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抗肿瘤药物医保限制支付范围内肿瘤分期与临床分期对比分析
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赵德华 ，龙小庆，王继生，范红英（绵阳市第三人民医院/四川省精神卫生中心医保物价科，四川 绵阳 621000）

中图分类号 R979.1；F840.684 文献标志码 A 文章编号 1001-0408（2025）10-1166-06
DOI 10.6039/j.issn.1001-0408.2025.10.03

摘 要 目的 对比分析抗肿瘤药物医保限制支付范围内的肿瘤分期与临床分期，以便更好地执行药品支付政策。方法 以《国家
基本医疗保险、工伤保险和生育保险药品目录（2024年）》（以下简称“医保目录”）收录的抗肿瘤药物为研究对象，整理和分析药物
限制支付范围内关于肿瘤分期的限定情况；通过查阅临床诊疗指南和相关文献将医保目录限制支付范围内的肿瘤分期与临床分
期进行映射比对。结果与结论 共有89个抗肿瘤药物的医保支付限制了肿瘤分期，其中西药86个（包括17个普通西药、68个协议
谈判药品和1个竞价药品），中成药3个（包括1个普通中成药和2个协议谈判药品）。非小细胞肺癌涉及的限制支付药品最多，有
36个；限制支付范围内的肿瘤分期以“转移性”和“局部晚期”居多，分别涉及67和48个药品。大部分限制支付范围内的肿瘤分期
可以和肿瘤临床分期进行对应，但中晚期食管癌、不可切除的胃肠间质瘤、不可切除的局部晚期神经内分泌瘤、局部晚期基底细胞
癌、无法手术的Ⅰ型神经纤维瘤病未见有权威指南和高质量临床研究提及有相应的临床分期，需要临床根据患者实际情况进行判
定。建议相关部门对限制支付范围内的肿瘤分期进行准确定义和标准化解读，以提高药品医保支付政策在执行过程中的准确性。
关键词 抗肿瘤药物；限制支付范围；肿瘤分期；临床分期；医保

Comparative analysis of tumor staging versus clinical staging in reimbursement scope restrictions under
medical insurance for antineoplastic agents
ZHAO Dehua，LONG Xiaoqing，WANG Jisheng，FAN Hongying（Dept. of Medical Insurance and Pricing，
Mianyang Third People’s Hospital/Sichuan Provincial Mental Health Center， Sichuan Mianyang 621000， China）

ABSTRACT OBJECTIVE To comparatively analyze tumor staging versus clinical staging in reimbursement scope restrictions
under medical insurance for antineoplastic agents in order to better implement the medicare drug payment policy. METHODS
Antineoplastic agents included in the National Basic Medical Insurance， Workers’ Compensation Insurance and Maternity
Insurance Drug Catalogue （2024） （hereinafter referred to as the “Medical Insurance Catalog”） were used as research subject to
compile and analyze reimbursement scope restrictions regarding tumor staging. By consulting clinical diagnosis and treatment
guidelines and relevant literature， the tumor staging in reimbursement scope restrictions of the Medical Insurance Catalog was
mapped and compared with clinical staging. RESULTS & CONCLUSIONS A total of 89 antineoplastic agents’ medical insurance
payments had tumor staging. Among these， there were 86 western drugs （including 17 ordinary western drugs， 68 negotiated
drugs， and 1 competitive drug） and 3 Chinese patent medicines （including 1 ordinary Chinese patent medicine and 2 negotiated
drugs）. Non-small cell lung cancer involved the most restricted payment drugs， with 36 drugs. The tumor staging in reimbursement
scope restrictions was mostly “metastatic” and “locally advanced”， involving 67 and 48 drugs respectively. Tumor staging in most
reimbursement scope restrictions could correspond to the clinical staging of the tumor. However， mid-advanced esophageal cancer，
unresectable gastrointestinal stromal tumors， unresectable locally advanced neuroendocrine tumors， locally advanced basal cell
carcinoma， and unresectable neurofibromatosis type Ⅰ did not have a corresponding clinical staging mentioned in authoritative
guidelines or high-quality clinical studies and need to be determined by the clinic according to the actual situation of the patient.
Therefore， it is recommended that the interpretation of tumor staging in reimbursement scope restrictions should be accurately
defined and standardized， so as to improve the accuracy of the drug payment policy in the actual implementation process.
KEYWORDS antineoplastic agents； reimbursement scope restrictions； tumor staging； clinical staging； medical insurance

恶性肿瘤严重危害人类的生命健康，给社会和患者 可及性、降低患者用药成本，国家已将大部分抗肿瘤药
家庭带来了极大的经济负担。为了提升抗肿瘤药物的 物纳入了《国家基本医疗保险、工伤保险和生育保险药
品目录（2024 年）》（以下简称“2024 年版医保目录”） 。
[1]
Δ 基金项目 北 京 医 药 卫 生 经 济 研 究 会 科 研 资 助 项 目（No.
由于不同肿瘤类型和不同肿瘤分期的药物治疗方案存
BJHE2023-PRP-008）
在差异，故医保目录对部分抗肿瘤药物设置了限制支付
＊第一作者 主管药师，硕士。研究方向：临床药学、医保管理。电
话：0816-2278591。E-mail：zhaoyaoshi0566@163.com 范围，如限制医保药品应用于某些特定肿瘤类型、用药

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