医疗保险新药品定价机制的局限性特朗普政府推出了新的医疗保险支付机制，旨在降低在医生诊所使用的药品价格，使其与海外国家的药品价格保持一致。© Nam Y. Huh, 美联社特朗普总统将降低药品价格作为其政府医疗可负担性政策的核心内容。根据“全球高效药品定价标准”（GLOBE）机制，如果药品价格超过某些国家的定价水平，制药公司必须向政府支付回扣。
Medicare de-fangs new drug pricing model The Trump administration rolled out the final version of a new Medicare payment model aimed at lowering the prices of drugs administered in doctors’ offices to match those paid in countries overseas. © Nam Y. Huh, Associated Press President Trump has made lower drug prices a signature part of his administration’s affordability agenda. The Global Benchmark for Efficient Drug Pricing (GLOBE) model requires drug companies to offer a rebate if a price exceeds rates in certain countries.
然而，最终实施的版本在具体规定上大幅放宽了最初提出的要求。据估计，该机制在七年内仅能节省4.4亿美元——远低于最初预计的120亿美元。虽然这一支付机制具有强制性，但存在大量豁免条款；其中最显著的豁免条件是：如果制药公司与白宫达成了针对Medicaid项目的“最惠国”定价协议。最终，只有三家制药公司受到该机制的约束，而最初预计受影响的制药公司数量约为40家。
But the final version is significantly scaled back from when it was first proposed. It’s now estimated that the GLOBE model will save $440 million over seven years — a 96 percent reduction from the proposed version, which estimated nearly $12 billion in savings over the same period. The payment model is mandatory, but there is a myriad of exemptions, most notably if a company entered a separate deal with the White House for “most-favored-nation” pricing in Medicaid. In the end, only three companies are covered by the final model, a decrease from about 40 firms estimated in the proposed rule.
药品行业顾问布莱恩·里德（Brian Reid）在周三写道：“政府制定的这一机制几乎不会对任何药品产生实际影响，也几乎无法实现任何成本节约。”
“The government has crafted it in such a way that it will touch almost no drugs and deliver almost no savings,” drug industry consultant Brian Reid wrote Wednesday.
要符合GLOBE机制的资格，一款药品每年在传统医疗保险（Medicare Part B）中的支出必须超过1亿美元。然而，最终实施的版本仅覆盖少数几种药品；美国医疗保险和医疗补助服务中心（CMS）估计，符合条件的药品中，仅有不到1%的支出会受到该机制的影响。
To qualify for GLOBE, a drug must account for more than $100 million in traditional Medicare Part B spending per year. The final version of the model only covers a handful of drugs; Centers for Medicare and Medicaid Services (CMS) now estimates that less than 1 percent of eligible Part B drug spending is initially targeted by GLOBE.
CMS局长梅赫梅特·奥兹（Mehmet Oz）在一份声明中表示：“我们的目标不仅仅是承诺降低医疗成本，而是通过试点新方法来降低成本、提高医疗质量，并同时保护医疗创新。”
“At CMS, we’re focused on more than promises to make healthcare more affordable — we’re taking action to pilot a new approach to lower costs and strengthen the quality of care while preserving medical innovation,” CMS Administrator Mehmet Oz said in a statement.
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