澳大利亚高值药物医保准入机制简介及对我国罕用药医保准入的启示
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篇名: 澳大利亚高值药物医保准入机制简介及对我国罕用药医保准入的启示
TITLE:
摘要: 目的:介绍澳大利亚高值药物医保准入机制,为我国罕用药医保准入的完善提供建议。方法:运用文献研究和政策分析法,对澳大利亚高值药物医保准入的遴选原则、风险共担机制、限制使用原则进行概述分析,并对高值药物医保准入机制实施效果进行评价。结果与结论:澳大利亚药物福利计划对高值药物的纳入不仅考虑成本效益比,同时关注药物的临床疗效、不可替代性及药物的社会性原则,通过风险共担机制和限制使用原则在保障患者用药可及性的同时维持医保基金的可持续,在保障患者用药、加强基本医疗保障福利方面取得显著成效。建议完善我国罕用药医保遴选标准,引入风险共担机制及规范罕用药的使用和报销。
ABSTRACT: OBJECTIVE: To introduce high-value drug insurance access mechanism in Australia, and to provide suggestion for improving orphan drug medical insurance access in China. METHODS: By literature study and policy analysis, access principle, risk-sharing mechanism and restricted use principle of high-value drug insurance access in Australia were summarized and analyzed, so as to evaluate the effects of high-value drug insurance access mechanism. RESULTS & CONCLUSIONS: The inclusion of high-value drug in Australian National Formulary considers not only the cost-effectiveness ratio, but also the drug’s clinical efficacy, irreplaceability and the social principles; risk-sharing mechanism and restricted use principle achieve a good balance between the accessibility of patient’s medication and the sustainability of health insurance fund; remarkable results are achieved in guaranteeing patient’s medication and strengthening basic medical insurance. It is recommended to perfect orphan drugs medical insurance access standard, introduce risk-sharing mechanism and standardize the use of orphan drugs and reimbursement in China.
期刊: 2017年第28卷第4期
作者: 任昉,颜建周,邵蓉
AUTHORS: REN Fang,YAN Jianzhou,SHAO Rong
关键字: 澳大利亚;高值药物;医保准入机制;罕用药;启示
KEYWORDS: Australia; High-value drug; Insurance access mechanism; Orphan drug; Enlightenment
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