Healthcare vs. Drug Price

Ivan Liu Take It Personally


Media in Taiwan has been reporting that drug price investigations result in low drug prices and pharmaceutical companies threaten to leave Taiwan.

台灣諸多媒體,一面講因為藥價調查造成健保核價太低、一面說原廠藥要退出台灣,連續不間斷地放送國外藥廠勾結醫師所發表的業配新聞。

他們藉此恐嚇公眾,並灌輸有病也無藥可用的醫療困境。

健保在藥品這個問題上當然有大問題,我們也認為核價這件事情應該有更合理的彈性。但是,大家是否清楚,在台灣,醫師開處方箋過度浮濫(順應病人要求)、病人的部分負擔太輕(上限NT$200)、各醫療院所為相同病人開立重複藥物、病人持處方箋取藥後未服用而廢棄之比例過高等的情事,已經造成台灣健保藥費在健保總支出上占有25%的比例。

我們再看看這篇WSJ報導:

Specialty medications for ills such as cancer and multiple sclerosis are so pricey that despite making up only about 1% of prescription volume at the University of Minnesota, they account for 28% of its drug costs, said Kenneth Horstman, director of benefits and compensation. Pharmacy costs are about 17% of its health plan’s spending, up from less than 14% in 2013

明尼蘇達大學給其現任及退休教職員與家屬(約39,000人)的醫療保險中,支付癌症和多發性硬化症的藥,雖然僅占處方箋的1%,但卻拿走了28%的藥費。2013年,藥費占全部醫療開支的14%,到2014已經到了17%,而17%,已讓老美陷入困境。

Another increasingly common strategy is “step therapy,” which requires that patients to be treated with lower-cost drugs before the health plan will pay for a more expensive option. This year, about 69% of employers had step-therapy rules, compared with 56% in 2011…

藥價年成長幅度近10%,高於其他醫療支出之成長幅度一倍。因此,愈來愈多的美國醫保方案,要求採用漸進式治療,也就是只准醫生處方箋上先開低價藥(否則不准核銷),如果無效才能再開較貴的藥品。2011年時只有56%的雇主採用這種模式的醫保,今年,升到69%。http://www.wsj.com/articles/employers-battle-drug-costs-1450488416

當然,還有其他措施,比方說提高病人必須自付的藥費的部分負擔。明尼蘇達大學已將最高上限調到了USD75,等於台幣$2,400,是台灣健保藥費部分負擔的12倍。

藥價與醫療保險政策,不是僅需搞定藥廠金援就可輕易解套。