">

亚博网页登陆 - 亚博手机版网页登陆

| |
當前頁面:首頁 » 新聞動態 » 媒體聚焦

直擊現場 | 國家醫保局發文建立“雙通道”機制,4個關鍵要點破解談判藥“進院難”

字體: 打印本頁|關閉本頁 視力保護色:

jinri,guojiayibaojufabu《guanyujianliwanshanguojiayibaotanpanyaopin“shuangtongdao”guanlijizhidezhidaoyijian》(yixiajiancheng《zhidaoyijian》),mingquejiangdingdianlingshouyaodiannarutanpanyaopingongyingbaozhangfanwei,yudingdianyiliaojigouyiqi,xingchengtanpanyaopinbaoxiaode“shuangtongdao”,pojie“jinyuannan”wenti,quebaoguojiayibaotanpanyaopinshunliluodi。

《指導意見》共分七部分,分別從分類管理、遴選藥店、規范使用、完善支付政策、優化經辦管理、強化監管、加強領導等方面,對談判藥品“雙通道”管理提出了要求,標志著談判藥品的供應保障朝著多元化方向邁出了一步。

官方科普:“雙通道”是指通過定點醫療機構和定點零售藥店兩個渠道,滿足談判藥品供應保障、臨床使用等方面的合理需求,并同步納入醫保支付的機制。

官方解讀:“雙通道”機制的4個關鍵要點

guojiayibaojuchengliyilai,dalituijinyaopinmuluguanligaige,jianlijianquanmuludongtaidiaozhengjizhi,yibaoyaopinmuludiaozhengzhouqicongyuanlaidezuichang8niandafusuoduanzhimeinian1ci,shenzhiyixiexinyaoshangshidangnianjiubeinaruyibaoyaopinmulu。danyucitongshi,bufenchuangxinyaopindeshichangzhunrumoshiyecongyuanlai“xianjinyiyuan,houjinyibao”bianchengle“xianjinyibao,zaijinyiyuan”,zheduiyiliaojigoukuaisuzhunruhelinchuangyishengduanqineiguangfanshiyongtichulegenggaoyaoqiu。yincikeguanshangjiang,bufentanpanyaopinchuxian“jinyuannan”xianxiang,yidingchengdushangshishenhuayibaoyaopinmuluguanligaigedejieguo。ercicifabude《zhidaoyijian》,jiushiguojiayibaojujingguoduitanpanyaopinluodiwentideguangfandiaoyan、zixiyanjiu,bingchongfenjiejiandifangshijianjingyandejichushang,congguojiacengmianyichutaizhengcewenjiandexingshi,mingquejiejuezheyiwentidekexinglujing。

根據家醫保局醫藥服務管理司長黃華波介紹,制定“雙通道”政策時需要考慮好以下幾方面關鍵問題:

一是確定“雙通道”管理藥品范圍時考慮的主要因素。原則上納入范圍由省級醫保行政部門綜合考慮本地區經濟發展水平、醫保基金承受能力和患者用藥需求等因素確定。要對談判藥品實施分類管理,對于臨床價值高、患者急需、替代性不高的品種要及時納入。“雙通道”藥品可根據情況變化定期進行調整。

二是做好“雙通道”定點零售藥店的遴選和動態管理。相比于普通定點零售藥店,納入“雙通道”管理的定點零售藥店要求更高。一是信息化方面,定點零售藥店要與醫保信息平臺、電子處方流轉平臺等對接,確保藥品、醫保支付等信息全面、準確、及時溝通;二是藥品管理方面,定點零售藥店需建立符合要求的儲存、配送體系,確保藥品質量安全,同時配備專業人才對患者合理用藥進行指導,確保臨床用藥安全;三是醫保基金監管方面,定點零售藥店應采取更加嚴格的措施對患者身份進行核實,確保“處方患者”和“實際用藥患者”一致,確保基金安全。

三是完善納入“雙通道”管理的藥品的醫保支付政策。要在定點醫療機構和定點零售藥店施行統一的支付政策,保障患者合理待遇。對使用周期較長、療程費用較高的談判藥品,可探索建立單獨的藥品保障機制。各地醫保部門將根據基金承受能力、住院補償水平等情況,確定適宜的保障水平。

四是以處方流轉中心為核心強化醫保基金監管。“雙通道”機制的建立,將原來藥品院內管理的一部分職能轉移至院外,管理環節明顯增多,對基金安全風險管控提出了新挑戰。因此,要以處方流轉中心為核心,連通醫保經辦機構、定點醫療機構、定點零售藥店,落實“定機構、定醫師、可追溯”等要求,實現患者用藥行為全過程監管;完善細化醫保用藥審核規則,引入智能監控,嚴厲打擊“雙通道”領域套騙取醫保資金的行為;加強“雙通道”用藥費用和基金支出常規分析和監測。

“雙通道”之外,還有這些舉措保障談判藥落地

genjuguanfangjiedu,chujianli“shuangtongdao”guanlijizhiwai,guojiayibaojuhuankaizhanleyixiasanfangmiangongzuo,bangzhupojietanpanyaopin“jinyuannan”wenti。

一是建立完善談判藥品落地監測機制,及時掌握落地進展。2020年以來,國家醫保局建立了談判藥品落地情況監測機制,組織各省份定期報送談判藥品的用量、費用和報銷情況等數據,定期分析各地進展,以及落地過程中發現的主要問題,及時向各地通報,推動落地。

二是加強督促指導,推動談判藥品落地。國家醫保局相關負責人先后赴北京等7個省份,督導調研談判藥落地的進展和做法,深入了解“進院”方面存在的困難和問題;調度了解32個省級醫保局(含兵團)在推動談判藥品落地方面的做法和成效,梳理總結典型經驗做法,發揮典型示范和輻射帶動作用。

三是收集并發布部分談判藥品已配備機構名單,供公眾查詢。近期,國家醫保局從2020年新增的談判藥品中篩選出首批臨床需求迫切、可替代性不強的19種藥品,安排相關企業報送了已配備的定點醫療機構和定點零售藥店信息,在“國家醫保服務平臺(APP)”中“藥品”模塊開通了公眾查詢渠道,并在4月30日召開媒體發布會向社會公開發布,以方便有需求的參保人員就醫購藥。

落實“雙通道”政策,這些經驗可供借鑒

sichuanshengzaozaizhixing36zhongguojiatanpanyaopinshi,jiufaxianleyongyaonanchenglequnzhongdetongdiandudian。weijiejuezhegewenti,zaishengjiyouguanbumendedailingxia,bufentongchoudiqutansuokaizhanletanpanyaopinfenleiguanlihedanxingzhifugongzuo。2019nian,zaizongjiegedijingyanjichushang,sichuanyibaojuchutaile《guanyuwanshanguojiatanpanyaopinhebufengaozhiyaopinzhifuguanliyouguanzhengcedetongzhi》,jiangguotanyaopinzhongjiageanggui、yongyaorenqunteding、yongyaozhizhengmingquedeyaopinnarudanxingzhifuguanli,zhixingtedingdezhifuzhengcehejingbanfuwu。

genjuwenjianguiding,sichuanshengdanxingzhifuyaopinzaibaoxiaozhengceshangshixingdingdianyiyuan、dingdianyaodian“shuangtongdao”gongyaobaoxiaozhidu;bunarudingdianyiyuanzongeyusuan、bunaruanjibingzhenduanxiangguanfenzufufeifanwei;buqufenmenzhen、zhuyuan,bujiqifuxian,zhijieyoujibenyibaojijinanyidingbilizhifu;zaijingbanshangshixing“wudingguanli”(dingrendingjigou、dingzhiliaojigou、dingzerenyishi、dinggongyaojigou、shimingzhiguanli),geiyouxuqiudehuanzhequntitigongjingzhunfuwuheguanli。

zhexiejucuoduiyugaishantanpanyaopinzaisichuanshengdeluodiqingkuangfahuilemingxianzuoyong。genjusichuanshengguanfangshujutongji,muqiandanxingzhifuyaopinyibaojijinzhichuyuezhanletanpanyaopinzongzhichude80%,danxingzhifuyaopingongyaojiesuanfuwuyue80%shitongguoyaodiantigongde。bingqie,sichuanshengdanxingzhifuyaopinmingdanyezaitongbugenjuguojiamuludongtaidiaozhengxiangyingdiaozheng,yijingcongzuichude37gezengjiadaolemuqiande88ge。ciwai,cong2020nian3yueqi,sichuanshengneiteshuyaopinyidizhijiejiesuanxitongshangxianyunxing,canbaorenyuanshengneiyidishiyongdanxingzhifuyaopinkezhijiejiesuan,buzaidianfufeiyong。

jiangsushengxuzhoushiyejijitansuoguotanyaoyongyaobaozhangdexinjucuo,tongguofenleiguanli、shuangtongdaogongyaodengfangshituijinguotanyaoluodihejingxihuaguanli。

zaifenleiguanlifangmian,xuzhoushigenjuyaopinzhiliaolingyu、zhiliaozhouqi、liaochengfeiyong、xiandingzhifufanweideng,duiguotanyaofenwei2leijinxingguanli。yileishigaozhiyaopin,baokuokangzhongliuzhuanxiangbaozhangjizhiyaopinhemenzhenanbingzhongfufeiyaopin。qianzhebusheqifubiaozhun,xianyouzhigong、juminjijinfenbiebaoxiao,ranhoujianggerenzifubufennaruzhigongbuchongyibaohejumindabingbaoxianbaoxiaofanwei;houzheyiyaopinnianzhiliaofeiyongzaishangnianduchengzhenjuminrenjunkezhipeishourude50%zuoyouweilinxuanbiaozhun,sheli14gemenzhendanbingzhong,xiangguanzhiliaoyaopinnaruqizhong。muqian,naruzhongliuzhuanxiangbaozhangjizhideyaopinyou56zhong,narumenzhenanbingzhongfufeideyaopinyou43zhong。lingyileishiputongyileiyaopin,tongguopinggulunzhenghoujiangguotanyaozhongzhijiezhiliaomanxingbingde55zhongxinzengyaopin,quanbunaruzhigongyibaomenzhenmanxingbinghejuminyibaogaoxueyatangniaobingmenzhenyongyaobuzhufanwei。qiyuyaopinzehelishedinggerenxianxingzifubilihouzhengchangxiangshoudaiyu。

zai“shuangtongdaogongyao”fangmian,mingquedingdianyiliaojigou、dingdianlingshouyaodianlianggegongyaoqudao,tongshikexiangshouxiangtongdedaiyubiaozhun。shouxian,anzhao“ziyuanshenqing、yangeshenhe、zongliangkongzhi、zeyouxuanyong”he“yiliaojigouweizhu、lingshouyaodianweifu”deyuanze,genjutedinglinxuanbiaozhun、chengxuheliqueding,bingsuizhuguotanyaopinzhongdebuduanzengduoshidangdongtaidiaozeng。qici,yashiyiliaojigouzhutizeren。yaoqiugedingdianyiliaojigouzuodao“youxubicai”,bingnaruyibaoxieyiguanli;jiadayibaojilizhichilidu,yiliaojigouanguifanshiyongxinnarudeguotanyaobuzhandangnianyibaozongeyusuanzhibiao;qianghuaduchadudao,lianheshiweijianweizuzhiguotanyaojinyuanqingkuangzhuanxiangjiancha。disan,guifan“siding”guanli。huanzheshiyonggaozhiyaopincaiqudingyiliaojigou、dingzerenyishi、dinglingshouyaodian、dingshuzhuzhongxinde“siding”guanlimoshi,bingtongbuyanjiuzhidingjingbancaozuoxizehe“siding”zhize、weiguichulibanfa,baozhangyewujingbanbiaozhunhua、daiyuzhifuguifanhua。disi,wanshanliutonghuanjieguanli,duizhushejiyaopin,shengchanqiye、yaodian、yiliaojigoujiaqiangpeisonghuanjiedeguanlihexianjie,peibeizhuanche、zhuanrenheshishidingweiwenkongxitong,huanzhequanchengbujiechuyaopin,shixianhuanzheyongyaoquanliuchengbihuanguanli,youxiaobaozhangyongyaoanquan。

muqian,xuzhoushigongyougaozhiyaopindingdianyiyuan14jia,dingdianyaodian11jia,qunzhongzaixianyuneijikequanchengwanchengguotanyaodaiyuxiangshou,jiuyigouyaodebianjiedudafutigao。

fu:

  • 上一篇
  • 下一篇
  • 相關信息