Empirical Exploration of the Determination Rules for Medical Insurance Payment Standards for Non-Winning Drugs in Centralized Volume-Based Procurement
- VernacularTitle:集中带量采购非中选药品医保支付标准确定规则的实证探索
- Author:
Jie TIAN
1
;
Rongjie SHAO
1
;
Jing WU
1
Author Information
1. 天津大学医学部药物科学与技术学院、天津大学社会科学数据调查中心 天津 300072
- Publication Type:Journal Article
- Keywords:
centralized volume-based procurement;
non-winning;
payment standard;
reference pricing;
volume-price weighting
- From:
Chinese Health Economics
2025;44(6):32-36,87
- CountryChina
- Language:Chinese
-
Abstract:
Objective:It aims to conduct empirical exploration on the rules for determining the medical insurance payment standards for non-winning drugs with the same generic name in the national medical centralized volume-based procurement,and provided decision-making references for further determination of medical insurance payment standards.Methods:Taking the first three batches of non-winning drugs for centralized procurement as research objects,based on real-world data from medical institutions nationwide,using commonly used pricing methods such as the German reference pricing method and the volume-price weighting method,different calculation schemes are designed to calculate the medical insurance payment standards of the above research objects.Comparation is conducted on the measurement for the decrease in payment standards of highest price of non-winning drugs and the individual burden under the payment standard between different calculation methods.Results:The German reference pricing method has slightly lower medical insurance payment standards compared to the volume-price weighting method,resulting in slightly higher price reductions and personal burdens.The results of different volume-price weighting method calculation schemes are similar.Conclusion:It is recommended to adopt the volume-price weighting method to formulate the medical insurance payment standard for the national centralized procurement of non-winning drugs,the reduction is more reasonable and the patient's personal burden is lower,and it can be better connected with the existing policy to gradually form a unified payment standard with the common name and return to the bid-winning price.
