我国公立医院药品价格形成机制的演变及未来政策选择

首先分析公立医院药品采购中的销售合同及采购合同,并指出两个合同中的"市场失灵"。而政府定价、行政降价、顺加作价、集中招标采购等行政手段实施后,药品采购相关利益方采取各种博弈行为,公立医院药品采购和价格形成出现"政府失灵"。未来的公立医院药品价格形成应该为政府有限调控下的市场定价,在保持集中招标采购和零差率两个行政手段的基础上,提高医疗保险机构的价格谈判和公立医院在招标过程中的参与度。     

药品集中招标采购过程中常见问题及解决方法

药品集中招标采购是推进医疗改革的重要环节,是降低药品价格、减轻患者负担,建立和谐社会的重要举措。分析了药品集中招标采购过程中存在药品招标代理收费问题;厂商的价格垄断,使药品竞争机制弱化;药品替代问题;招标药品的采购工作不规范的问题,并针对问题,提出了严格新药的审批和管理,规范药品招标采购行为;改进药品招标代理收费标准;合理制定招标药品组合,增强药品招标采购的科学性;加强医院用药规范管理;推广网上采购工作的解决方法。     

应把“二次议价”权还给医院

不久前,《湖北省医疗机构药品集中采购管理办法（试行）》出台,允许二级以上医疗机构探索以带量采购方式与药品企业进行议价采购。这意味着二级以上医院可在省级集中招标采购基础上,直接参与和药企的谈判,实行量价挂钩,打破了＂集中招标采购,不得二次议价＂的常规。＂二次议价＂是指医疗机构在省级招标价格基础上,要求供应商对进入医院的中标药品再次降价。     

推行药品集中招标采购深化医药卫生体制改革

医疗机构药品集中招标采购是医药卫生体制改革的重要内容,也是纠正卫生部门行业不正之风的重要措施。搞好医疗机构药品集中招标采购,必须进一步统一思想、提高认识,加强对药品集中招标采购的招标主体、招标范围、工作步骤、操作规则、药品价格合同履行等具体运作行为的规范、监督,正视成效、困难与问题,逐步完善政策、健全机制,以药品集中招标采购为突破口,稳步推进我国城镇医药卫生体制改革。     

关键看患者是否获益

正药品招标方式的改变,是要降低药品采购成本,使患者享受更低廉的药价,单其本质上是要改变公立医院以药品为盈利中心的现状。逐步减少医疗行业的药品盈利已是大势所趋。多年来,我国实行的药品集中招标采购,虽然从一定程度上遏制了增长过快的药品价格,但由于集中招标采购存在的一些缺陷和问题,未能很好建立合理的药品价格形成机制。药品价格居高不下,仍然是困扰医药卫生体制改革的严重问题。允许公立医院单独或组团采     

我院药品集中招标挂网采购的实践与体会

目的 针对我省药品在招标挂网采购工作中出现的问题,探讨解决方案.方法 总结我院药品招标挂网采购实践经验,提出进一步完善药品集中招标挂网采购的建议.结果 我院依托全省药品招标挂网采购工作,在规范药品采购行为、降低药品价格等方面都起到了积极的作用.但药品招标挂网采购在作价方法、数据平台功能、定价机制等方面有待进一步改进和完善.结论 药品集中招标挂网采购是医疗机构重要的药品管理手段,相关部门应尽快加以完善.     

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。     

国际经验对我国完善基本药物招标采购机制的启示

目的：针对我国基本药物招标采购存在的问题,通过归纳主要发达国家、地区药品价格和招标采购经验形成改革思路。方法：文献归纳与理论分析。结果：首先,医保基金作为支付者参与药品价格管理是国际主流做法。其次,药品管理方式应该与药品种类相适应。第三,在实施批量采购时,中央合同式的集中采购对象为应用量大,占药品费用支出比例高的少数药品品种。此外, WHO建议建立事前与事后评价机制以确保中标药品质量。结论：建议建立药品使用后评价机制,加强医保基金在基本药物招标采购中的作用,并落实药品分类管理,根据药品特点实施不同采购策略。     

叩问宁夏药品“三统一”改革

药品集中招标采购作为一项改革，自实施以来一直伴随着许多争议和质疑。特别是在近年来“看病难”、“看病贵”问题成为各方关注的焦点问题的背景下，深化药品招标采购改革、建立药品招标采购新机制的需求日益迫切，一些地方陆续展开了有关政策研究和实践。宁夏回族自治区推行的药品“三统一”改革，经过近两年的探索，脱颖而出，让人们在看到规范医药购销领域秩序的同时，带来的平抑药品价格和医疗费用的作用。     

医院药品集中采购政策的背景和演变

医院是我国药品的主要销售渠道,且长期以来药品由单个医院分散采购。针对药品生产、流通秩序混乱,药品价格虚高等问题,有关部门从2000年开始在全国推行以地（市）为单位的药品集中招标采购。整个制度演变可分为地方自发探索集中采购（1993--1999年）,全国推行集中招标采购（2000--2004年）,各地探索新的集中采购方式（2005年至今）三个阶段。政策目标则从单一的“规范医疗机构购药行为”扩展为“整顿药品流通秩序、规范药品价格、纠正医药购销的不正之风、降低群众医药费用负担”等多重目标,并将降低药品价格作为首要目标之一。     

探索健康公平性之建立药品价格谈判机制的思考

我国对药品价格谈判机制的构建处于探索阶段,药品费用高成为主要的就医难的表现之一,影响公民的健康公平性.本文在可行性分析的基础上,从药品的分类标准、谈判定价模式以及后续保障,探索构建我国医保药品价格谈判机制,以期实现谈判机制可持续运作,优化药品费用的控制.     

加拿大药品返利协议研究及对我国的启示

目的:通过介绍泛加拿大制药联盟谈判药品返利协议的签订机制,分析协议条款构成、价格保密设定方式和协议执行方式,为我国医保谈判药品的价格保密协议制定提供借鉴.方法:运用文献研究和政策分析法,对加拿大药品返利协议的签订流程、协议条款内容、价格保密机制进行梳理与分析.结果:加拿大药品谈判协议以返利的方式形成机密折扣,有效平衡了...     

药物经济学在医保药品谈判中的角色 ——以丙型肝炎直接抗病毒药物为例

目的:以参加2019年国家医保药品谈判的丙型肝炎治疗药物为例,探讨药物经济学在医保药品谈判中的作用,为医保药品目录调整和同类药品谈判提供参考.方法:通过成本效用分析和阈值分析,测算丙肝治疗药物的降价幅度并与实际降价幅度进行对比,结合具体谈判方式探讨相关影响因素.结果:2019年丙肝药品谈判采用了竞争性谈判和比价磋商谈判...     

Price and Consumer Cost Responsibility Effects on Quality Perceptions and Price Negotiation Likelihood for Healthcare Services

This paper presents the results of an experimental study that assessed potential differences in consumer quality perceptions and price negotiation likelihood for three healthcare procedures: a routine physical, rhinoplasty, and a root canal, based on varying levels of price and consumer cost responsibility. Results of this study did not support a general positive price-perceived quality relationship for any of the three procedures. However, several significant effects were observed for price negotiation likelihood. First, price negotiation likelihood was found to be higher for more expensive services (i.e., rhinoplasty) than less expensive services (i.e., routine physical). In addition, consumers were more likely to negotiate price when they were both responsible for the entire cost of an expensive procedure and not accustomed to paying the full cost. Lastly, people who likely perceived a relationship between price and quality were less likely to negotiate pricing at high price levels vis-à-vis low price levels.     

我国专利药品医疗保险价格谈判的演化博弈研究

利用演化博弈理论,结合我国专利药价格谈判现状,建立专利药品价格谈判博弈的演化模型,并进行仿真模拟分析,探究对演化博弈稳定状态产生影响的因素及其作用路径。结果发现,谈判前后专利药品的销售额、谈判双方的谈判初始意愿和变化方向以及对于社会声誉的考量均能够对演化稳定结果产生影响,最终从上述角度提出谈判双方优化专利药品价格谈判的相关建议。     

Medicare Drug Price Negotiation in the United States: Implications and Unanswered Questions

The United States is a relatively free-pricing market for pharmaceutical manufacturers to set list prices at the product launch. Few drug price controls exist, and federal price negotiation as a policy has historically been politically untenable. After decades of debate on whether the federal government, specifically the Medicare program, should more actively manage drug prices, the US Congress passed legislation authorizing Medicare to directly negotiate prices with manufacturers. The purpose of this article is to describe elements and implementation of the price negotiation provisions and then comment on the potential impacts on payers, innovations, and the pharmaceutical industry. While impacting only a few drugs each year in the beginning, price negotiation in the Medicare program will have secondary and long-term effects in the US market and beyond. It is clear that in the United States, the Medicare market for drugs will no longer be a free-pricing environment in the industry.     

药品价格谈判国际经验与国内实践的比较研究

本文采用回顾性研究方法,通过文献检索不同国家或地区药品价格谈判的谈判主体、药品类型、药品准入机制、谈判环节和谈判结果等信息进行统计和分析。在国外,药品价格谈判机制已实施多年,许多国家已建立了比较完善的谈判制度,选取其中7个具有代表性的典型国家和地区进行统计分析,分别为加拿大、美国、澳大利亚、法国、德国、意大利、韩国。近年来,我国部分省市医疗保险部门进行了药品价格谈判的试点工作,在药品价格谈判结果实施方面积累了一些实践经验,选取其中6个实施结果较为成功的地区进行统计分析,分别为浙江、湖南、江苏、江西、成都、青岛。通过对国内外典型地区药品价格谈判机制统计结果进行对比分析,发现典型国家药品价格谈判机制更为成熟健全,国内地区与之相比仍存在一定差距,可借鉴国外的成功经验,结合实际情况,建立健全适合我国国情的药品价格谈判机制。     

Evolution of Drug Reimbursement in Canada: The Pan-Canadian Pharmaceutical Alliance for New Drugs

Canada has a unique system of public drug coverage and reimbursement characterized by a centralized review agency that makes funding recommendations along with decentralized authority for delivering health care across 10 provinces and three territories. There has been a significant increase in price negotiation for new pharmaceuticals in the past 10 years, first by individual provinces and now through a collective price negotiation process called the “Pan-Canadian Pharmaceutical Alliance.” As of February 2014, the Pan-Canadian Pharmaceutical Alliance has already completed 32 negotiations despite still being in a formative stage; it is anticipated that a formal process will be developed in the coming year. In this article, we describe the evolution of price negotiation in Canada and identify several opportunities for improvement of the current process, including the incorporation of economic considerations into price negotiation.     

新经济形势下药品价格形成机制探讨

目前,我国医药行业竞争性较强,药价虚高而导致“看病贵”的现状越发严重。针对当前药价过高,对现今药品供求关系、药品市场结构、药品流通制度以及政府对药品的管制等方面进行分析,探讨当下药品价格形成机制。     

Drug Prices and Value of Oncology Drugs in Italy

ObjectiveThe main objective of this study was to evaluate the potential role of efficacy data and other information available at the time of price and reimbursement (P&R) decision-making process within the definition of oncology treatment costs in Italy.MethodsThe study included all P&R dossiers submitted to the Italian Medicines Agency between July 2015 and December 2017. It prospectively collected the data of the P&R process starting from dossier submission up to the Italian Health Service reimbursement decision. The cost of treatment per patient was estimated using both the list price (“gross cost”) and the confidential net price (“net cost”) of drug packages and applied to the median duration of treatment. A 2-sample stage Heckman decomposition model was used to evaluate the potential role of efficacy data and other information available at the time of P&R decision making on the gross and net cost.ResultsA total of 37 oncology drugs related to 58 therapeutic indications were analyzed. The multivariate model showed that the variation of progression-free survival is the only variable predictor statistically associated with treatment cost, but this effect was observed only when confidential net prices were used (P=.026).ConclusionsConsidering the perspective of a developed country having a public healthcare service with a central reimbursement negotiation is determined a relevant reduction in the treatment cost purchased by public payers. This is a useful approach to guarantee the affordability of innovative oncology drugs and to contain public expenditures on healthcare. Furthermore, the negotiation of confidential discounts and agreement clauses in managed entry agreements seemed to reward oncology drugs displaying an added therapeutic benefit.