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.
Key words
innovative drug /
price formation mechanism /
medical insurance negotiated drug /
strategic purchase of medical insurance /
value-based pricing
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
[1] 孙利华,李世琪,范嘉宁.创新药阈值及其医保支付模式探讨[J].中国医疗保险,2022(08):53-55.
[2] 杨树俊,俞颖慧,周斌.Hub-and-Spoke模式作为生物医药初创企业组建模式研究及启示[J].中国新药杂志,2023,32(5):455-461.
[3] DANZON P, TOWSE A, MESTRE-FERRANDIZ J.Value-based differential pricing: efficient prices for drugs in a global context[J]. Health economics, 2015, 24(3): 294-301.
[4] KYLE M K.Lessons for the United States from pharmaceutical regulation abroad[J]. Journal of economic perspectives, 2025, 39(2): 53-78.
[5] CARLSON J J, CHEN S X, GARRISON L P Jr. Performance-based risk-sharing arrangements: an updated international review[J]. PharmacoEconomics, 2017, 35(10): 1063-1072.
[6] Avalere Health. 58% of payers use outcomes-based contracts[EB/OL]. (2023-04-05)[2025-11-20]. https://advisory.avalerehealth.com/insights/58-of-payers-use-outcomes-based-contracts.
[7] PIATKIEWICZ T J, TRAULSEN J M, HOLM-LARSEN T.Risk-sharing agreements in the EU: a systematic review of major trends[J]. PharmacoEconomics-open, 2018, 2(2): 109-123.
[8] HELMOLD M.Performance excellence in marketing, sales and pricing[M]. Bayonne: Springer, 2022.
[9] COMANOR W S, SCHWEITZER S O, RIDDLE J M, et al.Value based pricing of pharmaceuticals in the US and UK: does centralized cost effectiveness analysis matter?[J]. Review of industrial organization, 2018, 52: 589-602.
[10] DOGANOVA L, RABEHARISOA V.The temporalities of prices: ‘Value-based pricing’ in pharmaceutical markets[J]. Economy and society, 2024, 53(2): 183-204.
[11] GONÇALVES E. Value-based pricing for advanced therapy medicinal products: emerging affordability solutions[J]. The European journal of health economics, 2022, 23(2): 155-163.
[12] 孙鑫,谭婧,唐立,等.重新认识真实世界研究[J].中国循证医学杂志,2017,17(2):126-130.
[13] HOUY N, JELOVAC I.Drug launch timing and international reference pricing[J]. Health economics, 2015, 24(8): 978-989.
[14] GROSSMAN G M, LAI E L-C. Parallel imports and price controls[J]. The RAND journal of economics, 2008, 39(2): 378-402.
[15] GARTHWAITE C.Economic markets and pharmaceutical innovation[J]. The journal of economic perspectives, 2025, 39(2): 3-26.
[16] 医药魔方. 2026上海生物医药合作大会|中国创新药BD交易占全球38%:全球生物医药格局重塑中美角色[EB/OL].(2025-10-29)[2025-11-20].https://www.cbpfcn.com/news/7160.
[17] 中国人寿再保险有限责任公司,上海镁信健康科技集团股份有限公司,波士顿咨询公司.中国创新药械多元支付白皮书(2025)[R/OL].(2025-02-27)[2025-11-20].https://www.cramc.cn/zhzjt/attachDir/2025/03/2025030308451097926.pdf.
