從百憂解事件談全民健保藥價制度【本期企劃】 試閱
Discuss Drug Payment System of National Health Insurance on the Issue of Prozac
衛生福利部中央健康保險署2019年度藥品支付價格之調整，引發百憂解等原廠藥宣稱將退出臺灣市場，以及藥價調整機制檢討聲浪。然從健保之基本保障原則，各藥廠生產之同種藥品，若療效與安全性皆受政府核准，健保選擇以低價之學名藥為支付標準，應屬妥當，但仍應容許自付差額，選擇他廠藥品。且健保在藥品給付上，應以必須、難以替代但價格高昂之藥品為主，多數民眾可負擔之低價藥品，則可考慮將危險自留。本文認為，可設藥品自負額，超過之藥費則依比例給付，兼採定額與定率部分負擔方式，以符合保險精神與分配正義。
In 2019, National Health Insurance (NHI) adjusted drug price, and may cause brand drugs such as Prozac to withdraw from the Taiwan market. Many physicians are initiative to review policy of drug price adjustment. On the basic guarantee principle of NHI, if the drugs produced from different pharmaceutical companies affirmed by the government with the same efficacy and safety, NHI will choose to pay a low-priced generic drug. It will be appropriate. Besides, patient allows to choose other drugs with deductible. Drug payment policy of NHI should pay the necessary, or hard to replace and expensive drugs. Most people are affordable low-cost drugs, and consider risk retention for the insured. This paper suggests that NHI adopt the drug deductible payment if drug price exceed, the insured should pay certain percentage of the price. The deductible payments with copayment and coinsurance meet the spirit of insurance and the distribution of justice.
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