《保险研究》20230608-《美国医疗保险对药品价格的控制——对《通货膨胀削减法案》的分析》（王向楠）

［摘   要］美国的药品价格很高，长期以来对美国的通货膨胀产生了拉抬作用，并越发成为民生负担。2022年8月，美国《通货膨胀削减法案》实施，历史性地赋予了美国联邦医保部门对药品价格进行控制的多项权力。本文按照政策措施开始实施的时间顺序，依次分析美国医保部门正在进行的四项控制药品价格的工作——提高仿制生物药的医保支付标准、给参保患者对胰岛素药品的每月自付费用“封顶”、让制药企业将药品价格增长超出同期通货膨胀的部分向医保部门退款、以及与制药企业就药品价格进行谈判。这四项改革措施在控制药价上形成了合力。然后，简要分析了美国商业保险受到的影响。最后，提炼出这四项改革措施的特点，希望为我国相关领域的决策提供参考信息。

［关键词］健康保险；生物药；仿制药；价格谈判；药品福利管理

［基金项目］国家社会科学基金年度项目（22BGL062）。

［作者简介］王向楠，中国社会科学院金融研究所副研究员、中国社会科学院保险与经济发展研究中心副主任。

The US Medical Insurance′s Control on Drug Prices:An Analysis of the “Inflation Reduction Act”

WANG Xiang-nan

Abstract：The drug prices in the United States are exorbitant,which has contributed to inflation over the long term and has increasingly become a burden on the livelihoods of its citizens.In August 2022,the US “Inflation Reduction Act” was implemented,which historically granted the federal medical insurance department(the Centers for Medicare and Medicaid Services,CMS) the authority to control drug prices.In chronological order,the paper analyzes the four initiatives implemented by the CMS to control drug prices:raising the payment benchmark for biosimilars to promote market competition,capping monthly out-of-pocket costs for insulin drugs for insured patients,requiring pharmaceutical companies to refund the portion of drug price increases that exceed the inflation rate,and negotiating drug prices with pharmaceutical companies.These four reform measures,regardless of whether they are comprehensive or precise,whether they focus on pre-or post-intervention,and whether they are direct or indirect,have worked together to control drug prices to some extent.Then,the paper briefly analyzes its impact on US commercial health insurance.Finally,it distills common characteristics from these four reform measures,aiming to provide reference information for decision-makers in related fields in China.At the same time,it summarizes the experiences from China′s medical insurance bureau′s drug price control measures for the consideration of the United States.

Key words：health insurance;biologic drug;generic drug;price negotiation;drug benefit management