美国Medicaid项目处方药费用控制措施介绍及对我国的启示-中国药房

美国Medicaid项目处方药费用控制措施介绍及对我国的启示

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篇名：	美国Medicaid项目处方药费用控制措施介绍及对我国的启示
TITLE：	Introduction to the Cost Control Measures of Medicaid Prescription Drugs in the United States and Its Enlighten- ment to China
摘要：	目的：研究美国Medicaid项目处方药费用控制措施，为我国医保药品支出控制改革提供参考。方法：通过研读政策文件、学术论文和新闻报道等，梳理美国Medicaid项目的药品费用控制政策的做法和对医保费用影响，并提出对我国医保药品控费的建议。结果与结论：美国Medicaid项目处方药费用控制措施包括药品利用管理和药品控费新措施，前者包括首选药品清单、事先授权和分步治疗、处方限额，后者包括药品支出增长上限控制、封闭式药品目录管理等。首选药品清单是一系列药品控费措施的基础，为事先授权和分步治疗提供了政策框架；事先授权和分步治疗是控费的具体做法，通过对具体病例的引导鼓励低价药品的使用；处方限额从控制单一患者用药费用入手，从另一个角度节省医保支出；药品支出增长上限控制是从医保支出总费用的角度进行控费，是对传统方法的补充；封闭式药品目录管理是突破首选药品清单局限性的新的政策尝试。Medicaid项目采用的处方药控费措施一定程度上能够有效缩减其药品支出，但也因可干预医师处方权，存在损害患者利益的可能性。我国应通过加强医保在医疗服务体系中的作用，谨慎借鉴美国Mdeicaid药品利用管理措施；健全医保支出费用动态控制机制，针对重点药品采取特别措施；健全药品目录管理机制，抓好准入、退出和动态调整三个环节，引导医疗机构合理用药。
ABSTRACT：	OBJECTIVE：To study the cost control measures for Medicaid prescription drugs in the United States ，and to provide reference for medical insurance cost control in China. METHODS ：The policy documents ，academic papers and news reports were studied to comb the practice of drug cost control policy of Medicaid project in the United States and its impact on medical insurance costs. The suggestions were put forward for medical insurance cost control in China. RESULTS & CONCLUSIONS：The cost control measures of Medicaid prescription drugs adopted in the United States include drug utilization management and drug cost control measure. The former included the list of preferred drugs ，pre-authorization and step therapy ， prescription cost limit ，while the latter included the upper limit control of drug expenditure growth ，closed drug list management ， etc. The list of preferred drugs is the basis of a series of drug cost control measures ，which provides a policy framework for prior authorization and step therapy ；pre-authorization and step therapy are the specific ways to controlling the cost ，and the use of low-cost drugs is encouraged through the guidance of specific cases ；the prescription cost limit starts from controlling the drug cost of a single patient and saves the medical insurance expenditure from another angle ；the drug growth caps control is controlling the total cost of medical insurance expenditure from aspect of overall cost ，which is a supplement to the traditional method ；closed drug list management is a new policy attempt to break through the limitation of preferred drug list. The prescription drug cost control measures adopted by Medicaid project can effectively reduce the drug expenditure to a certain extent ，but it also has the possibility of harming the interests of patients because it can interfere with doctors ’prescription right. China should further strengthen the role of medical insurance in the medical service system ，and carefully learn from the management measures of Medicaid drug utilization in the United States ；improve the dynamic control mechanism of medical insurance expenditure ，take special measures for key drugs ； improve the drug list management mechanism ，pay attention to the three links of access， exit and dynamic adjustment ， guide medical cn institutions to use drugs rationally.
期刊：	2021年第32卷第03期
作者：	林筑，吕兰婷
AUTHORS：	LIN Zhu ，LYU Lanting
关键字：	美国；Medicaid项目；费用控制；医保；药品利用管理；启示
KEYWORDS：	United States ； Medicaid； Cost control ；
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