Study on value-based medical insurance access and pricing methods of multi-indication drugs

WANG Yingcheng; WU Yao; YANG Lan; RUI Mingjun; LI Hongchao

doi:10.6039/j.issn.1001-0408.2023.02.10

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Study on value-based medical insurance access and pricing methods of multi-indication drugs

更新时间：2023-02-22

- Study on value-based medical insurance access and pricing methods of multi-indication drugs
- ZHONGGUO YAOFANG Vol. 34, Issue 2, Pages: 179-184(2023)
- 作者机构：
  
  1.中国药科大学国际医药商学院，南京　211198
  2.中国药科大学药物经济学评价研究中心，南京　211198
- 作者简介：
- 基金信息：
- DOI：10.6039/j.issn.1001-0408.2023.02.10
  CLC： R956
- Published：30 January 2023，
  
  Received：22 March 2022，
  
  Revised：16 November 2022，
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王樱澄,吴尧,杨岚等.基于价值的多适应证药品医保准入与定价方法研究 ^Δ[J].中国药房,2023,34(02):179-184.

WANG Yingcheng,WU Yao,YANG Lan,et al.Study on value-based medical insurance access and pricing methods of multi-indication drugs[J].ZHONGGUO YAOFANG,2023,34(02):179-184.
王樱澄,吴尧,杨岚等.基于价值的多适应证药品医保准入与定价方法研究 ^Δ[J].中国药房,2023,34(02):179-184. DOI： 10.6039/j.issn.1001-0408.2023.02.10.

WANG Yingcheng,WU Yao,YANG Lan,et al.Study on value-based medical insurance access and pricing methods of multi-indication drugs[J].ZHONGGUO YAOFANG,2023,34(02):179-184. DOI： 10.6039/j.issn.1001-0408.2023.02.10.

摘要

目的

探讨多适应证药品的医保准入与定价方法。

方法

梳理我国多适应证药品在历年医保谈判中的准入情况，参考基于价值定价的经济学理论和其他国家的相关经验，总结3类共5种在我国可能适用的多适应证药品定价方法。以头孢他啶-阿维巴坦为例，针对该药的不同适应证开展成本-效用分析，并探讨该药合适的定价方法。结果与

结论

目前我国多适应证药品均为单一定价。可探索的定价方法包括基于产品的单一定价方法（如基于低价值适应证的单一定价和混合/加权的单一定价）、基于适应证的定价方法（如按适应证协议不同折扣的单一定价和根据不同适应证以不同商品名上市并分别定价），以及补偿准入限制的定价方法。每种定价方式各有优势和局限性。通过头孢他啶-阿维巴坦的案例分析可知，多适应证药品首先要对各个适应证分别开展价值评估，再基于价值综合考量合适的准入情况与定价方法。单一的定价方法虽然简单，但是难以完全反映价值；而基于适应证的定价方法和补偿准入限制依赖于完善的信息系统和多部门的配合。我国应逐步应用基于价值的多适应证药品的定价方法，不断探索合理的准入方式，提高整体社会福利。

Abstract

OBJECTIVE

To discuss medical insurance access and pricing methods for multi-indication drugs.

METHODS

The access situation of multi-indication drugs in China’s medical insurance negotiation over the years was sorted out. Referring to the economic theory of value-based pricing and the relevant experience of other countries， five applicable pricing methods of 3 categories for multi-indication drug in China were summarized. Taking ceftazidime-avibactam（CAZ-AVI） as an example， cost-utility analyses were performed for different indications， and appropriate pricing methods were applied.

RESULTS &CONCLUSIONS

All multi-indication drugs in China adopted a single pricing method. The pricing methods that could be explored include product-based pricing， such as single pricing based on the lower-value indication or mixed/weighted single pricing； indication-based pricing， such as developing a new agreement for single pricing under different discounts and listing with different brands and pricing of the same medicine for different indications； and compensation for access restrictions. Each method has its advantages and limitations. The case of CAZ-AVI showed that it is necessary to estimate the value of each indication for multi-indication drugs， and comprehensively consider appropriate access conditions and pricing methods based on value. Although single pricing is simple to operate， it is different to reflect the value entirely. The indication-based pricing and compensation for access restrictions all depend on the information collection system and the cooperation of multiple departments. China is supposed to carry out the value-based pricing of multi-indication drugs and constantly explore reasonable access methods to improve overall social welfare.

关键词

多适应证药品价值定价定价方法医保准入

Keywords

value-based pricingpricing methodsmedical insurance access

references

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