创新与可及性的平衡：中国创新药医保谈判定价机制理论分析与思考

赵明月; 赵昱涵; 方宇

doi:10.19546/j.issn.1674-3830.2025.12.002

中国医疗保险 ›› 2025, Vol. 0 ›› Issue (12) : 11-18. DOI: 10.19546/j.issn.1674-3830.2025.12.002

赵明月^1,2, 赵昱涵^1,2, 方宇^1,2

作者信息 +

Balancing Innovation and Accessibility: Theoretical Analysis and Reflections on Pricing Mechanism for Innovative Drugs in China’s National Healthcare Security Negotiations

Author information +

文章历史 +

摘要

在医保战略性购买背景下,创新药价格形成机制是平衡创新激励与患者可及的关键。本文基于创新药市场的经济学特性及失灵表现,系统梳理了成本加成定价、价值定价、国际参考定价与谈判定价四种主流定价模式。聚焦我国国家药品谈判政策,探讨了基于价值评估与预算约束的“信封价”形成路径,并以博弈模型阐释企业与医保的策略互动与均衡过程。研究发现,国谈机制在缓解信息不对称与提高支付效率方面具有积极作用,但仍面临价值评估体系不完善、价格与支付保障脱节、创新激励链条不完整等问题。据此,本文提出完善多维价值评估标准、优化价格—支付衔接机制与强化全链条创新激励体系的政策建议,以期为我国创新药价格机制的完善提供理论依据与实践启示。

Abstract

Under the background of strategic purchasing in medical insurance, the price formation mechanism of innovative drug is crucial to balancing innovation incentives and patient accessibility. Based on the economic characteristics and manifestations of market failures in the innovative drug market, this paper systematically reviews four mainstream pricing models—cost-plus pricing, value-based pricing, international reference pricing, and price negotiation. Focusing on National Drug Price Negotiation (NDPN) policy, it explores the formation path of the "envelope price" driven by value assessment and budget constraints, and employs a game-theoretical model to explain the strategic interaction and equilibrium between enterprises and the National Healthcare Security Administration. The study finds that the NDPN mechanism plays a positive role in mitigating information asymmetry and improving payment efficiency, yet challenges remain in the areas of value assessment, a disconnect between pricing and payment safeguards, and innovation incentive mechanisms. Accordingly, this paper proposes policy recommendations to improve multi-dimensional value assessment standards, optimize the linkage between pricing and payment, and strengthen the full-chain innovation incentive system, providing theoretical and practical insights for refining China’s innovative drug pricing mechanism.

导出引用

赵明月, 赵昱涵, 方宇. 创新与可及性的平衡：中国创新药医保谈判定价机制理论分析与思考[J]. 中国医疗保险. 2025, 0(12): 11-18 https://doi.org/10.19546/j.issn.1674-3830.2025.12.002

Balancing Innovation and Accessibility: Theoretical Analysis and Reflections on Pricing Mechanism for Innovative Drugs in China’s National Healthcare Security Negotiations[J]. China Health Insurance. 2025, 0(12): 11-18 https://doi.org/10.19546/j.issn.1674-3830.2025.12.002

中图分类号： F840.684 C913.7

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