研析美國降低通貨膨脹法中處方藥價管制與聯邦醫療保險改革之政策及影響

Analyzing the Policy and Impacts related to Prescription Drug Pricing Controls and Medicare Reform in the U.S. Inflation Reduction Act

目前世界國家因人口老化問題導致醫療及照護需求激增，而且大多數這些情況是不可逆轉的，連帶造成國家整體健康照護體系的負擔沈重。許多國家目前正積極透過新的政策來強化法定健康照護保險的可持續性，尤其是健康照護支出長年居OECD榜首的美國。
美國高額藥價與聯邦醫療保險（Medicare）瀕臨破產的問題亦一向為美國民眾所詬病。這是因為美國的藥品是自由定價政策，政府不得干預，導致藥價愈漲愈烈之態勢，嚴重影響Medicare的可持續性。在此背景下，拜登總統於2022年8月16日簽署了《降低通貨膨脹法》（Inflation Reduction Act, IRA），其中的《副標題B——處方藥定價改革》（Subtitle B—Prescription Drug Pricing Reform）從多個面向進行藥價管制與聯邦醫療保險調整，又被稱為「美國的新處方藥法」（new prescription drug law）。
IRA旨在透過藥價談判、通膨補貼、減少Medicare受益人自付費用、其他與藥價可負擔能力和近用性相關措施等政策以提高健康平權，預期將對法定健康照護保險的藥價支出與成本管控有所影響，其他國家的政府單位也可能參考美國的政策檢視自身之法定健康照護保險的政策走向。因此，本文擬透過研析IRA的藥價管制與聯邦醫療保險政策變化，從中找出美國相關經驗作為我國相關政策發展之參考。

Aging population in the world have caused an increasing surge in medical and healthcare demands, and most of these conditions are irreversible, resulting in huge burden on healthcare system. Many countries are actively adopting new policies to strengthen the sustainability of statutory health insurance, especially the United States, which has ranked first in the OECD for health care expenditures for many years.
U.S.'s high prescription drug prices and Medicare's enormous financial challenge have been criticized by the Americans. This is because the drug pricing mechanism in U.S. is free market pricing principles and the government is not allowed to intervene. As a result, drug prices are rising more and more, seriously affecting the sustainability of Medicare. Under this background, President Joe Biden signed the Inflation Reduction Act (IRA) on August 16, 2022, of which ''Subtitle B—Prescription Drug Pricing Reform''carries out drug price controls and Medicare adjustments from multiple aspects, also known as the ''new prescription drug law in the United States.'' After the launch of IRA, it is expected to have an impact on many aspects, such reorganization of related industries, adjustment of drug price expenditures and statutory health insurance costs, and other countries's reference on health policies. Therefore, this article intends to analyze IRA's drug price control and changes in Medicare policies to find out the relevant experience in the United States as a reference for rethinking and developing relevant policies in Taiwan.