发挥作用。
Abstract
In the context of the national medical insurance negotiations for the new innovative drugs, what may affect the price formation and medical insurance access of innovative drugs has become a widely concerned issue for decision-makers and various sector. This study analyzes from aspects of the economic principles in the formation of innovative drug prices, the practice of medical insurance negotiations in China, different models of medical insurance access, and the main findings of studies. Research has found that at the micro level, value and cost are the upper and lower limits of innovative drug prices, and clinical value is the most important value dimension that requires continuous evaluation. From a macro perspective, the level of national economic development will have complex and far-reaching impacts on both the payer and the supply side. Based on the "strategic purchasing" approach, medical insurance needs to select drugs with higher cost-effectiveness. Pharmacoeconomic evaluation is one of the necessary tools, which helps to reduce decision-making risks and promote the better performance of "effective markets" and "promising governments".
关键词
创新药 /
价格形成机制 /
医保谈判准入
Key words
innovative drugs /
price formation mechanism /
medical insurance access with negotiation
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基金
国家自然科学基金青年项目“药物经济学评价模型的参数体系构建与本土化研究：以晚期肺癌模型为例”（72104151）
