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医保谈判药品目录是怎么产生的

2017-08-08 15:08:29   中国青年网

药品目录

药品目录

人力资源和社会保障部日前发布通知,将36种谈判药品纳入了《国家基本医疗保险、工伤保险和生育保险药品目录(2017年版)》乙类范围,并同步确定了这些药品的医保支付标准,这36种药品的价格平均降低44%。

创新药物疗效显著,对于治愈或改善疾病症状、提升患者生活质量都有着不可替代作用。另一方面,由于专利排他性保护,创新药物通常具有市场垄断、单一货源渠道等属性,在市场资源无法有效配置的前提下,其价格居高不下,药品可支付性差,无法满足广大参保人用药需求。因此,由国家出面与药品生产企业进行谈判,以进入医保为条件,换取药品的大幅度降价,最终受益的将是广大参保人员。

谈判药品降价

最高达到70%

人社部社保中心副主任徐延君介绍,此次参与谈判的共有44个药品,其中谈判成功的36个,成功率达到81.8%,谈判成功的药品统一纳入药品目录乙类范围。谈判确定的支付标准与2016年平均零售价相比,平均降幅达到44%,降幅最高的达到70%,明显减轻了参保人员药费负担,同时也有效控制了医保基金支出。

此次谈判成功的36个药品中包括了31个西药和5个中成药,31个西药中有15个是肿瘤治疗药,涉及肺癌、胃癌、乳腺癌、结直肠癌、淋巴瘤、骨髓瘤等常见癌种,包括了此前参保人员反映比较多的曲妥珠单抗、利妥昔单抗、硼替佐米、来那度胺等;还有5个是心血管病用药,如治疗急性冠脉综合症的替格瑞洛、治疗急性心梗的重组人尿激酶原等;其他的药品分别是肾病、眼科、精神病、抗感染、糖尿病以及罕见病用药。5个中药中3个是肿瘤药,还有2个是心脑血管用药。

本次谈判对创新药和罕见病药给予了高度重视,列入“十二五”以来国家重大新药创制专项的西达本胺、康柏西普、阿帕替尼等全部谈判成功,治疗血友病的重组人凝血因子Ⅶa和治疗多发性硬化症的重组人干扰素β-1b也都成功纳入药品目录。通过谈判将社会反映比较强烈的肿瘤靶向药等重大疾病治疗用药纳入药品目录,大大提高了基本医疗保险的保障水平,同时也兼顾了基金负担能力,并有利于引导合理医疗行为、促进医药产业发展创新,基本实现了医保、企业、参保人“三赢”的目标。

高出预期15%

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