Page 7 - 《中国药房》2023年8期

·药事管理·

美国340B药品定价计划下院外药房管理的经验与启示
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贾月明 1， 2＊ ，姜 来 ，吕兰婷 （1.北京明德医院药剂科，北京 100015；2.中国人民大学卫生技术评估与
医药政策研究中心，北京 100872；3.中国人民大学公共管理学院，北京 100872）

中图分类号 R95 文献标志码 A 文章编号 1001-0408（2023）08-0897-05
DOI 10.6039/j.issn.1001-0408.2023.08.01

摘 要 目的 借鉴美国340B药品定价计划（简称340B计划）经验，为优化我国药品“双通道”政策下定点零售药店的运行与管理
提供参考。方法 通过梳理美国实施340B计划下院外药房的实施现状，总结该计划下院外药房管理的经验，提出我国药品“双通
道”政策下定点零售药店的管理思路和可能遇到的问题。结果与结论 340B计划下的院外药房相对于医疗机构而言缺乏充分的
患者基本信息和医保状态信息，易出现重复折扣和药品转移的问题；同时由于院外药房脱离了医疗机构内药品使用的管理和限
制，加上销售药品带来的经济激励，使得美国340B计划面临高额医疗卫生费用支出与院外药房逆向选择风险。建议我国在进行
药品“双通道”政策定点零售药店建设时，应该明确定点零售药店遴选标准，增强医疗机构和定点零售药店的财务透明度，建立科
学的处方流转机制，加强参保患者与处方的审核以及认证管理，健全监督管理机制，同时将定点零售药店的药品销售情况合理纳
入医疗机构用药管理中，从而实现药品可及的同时不滥用，科学控费。
关键词 340B药品定价计划；双通道；定点零售药店；重复折扣；药品转移

Experience and enlightenment of out-of-hospital pharmacy management under the 340B drug pricing
program in the United States
JIA Yueming ，JIANG Lai ，LYU Lanting （1. Dept. of Pharmacy， OASIS International Hospital， Beijing
1， 2
2， 3
2， 3
100015， China；2. Center for Health Technology Assessment and Policy Evaluation， Renmin University of
China， Beijing 100872， China；3. School of Public Administration and Policy， Renmin University of China，
Beijing 100872， China）

ABSTRACT OBJECTIVE To learn from 340B drug pricing program （short for 340B program） in the United States， and
provide reference for optimizing the operation and management of designated retail pharmacies under the “dual channel” policy in
China. METHODS The status quos of the implementation of out-of-hospital pharmacies under the 340B program in the United
States was reviewed to summarize the experience of the management of out-of-hospital pharmacies under the program in the United
States， and to propose thoughts of management and possible problems for designated retail pharmacies under the “dual channel”
policy in China. RESULTS & CONCLUSIONS Out-of-hospital pharmacies under the 340B program lacked sufficient basic
information and medical insurance status of patients compared to medical institutions， which easily led to duplicate discounts and
drug diversion issues. Due to the separation of out-of-hospital pharmacies from the management and restrictions on the use of drugs
in medical institutions， coupled with the economic incentives brought by the sale of drugs， the 340B program in the United States
faced high medical expenditure and adverse selection risks for out-of-hospital pharmacies. In this regard， when China is carrying out
the construction of designated retail pharmacies under the “dual channel” policy， it is necessary to clarify the selection criteria for
designated retail pharmacies， enhance the financial transparency of medical institutions and designated retail pharmacies， establish a
scientific prescription circulation mechanism， strengthen the review and certification of insured patients and prescriptions， and
improve the supervision and management mechanism. Meanwhile， the drug sales situation of designated retail pharmacies should be
reasonably incorporated into the drug use management of
Δ 基金项目 国家社科基金重大项目（No.22ZDA096）；中国人民
medical institutions， so as to achieve the availability of drugs
大学公共健康与卫生疾控跨学科交叉平台资金项目（No.2021PDPC）
＊第一作者 主管药师，硕士。研究方向：公共管理。E-mail： without abuse， and effectively control costs.
Janelunar@126.com KEYWORDS 340B drug pricing program； dual-channel；
# 通信作者 副教授，硕士生导师，博士。研究方向：卫生经济学在 designated retail pharmacy； duplicate discounts； drug diversion
卫生政策制定、决策分析模型、卫生资源管理中的应用。E-mail：
lanting.lu@ruc.edu.cn

中国药房 2023年第34卷第8期 China Pharmacy 2023 Vol. 34 No. 8 · 897 ·