药品流通的特殊性及药品价格虚高的成因探讨

本文针对药品流通中价格虚高的问题，从药品的特殊性和药品流通中的政策缺陷、寻租、政府规制失效等造成药品流通中的机会主义行为和虚假差异化竞争，造成了政府规制俘获，使药品价格虚高。论文系统论述了药品价格虚高的成因，并提出了解决问题的途径。     

药品价格虚高成因剖析与对策

药品“价格虚高” ,系指药品定价远高于其实际成本加合理的利润。药品价格虚高由来已久 ,已引起政府有关部门的高度重视 ,并采取了一些抑制措施。然而 ,药品价格虚高问题至今尚未从根本上得到治理。笔者认为 ,仍有必要对药品价格虚高的成因作进一步剖析 ,以便采取应对措施。一、药品价格虚高成因剖析(一 )药品生产成本测算难度大药品生产专业性强 ,技术含量较高 ,原料构成复杂 ,且品种繁多 ,这就为相关企业虚高定价提供了极为有利的机会。而药品的主管部门 ,尤其物价管理部门又难以对其成本构成作出准确核定 ,受专业知识、审查的社会成本以…     

药品价格虚高分析及对策

文章简要介绍药品价格虚高的现状、药品定价政策的演变及企业自主定价的基本方式，分析药品价格虚高的成因，介绍国外药品定价模式，对遏制药品价格虚高提出相应对策。     

药价虚高的成因及对策

目的探讨药价虚高的成因及对策。方法剖析我国政府的治理药价虚高措施失灵的原因、药品价格虚高成因并提出对策。结果药品价格虚定、医疗机构的垄断、流通环节多、药品的特殊性共同促成药价虚高。结论通过完善药品价格管理,规范药品流通环节、修改“新药”规定,严格药品审批来根治药价虚高。     

刍议第三部门参与药品价格虚高的治理

药品价格虚高已成为严重的社会问题,攀升不止的药价直接导致药品的可及性、可得性较差,损害了人类最基本的生存权和健康权。扭曲的药品价格形成机制是药品价格虚高的根源,而药品价格形成机制的源头——政府药品价格监管制度自然要承担不可推卸的责任。《中共中央国务院关于深化医药卫生体制改革的意见》指出,要“改革药品价格形成机制”;     

国家计委整顿药品价格秩序

针对目前仍然存在的药品虚高定价、价格折扣率高等问题,国家计委采取以下六项措施:一是及时降低药品的虚高价格。二是     

推进药品招标采购 促进新农合持续健康发展

药品价格虚高是近年来人民群众反映强烈的热点和难点问题之一。由于药品收入在县乡村医疗机构收入中所占比重较高，其中县级综合医院约55％、乡镇卫生院约70％，而村卫生室则在90％以上，因此药品价格虚高也是制约新型农村合作医疗（以下简称“新农合”）良性发展的瓶颈。对此，赣榆县按照“药品竞价采购、乡村一体、网络招标、统一配送”方案推行药品竞价招标、统一配送工作，有效解决了新农合定点医疗机构药品价格虚高问题，促进了新农合持续健康发展。     

我国药品价格虚高利益主体的利益分布及成因分析

目的:探讨现有药价虚高、药品市场混乱和药品定价政策缺乏科学性等深层次原因,为解决“药品价格虚高”问题中所涉及的机制转化提供理论和方法学依据。方法:依据卫生统计学和卫生经济学等理论分析“药品价格虚高”问题的深层次原因。结果:药品是特殊的商品,表现在它具有其独特的需求结构,患者在接受医疗服务和药品时处于被动和从属地位,医生是患者的代理人,由于利益的驱动,医生往往会代理失灵。结论:对“药品价格虚高”问题的现况进行科学分析,有利于下一步继续构建系统动力学模型。     

浅议药品集中招标采购的原则

近年来,药品价格虚高已成为社会各界反应强烈的问题。国家发改委已多次对药品发出＂降价令＂,但老百姓的切身体会是药价越来越贵。药品集中招标采购是降低药品价格虚高的一种手段,但药品不同于其它商品,它关系到人们的身体健康,所以,     

我国药价虚高的原因及对策

剖析我国药品价格虚高、药品市场混乱的根本原因,指出在药品价格政策和流通环节存在的问题和缺陷,提出改革现行药品的价格政策和减少药品流通的中间环节才是根治药价虚高的根本方法。     

Retail prices of essential drugs in Brazil: an international comparison.

OBJECTIVES: Price is a key obstacle for consumer access to essential drugs, especially in developing countries. This study sought to compare the retail prices of essential drugs on the private market in Brazil with that of two international pricing standards. METHODS: The retail price of all drugs on Brazil's Essential Drugs List, July 2000 edition, were compared to the retail price of the same drugs on the Swedish market and on a referential bulk-price indicator from low-cost suppliers on the international market. Ratios of Brazil's prices to Sweden's prices and Brazil's prices to the international bulk mean price-per-unit for each drug were calculated. Using linear regression analysis, the ratios were also studied in relation to the number of manufacturers. RESULTS: For the 132 drugs that were listed on both Brazil's and Sweden's lists, unitary retail prices in Brazil were 1.9 times higher. Of the 94 drugs found on both Brazil's list and the international unit-price indicator, Brazil's national mean unit prices were 13.1 more expensive. No relationship was found between the number of manufacturers for each product and the ratios of prices. CONCLUSIONS: Average retail prices of essential drugs in Brazil are significantly higher than in Sweden. Furthermore, international bulk prices indicate that drugs are brought to market by Brazil's private pharmacies at prices that may be excessively high in relation to production costs, creating high profit margins. The expected price-lowering effects of competition were not identified.     

International prices and availability of pharmaceuticals in 2005

This paper compares pharmaceutical spending, availability, use, and prices in twelve countries in 2005. Drug spending per capita was higher in the United States than in other countries. The United States had relatively high use of new drugs and high-strength formulations; other countries used more of older drugs and weaker formulations. Thus, whether U.S. overall volume of use is lower or higher depends on the measure of volume and type of product. Comprehensive price indexes show foreign prices to be 20-40 percent lower than U.S. manufacturer prices, but only 10-30 percent lower than U.S. public prices. Generics are cheaper in the United States than in other countries.     

Pharmaceutical Pricing in Emerging Markets: Effects of Income,Competition, and Procurement

This paper analyzes determinants of ex‐manufacturer prices for originator and generic drugs across countries. We focus on drugs to treat HIV/AIDS, TB, and malaria in middle and low‐income countries (MLICs), with robustness checks to other therapeutic categories and the full income range of countries. We examine the effects of per capita income, income dispersion, competition from originator and generic substitutes, and whether the drugs are sold to retail pharmacies versus tendered procurement by non‐government organizations. The cross‐national income elasticity of prices is 0.27 across the full income range of countries but is 0.0–0.10 between MLICs, implying that drugs are least affordable relative to income in the lowest income countries. Within‐country income inequality contributes to relatively high prices in MLICs. Although generics are priced roughly 30% lower than originators on average, the variance is large. Additional generic competitors only weakly affect prices, plausibly because generic quality uncertainty leads to competition on brand rather than price. Tendered procurement that imposes quality standards attracts multinational generic suppliers and significantly reduces prices of originator and generic drugs, compared with their respective prices to retail pharmacies. ©2013 The Authors. Health Economics Published by John Wiley & Sons Ltd.     

中国药品集中采购的演变以及与医保支付的逻辑关系

本文主要通过政策梳理和文献回顾的方法,详细阐述了药品集中采购政策的发展演变及其与医保支付的逻辑关系。文章首先梳理了药品集中采购的三个发展阶段,并分析了当前药品集中招标采购的特点和趋势;进而重点探讨了药品集中采购与医保支付体系的关系以及两者配套改革对于解决药品问题的现实可行性。研究认为,药品集中招标采购已经演变为省级平台限价下的议价、最低价联动采购方式;药品集中招标采购可为医保支付标准的形成提供依据,但国家药品谈判以及省级医保特药谈判存在功能重叠;药品招标采购、医保支付等制度安排可助推医药分开,配套相关改革可为解决"药价虚高"提供一种思路。     

对药品价格问题的探讨

现行的药品价格管理形式与定价原则为经营者自主定价提供了较大的利润空间。企业虚列成本、流通环节费用过高、价格管理缺陷以及用药行为异化等构成了影响药品价格不良费用增长的主要因素。以药“补”医的国家特殊政策被错误理解为以药“养”医，观念的错误导致褒贬不一的医药分业和药品集中招标采购制度都未能从根本上解决药价虚高的问题。科学合理定价，从源头上拧掉药品价格的水分，清理整顿医药市场，强化监督，调整医疗收费价格，才能真正使药品价格维持在一个规范合理的水平。     

Drugs for rare diseases: Influence of orphan designation status on price

The literature indicates that the expenditure on orphan drugs will be increasing over the coming years. The market for orphan drugs has inherent market characteristics that sometimes result in high prices. The aim of this study was to analyse whether awarding orphan designation status has an influence on the price setting of drugs for rare disease indications. To this effect, prices of designated orphan drugs were compared with other non-designated drugs for rare disease indications. We identified 28 designated orphan drugs and 16 comparable non-designated drugs for rare disease indications for which we collected official hospital prices (per defined daily dose) in Belgium in 2010. Orphan-designated drugs had a higher median price (138.56 Euros [interquartile range; IQR 406.57 Euros]) than non-designated drugs (16.55 Euros [IQR 28.05 Euros]) for rare disease indications (p < 0.01). In conclusion, our results suggest that awarding orphan designation status in itself is associated with higher prices for drugs for rare disease indications. In order to gain full insight into orphan drug pricing mechanisms, future research should focus on collecting information about the different factors influencing orphan drug pricing.     

Prices, profits, and innovation: examining criticisms of new psychotropic drugs' value

High profits and high drug costs have brought increased scrutiny of the pharmaceutical industry over the issue of whether the drugs they produce are worth the costs. I examine several related complaints, including the proliferation of me-too drugs and product reformulations, which some argue have little value relative to their cost; the baseless promotion of newer drug classes as more effective than existing, less expensive drugs; legal strategies to extend market exclusivity that result in high brand-name drug prices for an extended period of time; and large promotional expenditures that result in higher prices.     

医院门诊药房与零售药店药品品种及价格的比较

目的了解医院门诊药房与零售药店药品品种与价格,知晓其差异,提出相关政策建议.方法对4个省的7家药店和8家医院门诊药房的药品品种和价格进行调查和比较分析.结果医院门诊药房和零售药店经营药品的种类差异较大;患者持医院处方到零售药店有60%的可能购不到所开药品;医院门诊药房与零售药店药品的质量、价格管理方式不同;医院门诊药房和零售药店药品同类品种的零售价格水平不同;单独定价药品价格虚高较为严重;医院药剂部门在拥有高中级药学人才方面占有绝对优势,其药事服务能力零售药店难以企及.结论医院门诊药房和零售药店具有较大差异性.目前情况下,出台剥离医院门诊药房,或者鼓励门诊病人到零售药店进行处方调剂的政策性规定,条件尚不成熟.医疗机构要进一步规范药品采购行为;要规范医疗机构医生的处方行为.     

福建省实施国家基本药物制度前后药品价格与销量比较分析

目的:了解基本药物制度实施之后,福建省基层医疗卫生机构18种药品价格及销量的变化情况.方法:采用世界卫生组织国际健康行动机构提供的标准方法,对福建省基层医疗卫生机构18种基本药物的价格进行了分析.结果:基本药物制度实施前,相对于国际药品参考价格来说,福建省基层医疗卫生机构药品价格偏高,一些药品的中位价格比值较大;基本药...     

Tiered co-payments,pricing, and demand in reference price markets for pharmaceuticals

Health insurance companies curb price-insensitive behavior and the moral hazard of insureds by means of cost-sharing, such as tiered co-payments or reference pricing in drug markets. This paper evaluates the effect of price limits – below which drugs are exempt from co-payments – on prices and on demand. First, using a difference-in-differences estimation strategy, we find that the new policy decreases prices by 5 percent for generics and increases prices by 4 percent for brand-name drugs in the German reference price market. Second, estimating a nested-logit demand model, we show that consumers appreciate co-payment exempt drugs and calculate lower price elasticities for brand-name drugs than for generics. This explains the different price responses of brand-name and generic drugs and shows that price-related co-payment tiers are an effective tool to steer demand to low-priced drugs.