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\"因\", \"start\": 567.918, \"end\": 568.098, \"score\": 0.879}, {\"word\": \"為\"}, {\"word\": \"絕\"}, {\"word\": \"對\"}, {\"word\": \"不\", \"start\": 568.098, \"end\": 568.138, \"score\": 0.503}, {\"word\": \"能\", \"start\": 568.138, \"end\": 568.178, \"score\": 0.502}, {\"word\": \"讓\"}, {\"word\": \"我\", \"start\": 568.178, \"end\": 568.218, \"score\": 0.492}, {\"word\": \"們\"}, {\"word\": \"的\", \"start\": 568.218, \"end\": 568.298, \"score\": 0.75}, {\"word\": \"國\"}, {\"word\": \"人\", \"start\": 568.298, \"end\": 568.338, \"score\": 0.498}, {\"word\": \"有\", \"start\": 568.338, \"end\": 568.458, \"score\": 0.897}, {\"word\": \"缺\", \"start\": 568.458, \"end\": 568.558, \"score\": 0.801}, {\"word\": \"藥\"}, {\"word\": \"的\", \"start\": 568.558, \"end\": 568.638, \"score\": 0.577}, {\"word\": \"現\"}, {\"word\": \"象\", \"start\": 568.638, \"end\": 568.658, \"score\": 0.0}]}, {\"start\": 574.48, \"end\": 599.796, \"text\": \"國家的調整過程 大家都知道嘛 專家共理會然後等等 這個他們是根據過去財務的狀況來分析嘛這個署長 如果您自己不到這個委員會裡面說按照法規的一個從寬來處理或是說 因為他們習慣 我在那邊太久了嘛習慣用這個財務衝擊嘛總共我要花多少錢來決定要不要這個速度跟委員報告 我們都在做改善你發了這個文\", \"words\": [{\"word\": \"國\"}, {\"word\": \"家\", \"start\": 574.48, \"end\": 574.64, \"score\": 0.864}, {\"word\": \"的\", \"start\": 574.64, \"end\": 574.98, \"score\": 0.907}, {\"word\": \"調\"}, {\"word\": \"整\", \"start\": 574.98, \"end\": 575.381, \"score\": 0.896}, {\"word\": \"過\"}, {\"word\": \"程\", \"start\": 575.381, \"end\": 575.781, \"score\": 0.851}, {\"word\": \"大\", \"start\": 575.781, \"end\": 575.801, \"score\": 0.864}, {\"word\": \"家\", \"start\": 575.801, \"end\": 575.961, \"score\": 0.874}, {\"word\": \"都\", \"start\": 575.961, \"end\": 576.081, \"score\": 0.896}, {\"word\": \"知\", \"start\": 576.081, \"end\": 576.101, \"score\": 0.001}, {\"word\": \"道\", \"start\": 576.101, \"end\": 576.221, \"score\": 0.805}, {\"word\": \"嘛\", \"start\": 576.221, \"end\": 576.661, \"score\": 0.898}, {\"word\": \"專\"}, {\"word\": \"家\", \"start\": 576.661, \"end\": 576.982, \"score\": 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599.796, \"score\": 0.555}]}, {\"start\": 601.737, \"end\": 626.956, \"text\": \"這個我們現在是這樣子今年呢我們在要價正式調整是4月1號所以我們在3月初就會發函給所有的這個廠商有調價的廠商廠商如果提出他有要價不符我們就會凍結所以在4月1號就不會調然後之後我們在審視他的合理成本之後才正式做最後的調整所以我們這個就是所謂的即時反應的\", \"words\": [{\"word\": \"這\"}, {\"word\": \"個\"}, {\"word\": \"我\", \"start\": 601.737, \"end\": 602.138, \"score\": 0.794}, {\"word\": \"們\"}, {\"word\": \"現\"}, {\"word\": \"在\", \"start\": 602.138, \"end\": 602.378, \"score\": 0.934}, {\"word\": \"是\", \"start\": 602.378, \"end\": 602.738, \"score\": 0.845}, {\"word\": \"這\"}, {\"word\": \"樣\"}, {\"word\": \"子\", \"start\": 602.738, \"end\": 603.018, \"score\": 0.95}, {\"word\": \"今\", \"start\": 603.018, \"end\": 603.238, \"score\": 0.949}, {\"word\": \"年\", \"start\": 603.238, \"end\": 603.479, \"score\": 0.99}, {\"word\": \"呢\", \"start\": 603.479, \"end\": 603.719, \"score\": 0.915}, {\"word\": \"我\", \"start\": 603.719, \"end\": 604.099, \"score\": 0.926}, {\"word\": \"們\"}, {\"word\": \"在\", \"start\": 604.099, \"end\": 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{\"word\": \"謝\"}, {\"word\": \"謝\"}, {\"word\": \"陳\"}, {\"word\": \"委\", \"start\": 893.317, \"end\": 893.638, \"score\": 0.933}, {\"word\": \"員\"}, {\"word\": \"謝\"}, {\"word\": \"謝\"}, {\"word\": \"部\", \"start\": 893.638, \"end\": 893.658, \"score\": 0.0}, {\"word\": \"長\"}], \"language\": \"zh\"}","srt":"1\n00:00:05,771 --> 00:00:06,554\n謝謝主席有請邱部長\n\n2\n00:00:15,583 --> 00:00:33,010\n部長川普總統他已經宣布就是說進口藥品他要分階段分階段來課徵最高達250%的一個關稅他也要求實際下跨國的藥廠他要在美國市場要提供全球最低價所謂的最惠國這個藥價\n\n3\n00:00:34,671 --> 00:00:51,793\n那根據這個楊交大的康兆周教授分析關稅本身未必直接會衝擊台灣的藥品的價格但是會衝擊剛剛您也報告到出口美國的學名藥廠商那尤其是這個在臨床上比較容易取代的相對也是低價的這個品項\n\n4\n00:00:52,794 --> 00:01:19,504\n那當然你也提到這個原料藥那其實台灣的原料品質很好但是因為他的相對價格高一點所以這個又不是經濟規模的生產敵不過那個印度啊中國這個原料大廠所以他大部分就是90%以外銷為主那美國又排在前幾名其實還是有很大的影響那台大醫院余中仁院長也提醒高關稅可能造成加速這個全球叫做碎片化這個是名詞\n\n5\n00:01:20,524 --> 00:01:39,121\n那藥廠會針對不同的市場做獨立的定價跟供貨策略那台灣是小市場啊台灣是小市場啊很難獲得這個優先供應那雖然我國目前對藥品是採取零關稅但是美國政策本身可能會這個對於改變各國各個藥廠他在全國的這個佈局全世界的佈局\n\n6\n00:01:44,185 --> 00:02:01,880\n那間接就會影響在台灣的這個藥價或供貨穩定性因為這個是遷移法動全身那部長就是我上述這些觀點您同意嗎您對這個關稅藥品要加上這個關稅的部分您做了美國的關稅的部分您做了影響評估嗎影響的評估\n\n7\n00:02:05,734 --> 00:02:22,823\n我想我們一直都在做影響評估那謝謝委員提供這麼專業跟精闢的一個分析我們不管是在確保台灣的一個藥品穩定的供應的策略\n\n8\n00:02:23,909 --> 00:02:44,030\n以及因為他隨著他關稅的一個可能的變化我們也都有相應相對應的一個對策這樣好了我們來具體來談幾個點我知道也許您不是很喜歡這樣聽但是我還是要講台灣藥品的這個供應的脆弱點\n\n9\n00:02:45,251 --> 00:03:14,097\n並不在於一定在於國際的供應鏈的一個變動那事實上健保還是有一些相當的影響長期是壓低藥價的那當然是來自財務的問題長期壓低藥價缺乏韌性的管理我們一點一點來討論第一個健保砍價跟缺藥其實是個惡性循環那藥價這個長期往下修導致國內的這個國內外廠商其實都會退出這個低價市場那已經達到地板價的這個藥品很容易缺貨請問健保署\n\n10\n00:03:14,717 --> 00:03:43,743\n你有因應措施嗎就是我先就這一點來談砍價跟缺藥其實是惡性循環那個委員所關心的這件事情也是大家所關心的啦因為我們一定要讓我們的藥廠能夠在地製造能夠在地製造而且要鼓勵的一個措施因為藥價一直砍所以這一年來其實在健保署也做了很多的措施來扶植在藥價的合理性有做\n\n11\n00:03:44,403 --> 00:04:10,757\n很多的一個改善但是缺貨還是在啊署長你的因應措施是什麼跟委員報告有一些是屬於到地板價的我們在健保上都有保護的措施不在下調那這些所謂到達地板價的多屬於這個學民藥或者是OTC或者是在國內生產為主所以我們有相對的這個政策那你允許他們有一些申訴的管道嗎\n\n12\n00:04:11,357 --> 00:04:38,833\n有有有我们都可以来提高这个像我们过去的这个发生者点滴的事件那么我们也调高了他的要价你说我保护他但是事实上相对他们的感受呢就是说我们都有调整要价的机制不是只有往下调也有往上调我们过去这一年就调高了200项所以他是你只要合理的成本提出来之后呢我们是可以调整的\n\n13\n00:04:39,133 --> 00:04:58,447\n我知道你也允許他們來申請條帳如果是因為這些尤其是關稅這些影響那你知道要多少時間嗎從他的申請到共理會然後到生肖你估大概要多少時間如果他有我們應該這樣講在我們的這個基本的藥品裡面呢我們都有預警制度說如果你要\n\n14\n00:04:59,147 --> 00:05:16,081\n可能会有缺药的情形你六个月之前就应该要来通报所以他要提前来提那么另外一个当然就是你调整要提高药价我们有的程序所以这个应该我们都会试他的这个紧急情形跟必要情形\n\n15\n00:05:16,641 --> 00:05:34,657\n那你目前有簡單的數據說這些申請調漲的廠商他被通過允許通過的我們也有一些特殊的情形下他可以跳過這個共理會我們上次在點滴的處理的事情都是當周就決定了\n\n16\n00:05:35,697 --> 00:06:04,443\n點滴實在是太一個沉痛的教訓了這是第一個砍價的問題第二個全球供應的優先次序台灣處比劣勢吧你同意吧因為當跨國藥廠面臨美國的降價壓力他可以有其他方法他其他國家漲價或是說他減量供應減量供應台灣為什麼台灣市場小嘛你給價又給的低啊大家台灣的藥價是有名的低啊那你常常被排在這個次次藥跟次次藥那個藥廠所謂的第三波啊\n\n17\n00:06:05,323 --> 00:06:25,069\n就是說這個是一個不容這個來這個否定的一個現實但是我要請問健保署你知道藥品他要經歷所謂MBAMBA就是收窄這個價量的一個協議嘛那又有PVA用量高你又要跟他跟他要求他有一些的這個回饋還有今年的藥價差這個藥價差已經高達30%那未來你要依據國際最低價來去調整它\n\n18\n00:06:30,791 --> 00:06:45,416\n那請問署長你有信心台灣的市場藥品市場不會被邊緣化嗎國外人會不會將來用不到先進的藥品我想跟委員報告我們也不需要太我們當然要戒慎恐懼但是也不需要妄自菲薄\n\n19\n00:06:46,056 --> 00:07:09,121\n那麼台灣在相對於許多的國家還是相當具有競爭力那麼以在整個亞洲來講呢那我們的全民健保明年呢就已經趨近兆元所以在這個健保的支出上具有相當的這個一致性的溢價能力啦跟當初是不一樣我講的是先進藥品國產的是一個基礎\n\n20\n00:07:10,422 --> 00:07:24,420\n對那先進藥品也是一樣我們很多的先進藥品在亞洲很多國家沒有禁我們也禁了所以這個是健保因為這個全民健保的是一個單一的保險人的制度所以它具有這樣的\n\n21\n00:07:25,061 --> 00:07:44,779\n我们是第三波先要发明我们是第三波才引进那两位首长就药价差的问题一直百烂不处理现在每年700亿我现在要谈的就是说医师开方如果跟药价差扣连在一起其实这是很不恰当之前我有提到中部的一些医学中心它已经开始有所谓的索药\n\n22\n00:07:47,322 --> 00:07:58,615\n鎖黨正是在開放的時候提醒醫師就是某些是藥價差利潤比較好的藥品這件事情部長你怎麼看這個是好的醫療行為嗎利用藥價差來扣連醫師處方那這個會影響病人權益啊\n\n23\n00:08:01,638 --> 00:08:19,966\n我想我們非常非常不同意的一個用管理的機制來影響到病人的權益跟醫療的專業部長他存在啊他存在啊而且越來越多人效法因為沒有去處理啊我想我們是不容許這樣的情況\n\n24\n00:08:21,787 --> 00:08:41,173\n醫學中心是表率醫院的醫學中心率先這麼多其他醫院當然效仿啊如果讓民眾都知道原來是靠藥價差的利率因為你給付的不夠嘛有一些可以檢討的我是相信協大多數的醫院是不會去影響到醫師的專業的一個潛力啦這個部分很容易被醫師法定出來\n\n25\n00:08:42,133 --> 00:09:02,207\n今年6月6號有給工協會寫函第4點提到因為美國對等關稅政策以盤點相關的健保用藥廠商若因為關稅問題依法可以提出價格調整建議必要時本署將爭取額外你剛才有提到額外的預算來指引來及時反映市場價格調整這個要價這是針對關稅的這個部分請問這個及時部長請您回答部長這個及時是多久\n\n26\n00:09:06,030 --> 00:09:28,658\n您給的函啊您說要及時反映藥品市場價格而且是因應關稅問題您覺得這個及時多久要花多少時間我想在健保的總預算裡面我想委員長期擔任過相關的一個委員都很清楚我們有一個風險的相關的基金這個是隨時可以用因為絕對不能讓我們的國人有缺藥的現象\n\n27\n00:09:34,480 --> 00:09:59,796\n國家的調整過程大家都知道嘛專家共理會然後等等這個他們是根據過去財務的狀況來分析嘛這個署長如果您自己不到這個委員會裡面說按照法規的一個從寬來處理或是說因為他們習慣我在那邊太久了嘛習慣用這個財務衝擊嘛總共我要花多少錢來決定要不要這個速度跟委員報告我們都在做改善你發了這個文\n\n28\n00:10:01,737 --> 00:10:26,956\n這個我們現在是這樣子今年呢我們在要價正式調整是4月1號所以我們在3月初就會發函給所有的這個廠商有調價的廠商廠商如果提出他有要價不符我們就會凍結所以在4月1號就不會調然後之後我們在審視他的合理成本之後才正式做最後的調整所以我們這個就是所謂的即時反應的\n\n29\n00:10:27,196 --> 00:10:48,250\n我才請教您說到底最後通過多少專家還是不給啊因為你們過去就是教專家要怎麼看預算啊你從來不會去看關稅銀行現在都是在看成本我們看成本你現在有改變一點點做法嗎您的向前一直沒有下達據我瞭解哦您的向前沒有下達你在這邊承諾我的常常都沒有出現在真正審議的委員會哦好那我想說這次我們對於關稅還在未以籌謀幾個點請再跟首長分享供應鏈的這個\n\n30\n00:10:58,197 --> 00:11:15,285\n評估跟預警剛剛你有提到是不是報告你已經有盤點了嗎國內用藥仰賴跨國供應你不能否認這一塊那這個關鍵藥品你有做了什麼處置嗎有提前通報嗎就是關鍵藥品過去比較沒有處理這一塊那避免出現突發性的缺藥這是第一點\n\n31\n00:11:17,546 --> 00:11:36,234\n那第二點要價差的部分我還是請大家不要我是希望署長您要根據這個不同生命週期的譬如說它是單元單一來源的譬如說它是必要藥品譬如說它已經靠近這個地板價還有過專利商品你可以有不同的類型的藥品它的要價差\n\n32\n00:11:37,194 --> 00:11:55,876\n我希望你已經有這個數字我希望你兩週內給我這個數字可以嗎你有要價差你有強大的電腦你一直在收集這個採購價格我想知道說這不同類別不同類別的要價差有什麼樣的不同樣態不同那我們再來研究討論怎麼來處理這些事情署長你可以給我這個資料嗎\n\n33\n00:11:58,659 --> 00:12:11,787\n我剛剛提到的是很中性的東西這個我們把整個因為這裡有些會涉及到廠商的商業機密你又來了所以我們可以把整體的統計的資料大概沒有辦法給個別的item\n\n34\n00:12:13,908 --> 00:12:30,498\n两周可以吗两周到办公室可以因为我们可以制定根据不同类型去制定不同的管制力道这个是你管理对这个很重要避免那个要价被边缘化那国产药品的部分我觉得不只是考虑那个价格你要考虑那个量你如果平常没有给他那个量\n\n35\n00:12:31,218 --> 00:12:51,094\n那到時候有缺的時候他也供應不來嘛生理食鹽水永風的就是一個非常慘痛的這個教訓所以到底這個部分給量的部分你要怎麼處理所以是不是要考慮這個過專利企業品在醫院是要並存的就是說他平常要有一些市場的一些保障那當然定型化企業或許可以保障量而不是重點\n\n36\n00:12:51,414 --> 00:13:19,383\n不只是保障價格因為它沒有量到時候就沒有辦法配合國家的政策來供應所以我覺得這個是一個非常重要的時機所以你一旦不但要保護國產藥品那當然你要兼顧輸入藥的一些公平性當然剛剛也提到要鼓勵本土廠商要做一些比較研發性的一些產品那我要講說兩位署長江署長跟石署長您在這個國會殿堂上你們已經握過手了\n\n37\n00:13:20,163 --> 00:13:43,414\n手牽手了對不對我一直說上游跟下游要合作嘛你們手牽手了應該有進一步的關係發展吧有他們兩個有繼續做嗎兩個非常密切的合作進一步發展是什麼那我最後再提一個就是讓部長也一起瞭解台灣有幾家藥廠我們要鼓勵本土保護本土台灣有幾家本土藥廠你現在說出來等一下說不出來\n\n38\n00:13:46,638 --> 00:14:11,565\n報告委員我們這邊現在國內的製劑廠300家然後我們的原料廠呢有將近有40家左右那整體來講剛才委員特別提到工藝任性任性的部分我們其實在今年度特別針對二月份做所謂的必要藥品的部分我們其實有做幾百家藥廠你可以想台灣這麼小他在國內就自己在那邊競爭就自相殘殺嘛\n\n39\n00:14:12,845 --> 00:14:39,088\n所以一定要做一些事情有時候我們要去做一些比較長遠的事情嘛大家都沒有辦法走出去所以我們也希望我們台灣的藥廠可以打國際盃啊不是在台內國內搶市場啊這也是我們在省醫療法的精神啊你如果生技產業都集中在台灣那你應該讓他出去嘛走出去嘛我們其實在二月份我onboard之後其實跟學名藥廠原廠藥廠生物利用藥廠各類的其實做了很多的公協會的\n\n40\n00:14:40,149 --> 00:14:53,658\n陸陸續續extension下去我們持續在努力當中兩位要牽手的署長相對年輕我想你們在這個你們職場上還很有可為啦希望你們做的事情是比較長遠的一些事情啦好謝謝謝謝主席好謝謝陳委員謝謝部長\n\n","tsv":"start\tend\ttext\n5771\t6554\t謝謝主席 有請邱部長\n15583\t33010\t部長 川普總統他已經宣布就是說進口藥品他要分階段分階段來課徵最高達250%的一個關稅他也要求實際下跨國的藥廠他要在美國市場要提供全球最低價所謂的最惠國這個藥價\n34671\t51793\t那根據這個楊交大的康兆周教授分析關稅本身未必直接會衝擊台灣的藥品的價格但是會衝擊剛剛您也報告到出口美國的學名藥廠商那尤其是這個在臨床上比較容易取代的相對也是低價的這個品項\n52794\t79504\t那當然你也提到這個原料藥那其實台灣的原料品質很好但是因為他的相對價格高一點所以這個又不是經濟規模的生產敵不過那個印度啊中國這個原料大廠所以他大部分就是90%以外銷為主那美國又排在前幾名其實還是有很大的影響那台大醫院余中仁院長也提醒高關稅可能造成加速這個全球叫做碎片化這個是名詞\n80524\t99121\t那藥廠會針對不同的市場做獨立的定價跟供貨策略那台灣是小市場啊台灣是小市場啊很難獲得這個優先供應那雖然我國目前對藥品是採取零關稅但是美國政策本身可能會這個對於改變各國各個藥廠他在全國的這個佈局全世界的佈局\n104185\t121880\t那間接就會影響在台灣的這個藥價或供貨穩定性因為這個是遷移法動全身那部長就是我上述這些觀點您同意嗎您對這個關稅藥品要加上這個關稅的部分您做了美國的關稅的部分您做了影響評估嗎影響的評估\n125734\t142823\t我想我們一直都在做影響評估那謝謝委員提供這麼專業跟精闢的一個分析我們不管是在確保台灣的一個藥品穩定的供應的策略\n143909\t164030\t以及因為他隨著他關稅的一個可能的變化我們也都有相應相對應的一個對策這樣好了我們來具體來談幾個點我知道也許您不是很喜歡這樣聽但是我還是要講台灣藥品的這個供應的脆弱點\n165251\t194097\t並不在於一定在於國際的供應鏈的一個變動那事實上健保還是有一些相當的影響長期是壓低藥價的那當然是來自財務的問題長期壓低藥價缺乏韌性的管理我們一點一點來討論第一個健保砍價跟缺藥其實是個惡性循環那藥價這個長期往下修導致國內的這個國內外廠商其實都會退出這個低價市場那已經達到地板價的這個藥品很容易缺貨請問健保署\n194717\t223743\t你有因應措施嗎就是我先就這一點來談砍價跟缺藥其實是惡性循環那個委員所關心的這件事情也是大家所關心的啦因為我們一定要讓我們的藥廠能夠在地製造能夠在地製造而且要鼓勵的一個措施因為藥價一直砍所以這一年來其實在健保署也做了很多的措施來扶植在藥價的合理性有做\n224403\t250757\t很多的一個改善 但是缺貨還是在啊署長你的因應措施是什麼跟委員報告 有一些是屬於到地板價的我們在健保上都有保護的措施不在下調那這些所謂到達地板價的多屬於這個學民藥或者是OTC或者是在國內生產為主所以我們有相對的這個政策那你允許他們有一些申訴的管道嗎\n251357\t278833\t有有有我们都可以来提高这个像我们过去的这个发生者点滴的事件那么我们也调高了他的要价你说我保护他但是事实上相对他们的感受呢就是说我们都有调整要价的机制不是只有往下调也有往上调我们过去这一年就调高了200项所以他是你只要合理的成本提出来之后呢我们是可以调整的\n279133\t298447\t我知道你也允許他們來申請條帳如果是因為這些尤其是關稅這些影響那你知道要多少時間嗎從他的申請到共理會然後到生肖你估大概要多少時間如果他有我們應該這樣講在我們的這個基本的藥品裡面呢我們都有預警制度說如果你要\n299147\t316081\t可能会有缺药的情形你六个月之前就应该要来通报所以他要提前来提那么另外一个当然就是你调整要提高药价我们有的程序所以这个应该我们都会试他的这个紧急情形跟必要情形\n316641\t334657\t那你目前有簡單的數據說這些申請調漲的廠商他被通過 允許通過的我們也有一些特殊的情形下他可以跳過這個共理會我們上次在點滴的處理的事情都是當周就決定了\n335697\t364443\t點滴實在是太一個沉痛的教訓了這是第一個 砍價的問題第二個 全球供應的優先次序台灣處比劣勢吧 你同意吧因為當跨國藥廠面臨美國的降價壓力他可以有其他方法他其他國家漲價或是說他減量供應減量供應台灣為什麼 台灣市場小嘛你給價又給的低啊大家台灣的藥價是有名的低啊那你常常被排在這個次次藥跟次次藥那個藥廠所謂的第三波啊\n365323\t385069\t就是說這個是一個不容這個來這個否定的一個現實但是我要請問健保署你知道藥品他要經歷所謂MBAMBA就是收窄這個價量的一個協議嘛那又有PVA用量高你又要跟他跟他要求他有一些的這個回饋還有今年的藥價差這個藥價差已經高達30%那未來你要依據國際最低價來去調整它\n390791\t405416\t那請問署長你有信心台灣的市場藥品市場不會被邊緣化嗎國外人會不會將來用不到先進的藥品我想跟委員報告我們也不需要太我們當然要戒慎恐懼但是也不需要妄自菲薄\n406056\t429121\t那麼台灣在相對於許多的國家還是相當具有競爭力那麼以在整個亞洲來講呢那我們的全民健保明年呢就已經趨近兆元所以在這個健保的支出上具有相當的這個一致性的溢價能力啦跟當初是不一樣我講的是先進藥品國產的是一個基礎\n430422\t444420\t對 那先進藥品也是一樣我們很多的先進藥品在亞洲很多國家沒有禁我們也禁了所以這個是健保因為這個全民健保的是一個單一的保險人的制度所以它具有這樣的\n445061\t464779\t我们是第三波先要发明我们是第三波才引进那两位首长就药价差的问题一直百烂不处理现在每年700亿我现在要谈的就是说医师开方如果跟药价差扣连在一起其实这是很不恰当之前我有提到中部的一些医学中心它已经开始有所谓的索药\n467322\t478615\t鎖黨 正是在開放的時候提醒醫師就是某些是藥價差 利潤比較好的藥品這件事情部長你怎麼看這個是好的醫療行為嗎利用藥價差來扣連醫師處方那這個會影響病人權益啊\n481638\t499966\t我想我們非常非常不同意的一個用管理的機制來影響到病人的權益跟醫療的專業部長他存在啊 他存在啊而且越來越多人效法因為沒有去處理啊我想我們是不容許這樣的情況\n501787\t521173\t醫學中心是表率醫院的醫學中心率先這麼多其他醫院當然效仿啊如果讓民眾都知道原來是靠藥價差的利率因為你給付的不夠嘛有一些可以檢討的我是相信協大多數的醫院是不會去影響到醫師的專業的一個潛力啦這個部分很容易被醫師法定出來\n522133\t542207\t今年6月6號有給工協會寫函第4點提到因為美國對等關稅政策以盤點相關的健保用藥廠商若因為關稅問題依法可以提出價格調整建議必要時本署將爭取額外你剛才有提到額外的預算來指引來及時反映市場價格調整這個要價這是針對關稅的這個部分請問這個及時部長請您回答部長這個及時是多久\n546030\t568658\t您給的函啊 您說要及時反映藥品市場價格而且是因應關稅問題您覺得這個及時多久 要花多少時間我想在健保的總預算裡面我想委員長期擔任過相關的一個委員都很清楚我們有一個風險的相關的基金這個是隨時可以用因為絕對不能讓我們的國人有缺藥的現象\n574480\t599796\t國家的調整過程 大家都知道嘛 專家共理會然後等等 這個他們是根據過去財務的狀況來分析嘛這個署長 如果您自己不到這個委員會裡面說按照法規的一個從寬來處理或是說 因為他們習慣 我在那邊太久了嘛習慣用這個財務衝擊嘛總共我要花多少錢來決定要不要這個速度跟委員報告 我們都在做改善你發了這個文\n601737\t626956\t這個我們現在是這樣子今年呢我們在要價正式調整是4月1號所以我們在3月初就會發函給所有的這個廠商有調價的廠商廠商如果提出他有要價不符我們就會凍結所以在4月1號就不會調然後之後我們在審視他的合理成本之後才正式做最後的調整所以我們這個就是所謂的即時反應的\n627196\t648250\t我才請教您說到底最後通過多少專家還是不給啊因為你們過去就是教專家要怎麼看預算啊你從來不會去看關稅銀行現在都是在看成本我們看成本你現在有改變一點點做法嗎您的向前一直沒有下達據我瞭解哦您的向前沒有下達你在這邊承諾我的常常都沒有出現在真正審議的委員會哦好那我想說這次我們對於關稅還在未以籌謀幾個點請再跟首長分享供應鏈的這個\n658197\t675285\t評估跟預警剛剛你有提到是不是報告你已經有盤點了嗎國內用藥仰賴跨國供應你不能否認這一塊那這個關鍵藥品你有做了什麼處置嗎有提前通報嗎就是關鍵藥品過去比較沒有處理這一塊那避免出現突發性的缺藥這是第一點\n677546\t696234\t那第二點 要價差的部分我還是請大家不要我是希望署長您要根據這個不同生命週期的譬如說它是單元 單一來源的譬如說它是必要藥品譬如說它已經靠近這個地板價還有過專利商品你可以有不同的類型的藥品它的要價差\n697194\t715876\t我希望你已經有這個數字我希望你兩週內給我這個數字可以嗎你有要價差你有強大的電腦你一直在收集這個採購價格我想知道說這不同類別不同類別的要價差有什麼樣的不同樣態不同那我們再來研究討論怎麼來處理這些事情署長你可以給我這個資料嗎\n718659\t731787\t我剛剛提到的是很中性的東西這個我們把整個因為這裡有些會涉及到廠商的商業機密你又來了所以我們可以把整體的統計的資料大概沒有辦法給個別的item\n733908\t750498\t两周可以吗两周到办公室可以因为我们可以制定根据不同类型去制定不同的管制力道这个是你管理对这个很重要避免那个要价被边缘化那国产药品的部分我觉得不只是考虑那个价格你要考虑那个量你如果平常没有给他那个量\n751218\t771094\t那到時候有缺的時候他也供應不來嘛生理食鹽水永風的就是一個非常慘痛的這個教訓所以到底這個部分給量的部分你要怎麼處理所以是不是要考慮這個過專利企業品在醫院是要並存的就是說他平常要有一些市場的一些保障那當然定型化企業或許可以保障量而不是重點\n771414\t799383\t不只是保障價格因為它沒有量到時候就沒有辦法配合國家的政策來供應所以我覺得這個是一個非常重要的時機所以你一旦不但要保護國產藥品那當然你要兼顧輸入藥的一些公平性當然剛剛也提到要鼓勵本土廠商要做一些比較研發性的一些產品那我要講說兩位署長江署長跟石署長您在這個國會殿堂上你們已經握過手了\n800163\t823414\t手牽手了對不對 我一直說上游跟下游要合作嘛你們手牽手了應該有進一步的關係發展吧有 他們兩個有繼續做嗎兩個非常密切的合作進一步發展是什麼那我最後再提一個就是讓部長也一起瞭解台灣有幾家藥廠我們要鼓勵本土 保護本土 台灣有幾家本土藥廠你現在說出來 等一下說不出來\n826638\t851565\t報告委員我們這邊現在國內的製劑廠300家然後我們的原料廠呢有將近有40家左右那整體來講剛才委員特別提到工藝任性任性的部分我們其實在今年度特別針對二月份做所謂的必要藥品的部分我們其實有做幾百家藥廠你可以想台灣這麼小他在國內就自己在那邊競爭就自相殘殺嘛\n852845\t879088\t所以一定要做一些事情有時候我們要去做一些比較長遠的事情嘛大家都沒有辦法走出去所以我們也希望我們台灣的藥廠可以打國際盃啊不是在台內 國內搶市場啊這也是我們在省醫療法的精神啊你如果生技產業都集中在台灣那你應該讓他出去嘛 走出去嘛我們其實在二月份我on board之後其實跟學名藥廠 原廠藥廠生物利用藥廠各類的其實做了很多的公協會的\n880149\t893658\t陸陸續續extension下去 我們持續在努力當中兩位要牽手的署長相對年輕我想你們在這個你們職場上還很有可為啦希望你們做的事情是比較長遠的一些事情啦好 謝謝 謝謝主席好 謝謝陳委員 謝謝部長\n","txt":"謝謝主席 有請邱部長\n部長 川普總統他已經宣布就是說進口藥品他要分階段分階段來課徵最高達250%的一個關稅他也要求實際下跨國的藥廠他要在美國市場要提供全球最低價所謂的最惠國這個藥價\n那根據這個楊交大的康兆周教授分析關稅本身未必直接會衝擊台灣的藥品的價格但是會衝擊剛剛您也報告到出口美國的學名藥廠商那尤其是這個在臨床上比較容易取代的相對也是低價的這個品項\n那當然你也提到這個原料藥那其實台灣的原料品質很好但是因為他的相對價格高一點所以這個又不是經濟規模的生產敵不過那個印度啊中國這個原料大廠所以他大部分就是90%以外銷為主那美國又排在前幾名其實還是有很大的影響那台大醫院余中仁院長也提醒高關稅可能造成加速這個全球叫做碎片化這個是名詞\n那藥廠會針對不同的市場做獨立的定價跟供貨策略那台灣是小市場啊台灣是小市場啊很難獲得這個優先供應那雖然我國目前對藥品是採取零關稅但是美國政策本身可能會這個對於改變各國各個藥廠他在全國的這個佈局全世界的佈局\n那間接就會影響在台灣的這個藥價或供貨穩定性因為這個是遷移法動全身那部長就是我上述這些觀點您同意嗎您對這個關稅藥品要加上這個關稅的部分您做了美國的關稅的部分您做了影響評估嗎影響的評估\n我想我們一直都在做影響評估那謝謝委員提供這麼專業跟精闢的一個分析我們不管是在確保台灣的一個藥品穩定的供應的策略\n以及因為他隨著他關稅的一個可能的變化我們也都有相應相對應的一個對策這樣好了我們來具體來談幾個點我知道也許您不是很喜歡這樣聽但是我還是要講台灣藥品的這個供應的脆弱點\n並不在於一定在於國際的供應鏈的一個變動那事實上健保還是有一些相當的影響長期是壓低藥價的那當然是來自財務的問題長期壓低藥價缺乏韌性的管理我們一點一點來討論第一個健保砍價跟缺藥其實是個惡性循環那藥價這個長期往下修導致國內的這個國內外廠商其實都會退出這個低價市場那已經達到地板價的這個藥品很容易缺貨請問健保署\n你有因應措施嗎就是我先就這一點來談砍價跟缺藥其實是惡性循環那個委員所關心的這件事情也是大家所關心的啦因為我們一定要讓我們的藥廠能夠在地製造能夠在地製造而且要鼓勵的一個措施因為藥價一直砍所以這一年來其實在健保署也做了很多的措施來扶植在藥價的合理性有做\n很多的一個改善 但是缺貨還是在啊署長你的因應措施是什麼跟委員報告 有一些是屬於到地板價的我們在健保上都有保護的措施不在下調那這些所謂到達地板價的多屬於這個學民藥或者是OTC或者是在國內生產為主所以我們有相對的這個政策那你允許他們有一些申訴的管道嗎\n有有有我们都可以来提高这个像我们过去的这个发生者点滴的事件那么我们也调高了他的要价你说我保护他但是事实上相对他们的感受呢就是说我们都有调整要价的机制不是只有往下调也有往上调我们过去这一年就调高了200项所以他是你只要合理的成本提出来之后呢我们是可以调整的\n我知道你也允許他們來申請條帳如果是因為這些尤其是關稅這些影響那你知道要多少時間嗎從他的申請到共理會然後到生肖你估大概要多少時間如果他有我們應該這樣講在我們的這個基本的藥品裡面呢我們都有預警制度說如果你要\n可能会有缺药的情形你六个月之前就应该要来通报所以他要提前来提那么另外一个当然就是你调整要提高药价我们有的程序所以这个应该我们都会试他的这个紧急情形跟必要情形\n那你目前有簡單的數據說這些申請調漲的廠商他被通過 允許通過的我們也有一些特殊的情形下他可以跳過這個共理會我們上次在點滴的處理的事情都是當周就決定了\n點滴實在是太一個沉痛的教訓了這是第一個 砍價的問題第二個 全球供應的優先次序台灣處比劣勢吧 你同意吧因為當跨國藥廠面臨美國的降價壓力他可以有其他方法他其他國家漲價或是說他減量供應減量供應台灣為什麼 台灣市場小嘛你給價又給的低啊大家台灣的藥價是有名的低啊那你常常被排在這個次次藥跟次次藥那個藥廠所謂的第三波啊\n就是說這個是一個不容這個來這個否定的一個現實但是我要請問健保署你知道藥品他要經歷所謂MBAMBA就是收窄這個價量的一個協議嘛那又有PVA用量高你又要跟他跟他要求他有一些的這個回饋還有今年的藥價差這個藥價差已經高達30%那未來你要依據國際最低價來去調整它\n那請問署長你有信心台灣的市場藥品市場不會被邊緣化嗎國外人會不會將來用不到先進的藥品我想跟委員報告我們也不需要太我們當然要戒慎恐懼但是也不需要妄自菲薄\n那麼台灣在相對於許多的國家還是相當具有競爭力那麼以在整個亞洲來講呢那我們的全民健保明年呢就已經趨近兆元所以在這個健保的支出上具有相當的這個一致性的溢價能力啦跟當初是不一樣我講的是先進藥品國產的是一個基礎\n對 那先進藥品也是一樣我們很多的先進藥品在亞洲很多國家沒有禁我們也禁了所以這個是健保因為這個全民健保的是一個單一的保險人的制度所以它具有這樣的\n我们是第三波先要发明我们是第三波才引进那两位首长就药价差的问题一直百烂不处理现在每年700亿我现在要谈的就是说医师开方如果跟药价差扣连在一起其实这是很不恰当之前我有提到中部的一些医学中心它已经开始有所谓的索药\n鎖黨 正是在開放的時候提醒醫師就是某些是藥價差 利潤比較好的藥品這件事情部長你怎麼看這個是好的醫療行為嗎利用藥價差來扣連醫師處方那這個會影響病人權益啊\n我想我們非常非常不同意的一個用管理的機制來影響到病人的權益跟醫療的專業部長他存在啊 他存在啊而且越來越多人效法因為沒有去處理啊我想我們是不容許這樣的情況\n醫學中心是表率醫院的醫學中心率先這麼多其他醫院當然效仿啊如果讓民眾都知道原來是靠藥價差的利率因為你給付的不夠嘛有一些可以檢討的我是相信協大多數的醫院是不會去影響到醫師的專業的一個潛力啦這個部分很容易被醫師法定出來\n今年6月6號有給工協會寫函第4點提到因為美國對等關稅政策以盤點相關的健保用藥廠商若因為關稅問題依法可以提出價格調整建議必要時本署將爭取額外你剛才有提到額外的預算來指引來及時反映市場價格調整這個要價這是針對關稅的這個部分請問這個及時部長請您回答部長這個及時是多久\n您給的函啊 您說要及時反映藥品市場價格而且是因應關稅問題您覺得這個及時多久 要花多少時間我想在健保的總預算裡面我想委員長期擔任過相關的一個委員都很清楚我們有一個風險的相關的基金這個是隨時可以用因為絕對不能讓我們的國人有缺藥的現象\n國家的調整過程 大家都知道嘛 專家共理會然後等等 這個他們是根據過去財務的狀況來分析嘛這個署長 如果您自己不到這個委員會裡面說按照法規的一個從寬來處理或是說 因為他們習慣 我在那邊太久了嘛習慣用這個財務衝擊嘛總共我要花多少錢來決定要不要這個速度跟委員報告 我們都在做改善你發了這個文\n這個我們現在是這樣子今年呢我們在要價正式調整是4月1號所以我們在3月初就會發函給所有的這個廠商有調價的廠商廠商如果提出他有要價不符我們就會凍結所以在4月1號就不會調然後之後我們在審視他的合理成本之後才正式做最後的調整所以我們這個就是所謂的即時反應的\n我才請教您說到底最後通過多少專家還是不給啊因為你們過去就是教專家要怎麼看預算啊你從來不會去看關稅銀行現在都是在看成本我們看成本你現在有改變一點點做法嗎您的向前一直沒有下達據我瞭解哦您的向前沒有下達你在這邊承諾我的常常都沒有出現在真正審議的委員會哦好那我想說這次我們對於關稅還在未以籌謀幾個點請再跟首長分享供應鏈的這個\n評估跟預警剛剛你有提到是不是報告你已經有盤點了嗎國內用藥仰賴跨國供應你不能否認這一塊那這個關鍵藥品你有做了什麼處置嗎有提前通報嗎就是關鍵藥品過去比較沒有處理這一塊那避免出現突發性的缺藥這是第一點\n那第二點 要價差的部分我還是請大家不要我是希望署長您要根據這個不同生命週期的譬如說它是單元 單一來源的譬如說它是必要藥品譬如說它已經靠近這個地板價還有過專利商品你可以有不同的類型的藥品它的要價差\n我希望你已經有這個數字我希望你兩週內給我這個數字可以嗎你有要價差你有強大的電腦你一直在收集這個採購價格我想知道說這不同類別不同類別的要價差有什麼樣的不同樣態不同那我們再來研究討論怎麼來處理這些事情署長你可以給我這個資料嗎\n我剛剛提到的是很中性的東西這個我們把整個因為這裡有些會涉及到廠商的商業機密你又來了所以我們可以把整體的統計的資料大概沒有辦法給個別的item\n两周可以吗两周到办公室可以因为我们可以制定根据不同类型去制定不同的管制力道这个是你管理对这个很重要避免那个要价被边缘化那国产药品的部分我觉得不只是考虑那个价格你要考虑那个量你如果平常没有给他那个量\n那到時候有缺的時候他也供應不來嘛生理食鹽水永風的就是一個非常慘痛的這個教訓所以到底這個部分給量的部分你要怎麼處理所以是不是要考慮這個過專利企業品在醫院是要並存的就是說他平常要有一些市場的一些保障那當然定型化企業或許可以保障量而不是重點\n不只是保障價格因為它沒有量到時候就沒有辦法配合國家的政策來供應所以我覺得這個是一個非常重要的時機所以你一旦不但要保護國產藥品那當然你要兼顧輸入藥的一些公平性當然剛剛也提到要鼓勵本土廠商要做一些比較研發性的一些產品那我要講說兩位署長江署長跟石署長您在這個國會殿堂上你們已經握過手了\n手牽手了對不對 我一直說上游跟下游要合作嘛你們手牽手了應該有進一步的關係發展吧有 他們兩個有繼續做嗎兩個非常密切的合作進一步發展是什麼那我最後再提一個就是讓部長也一起瞭解台灣有幾家藥廠我們要鼓勵本土 保護本土 台灣有幾家本土藥廠你現在說出來 等一下說不出來\n報告委員我們這邊現在國內的製劑廠300家然後我們的原料廠呢有將近有40家左右那整體來講剛才委員特別提到工藝任性任性的部分我們其實在今年度特別針對二月份做所謂的必要藥品的部分我們其實有做幾百家藥廠你可以想台灣這麼小他在國內就自己在那邊競爭就自相殘殺嘛\n所以一定要做一些事情有時候我們要去做一些比較長遠的事情嘛大家都沒有辦法走出去所以我們也希望我們台灣的藥廠可以打國際盃啊不是在台內 國內搶市場啊這也是我們在省醫療法的精神啊你如果生技產業都集中在台灣那你應該讓他出去嘛 走出去嘛我們其實在二月份我on board之後其實跟學名藥廠 原廠藥廠生物利用藥廠各類的其實做了很多的公協會的\n陸陸續續extension下去 我們持續在努力當中兩位要牽手的署長相對年輕我想你們在這個你們職場上還很有可為啦希望你們做的事情是比較長遠的一些事情啦好 謝謝 謝謝主席好 謝謝陳委員 謝謝部長\n","vtt":"WEBVTT\n\n00:05.771 --> 00:06.554\n謝謝主席有請邱部長\n\n00:15.583 --> 00:33.010\n部長川普總統他已經宣布就是說進口藥品他要分階段分階段來課徵最高達250%的一個關稅他也要求實際下跨國的藥廠他要在美國市場要提供全球最低價所謂的最惠國這個藥價\n\n00:34.671 --> 00:51.793\n那根據這個楊交大的康兆周教授分析關稅本身未必直接會衝擊台灣的藥品的價格但是會衝擊剛剛您也報告到出口美國的學名藥廠商那尤其是這個在臨床上比較容易取代的相對也是低價的這個品項\n\n00:52.794 --> 01:19.504\n那當然你也提到這個原料藥那其實台灣的原料品質很好但是因為他的相對價格高一點所以這個又不是經濟規模的生產敵不過那個印度啊中國這個原料大廠所以他大部分就是90%以外銷為主那美國又排在前幾名其實還是有很大的影響那台大醫院余中仁院長也提醒高關稅可能造成加速這個全球叫做碎片化這個是名詞\n\n01:20.524 --> 01:39.121\n那藥廠會針對不同的市場做獨立的定價跟供貨策略那台灣是小市場啊台灣是小市場啊很難獲得這個優先供應那雖然我國目前對藥品是採取零關稅但是美國政策本身可能會這個對於改變各國各個藥廠他在全國的這個佈局全世界的佈局\n\n01:44.185 --> 02:01.880\n那間接就會影響在台灣的這個藥價或供貨穩定性因為這個是遷移法動全身那部長就是我上述這些觀點您同意嗎您對這個關稅藥品要加上這個關稅的部分您做了美國的關稅的部分您做了影響評估嗎影響的評估\n\n02:05.734 --> 02:22.823\n我想我們一直都在做影響評估那謝謝委員提供這麼專業跟精闢的一個分析我們不管是在確保台灣的一個藥品穩定的供應的策略\n\n02:23.909 --> 02:44.030\n以及因為他隨著他關稅的一個可能的變化我們也都有相應相對應的一個對策這樣好了我們來具體來談幾個點我知道也許您不是很喜歡這樣聽但是我還是要講台灣藥品的這個供應的脆弱點\n\n02:45.251 --> 03:14.097\n並不在於一定在於國際的供應鏈的一個變動那事實上健保還是有一些相當的影響長期是壓低藥價的那當然是來自財務的問題長期壓低藥價缺乏韌性的管理我們一點一點來討論第一個健保砍價跟缺藥其實是個惡性循環那藥價這個長期往下修導致國內的這個國內外廠商其實都會退出這個低價市場那已經達到地板價的這個藥品很容易缺貨請問健保署\n\n03:14.717 --> 03:43.743\n你有因應措施嗎就是我先就這一點來談砍價跟缺藥其實是惡性循環那個委員所關心的這件事情也是大家所關心的啦因為我們一定要讓我們的藥廠能夠在地製造能夠在地製造而且要鼓勵的一個措施因為藥價一直砍所以這一年來其實在健保署也做了很多的措施來扶植在藥價的合理性有做\n\n03:44.403 --> 04:10.757\n很多的一個改善但是缺貨還是在啊署長你的因應措施是什麼跟委員報告有一些是屬於到地板價的我們在健保上都有保護的措施不在下調那這些所謂到達地板價的多屬於這個學民藥或者是OTC或者是在國內生產為主所以我們有相對的這個政策那你允許他們有一些申訴的管道嗎\n\n04:11.357 --> 04:38.833\n有有有我们都可以来提高这个像我们过去的这个发生者点滴的事件那么我们也调高了他的要价你说我保护他但是事实上相对他们的感受呢就是说我们都有调整要价的机制不是只有往下调也有往上调我们过去这一年就调高了200项所以他是你只要合理的成本提出来之后呢我们是可以调整的\n\n04:39.133 --> 04:58.447\n我知道你也允許他們來申請條帳如果是因為這些尤其是關稅這些影響那你知道要多少時間嗎從他的申請到共理會然後到生肖你估大概要多少時間如果他有我們應該這樣講在我們的這個基本的藥品裡面呢我們都有預警制度說如果你要\n\n04:59.147 --> 05:16.081\n可能会有缺药的情形你六个月之前就应该要来通报所以他要提前来提那么另外一个当然就是你调整要提高药价我们有的程序所以这个应该我们都会试他的这个紧急情形跟必要情形\n\n05:16.641 --> 05:34.657\n那你目前有簡單的數據說這些申請調漲的廠商他被通過允許通過的我們也有一些特殊的情形下他可以跳過這個共理會我們上次在點滴的處理的事情都是當周就決定了\n\n05:35.697 --> 06:04.443\n點滴實在是太一個沉痛的教訓了這是第一個砍價的問題第二個全球供應的優先次序台灣處比劣勢吧你同意吧因為當跨國藥廠面臨美國的降價壓力他可以有其他方法他其他國家漲價或是說他減量供應減量供應台灣為什麼台灣市場小嘛你給價又給的低啊大家台灣的藥價是有名的低啊那你常常被排在這個次次藥跟次次藥那個藥廠所謂的第三波啊\n\n06:05.323 --> 06:25.069\n就是說這個是一個不容這個來這個否定的一個現實但是我要請問健保署你知道藥品他要經歷所謂MBAMBA就是收窄這個價量的一個協議嘛那又有PVA用量高你又要跟他跟他要求他有一些的這個回饋還有今年的藥價差這個藥價差已經高達30%那未來你要依據國際最低價來去調整它\n\n06:30.791 --> 06:45.416\n那請問署長你有信心台灣的市場藥品市場不會被邊緣化嗎國外人會不會將來用不到先進的藥品我想跟委員報告我們也不需要太我們當然要戒慎恐懼但是也不需要妄自菲薄\n\n06:46.056 --> 07:09.121\n那麼台灣在相對於許多的國家還是相當具有競爭力那麼以在整個亞洲來講呢那我們的全民健保明年呢就已經趨近兆元所以在這個健保的支出上具有相當的這個一致性的溢價能力啦跟當初是不一樣我講的是先進藥品國產的是一個基礎\n\n07:10.422 --> 07:24.420\n對那先進藥品也是一樣我們很多的先進藥品在亞洲很多國家沒有禁我們也禁了所以這個是健保因為這個全民健保的是一個單一的保險人的制度所以它具有這樣的\n\n07:25.061 --> 07:44.779\n我们是第三波先要发明我们是第三波才引进那两位首长就药价差的问题一直百烂不处理现在每年700亿我现在要谈的就是说医师开方如果跟药价差扣连在一起其实这是很不恰当之前我有提到中部的一些医学中心它已经开始有所谓的索药\n\n07:47.322 --> 07:58.615\n鎖黨正是在開放的時候提醒醫師就是某些是藥價差利潤比較好的藥品這件事情部長你怎麼看這個是好的醫療行為嗎利用藥價差來扣連醫師處方那這個會影響病人權益啊\n\n08:01.638 --> 08:19.966\n我想我們非常非常不同意的一個用管理的機制來影響到病人的權益跟醫療的專業部長他存在啊他存在啊而且越來越多人效法因為沒有去處理啊我想我們是不容許這樣的情況\n\n08:21.787 --> 08:41.173\n醫學中心是表率醫院的醫學中心率先這麼多其他醫院當然效仿啊如果讓民眾都知道原來是靠藥價差的利率因為你給付的不夠嘛有一些可以檢討的我是相信協大多數的醫院是不會去影響到醫師的專業的一個潛力啦這個部分很容易被醫師法定出來\n\n08:42.133 --> 09:02.207\n今年6月6號有給工協會寫函第4點提到因為美國對等關稅政策以盤點相關的健保用藥廠商若因為關稅問題依法可以提出價格調整建議必要時本署將爭取額外你剛才有提到額外的預算來指引來及時反映市場價格調整這個要價這是針對關稅的這個部分請問這個及時部長請您回答部長這個及時是多久\n\n09:06.030 --> 09:28.658\n您給的函啊您說要及時反映藥品市場價格而且是因應關稅問題您覺得這個及時多久要花多少時間我想在健保的總預算裡面我想委員長期擔任過相關的一個委員都很清楚我們有一個風險的相關的基金這個是隨時可以用因為絕對不能讓我們的國人有缺藥的現象\n\n09:34.480 --> 09:59.796\n國家的調整過程大家都知道嘛專家共理會然後等等這個他們是根據過去財務的狀況來分析嘛這個署長如果您自己不到這個委員會裡面說按照法規的一個從寬來處理或是說因為他們習慣我在那邊太久了嘛習慣用這個財務衝擊嘛總共我要花多少錢來決定要不要這個速度跟委員報告我們都在做改善你發了這個文\n\n10:01.737 --> 10:26.956\n這個我們現在是這樣子今年呢我們在要價正式調整是4月1號所以我們在3月初就會發函給所有的這個廠商有調價的廠商廠商如果提出他有要價不符我們就會凍結所以在4月1號就不會調然後之後我們在審視他的合理成本之後才正式做最後的調整所以我們這個就是所謂的即時反應的\n\n10:27.196 --> 10:48.250\n我才請教您說到底最後通過多少專家還是不給啊因為你們過去就是教專家要怎麼看預算啊你從來不會去看關稅銀行現在都是在看成本我們看成本你現在有改變一點點做法嗎您的向前一直沒有下達據我瞭解哦您的向前沒有下達你在這邊承諾我的常常都沒有出現在真正審議的委員會哦好那我想說這次我們對於關稅還在未以籌謀幾個點請再跟首長分享供應鏈的這個\n\n10:58.197 --> 11:15.285\n評估跟預警剛剛你有提到是不是報告你已經有盤點了嗎國內用藥仰賴跨國供應你不能否認這一塊那這個關鍵藥品你有做了什麼處置嗎有提前通報嗎就是關鍵藥品過去比較沒有處理這一塊那避免出現突發性的缺藥這是第一點\n\n11:17.546 --> 11:36.234\n那第二點要價差的部分我還是請大家不要我是希望署長您要根據這個不同生命週期的譬如說它是單元單一來源的譬如說它是必要藥品譬如說它已經靠近這個地板價還有過專利商品你可以有不同的類型的藥品它的要價差\n\n11:37.194 --> 11:55.876\n我希望你已經有這個數字我希望你兩週內給我這個數字可以嗎你有要價差你有強大的電腦你一直在收集這個採購價格我想知道說這不同類別不同類別的要價差有什麼樣的不同樣態不同那我們再來研究討論怎麼來處理這些事情署長你可以給我這個資料嗎\n\n11:58.659 --> 12:11.787\n我剛剛提到的是很中性的東西這個我們把整個因為這裡有些會涉及到廠商的商業機密你又來了所以我們可以把整體的統計的資料大概沒有辦法給個別的item\n\n12:13.908 --> 12:30.498\n两周可以吗两周到办公室可以因为我们可以制定根据不同类型去制定不同的管制力道这个是你管理对这个很重要避免那个要价被边缘化那国产药品的部分我觉得不只是考虑那个价格你要考虑那个量你如果平常没有给他那个量\n\n12:31.218 --> 12:51.094\n那到時候有缺的時候他也供應不來嘛生理食鹽水永風的就是一個非常慘痛的這個教訓所以到底這個部分給量的部分你要怎麼處理所以是不是要考慮這個過專利企業品在醫院是要並存的就是說他平常要有一些市場的一些保障那當然定型化企業或許可以保障量而不是重點\n\n12:51.414 --> 13:19.383\n不只是保障價格因為它沒有量到時候就沒有辦法配合國家的政策來供應所以我覺得這個是一個非常重要的時機所以你一旦不但要保護國產藥品那當然你要兼顧輸入藥的一些公平性當然剛剛也提到要鼓勵本土廠商要做一些比較研發性的一些產品那我要講說兩位署長江署長跟石署長您在這個國會殿堂上你們已經握過手了\n\n13:20.163 --> 13:43.414\n手牽手了對不對我一直說上游跟下游要合作嘛你們手牽手了應該有進一步的關係發展吧有他們兩個有繼續做嗎兩個非常密切的合作進一步發展是什麼那我最後再提一個就是讓部長也一起瞭解台灣有幾家藥廠我們要鼓勵本土保護本土台灣有幾家本土藥廠你現在說出來等一下說不出來\n\n13:46.638 --> 14:11.565\n報告委員我們這邊現在國內的製劑廠300家然後我們的原料廠呢有將近有40家左右那整體來講剛才委員特別提到工藝任性任性的部分我們其實在今年度特別針對二月份做所謂的必要藥品的部分我們其實有做幾百家藥廠你可以想台灣這麼小他在國內就自己在那邊競爭就自相殘殺嘛\n\n14:12.845 --> 14:39.088\n所以一定要做一些事情有時候我們要去做一些比較長遠的事情嘛大家都沒有辦法走出去所以我們也希望我們台灣的藥廠可以打國際盃啊不是在台內國內搶市場啊這也是我們在省醫療法的精神啊你如果生技產業都集中在台灣那你應該讓他出去嘛走出去嘛我們其實在二月份我onboard之後其實跟學名藥廠原廠藥廠生物利用藥廠各類的其實做了很多的公協會的\n\n14:40.149 --> 14:53.658\n陸陸續續extension下去我們持續在努力當中兩位要牽手的署長相對年輕我想你們在這個你們職場上還很有可為啦希望你們做的事情是比較長遠的一些事情啦好謝謝謝謝主席好謝謝陳委員謝謝部長\n\n","segments":[{"start":5.771,"end":6.554,"text":"謝謝主席 有請邱部長"},{"start":15.583,"end":33.01,"text":"部長 川普總統他已經宣布就是說進口藥品他要分階段分階段來課徵最高達250%的一個關稅他也要求實際下跨國的藥廠他要在美國市場要提供全球最低價所謂的最惠國這個藥價"},{"start":34.671,"end":51.793,"text":"那根據這個楊交大的康兆周教授分析關稅本身未必直接會衝擊台灣的藥品的價格但是會衝擊剛剛您也報告到出口美國的學名藥廠商那尤其是這個在臨床上比較容易取代的相對也是低價的這個品項"},{"start":52.794,"end":79.504,"text":"那當然你也提到這個原料藥那其實台灣的原料品質很好但是因為他的相對價格高一點所以這個又不是經濟規模的生產敵不過那個印度啊中國這個原料大廠所以他大部分就是90%以外銷為主那美國又排在前幾名其實還是有很大的影響那台大醫院余中仁院長也提醒高關稅可能造成加速這個全球叫做碎片化這個是名詞"},{"start":80.524,"end":99.121,"text":"那藥廠會針對不同的市場做獨立的定價跟供貨策略那台灣是小市場啊台灣是小市場啊很難獲得這個優先供應那雖然我國目前對藥品是採取零關稅但是美國政策本身可能會這個對於改變各國各個藥廠他在全國的這個佈局全世界的佈局"},{"start":104.185,"end":121.88,"text":"那間接就會影響在台灣的這個藥價或供貨穩定性因為這個是遷移法動全身那部長就是我上述這些觀點您同意嗎您對這個關稅藥品要加上這個關稅的部分您做了美國的關稅的部分您做了影響評估嗎影響的評估"},{"start":125.734,"end":142.823,"text":"我想我們一直都在做影響評估那謝謝委員提供這麼專業跟精闢的一個分析我們不管是在確保台灣的一個藥品穩定的供應的策略"},{"start":143.909,"end":164.03,"text":"以及因為他隨著他關稅的一個可能的變化我們也都有相應相對應的一個對策這樣好了我們來具體來談幾個點我知道也許您不是很喜歡這樣聽但是我還是要講台灣藥品的這個供應的脆弱點"},{"start":165.251,"end":194.097,"text":"並不在於一定在於國際的供應鏈的一個變動那事實上健保還是有一些相當的影響長期是壓低藥價的那當然是來自財務的問題長期壓低藥價缺乏韌性的管理我們一點一點來討論第一個健保砍價跟缺藥其實是個惡性循環那藥價這個長期往下修導致國內的這個國內外廠商其實都會退出這個低價市場那已經達到地板價的這個藥品很容易缺貨請問健保署"},{"start":194.717,"end":223.743,"text":"你有因應措施嗎就是我先就這一點來談砍價跟缺藥其實是惡性循環那個委員所關心的這件事情也是大家所關心的啦因為我們一定要讓我們的藥廠能夠在地製造能夠在地製造而且要鼓勵的一個措施因為藥價一直砍所以這一年來其實在健保署也做了很多的措施來扶植在藥價的合理性有做"},{"start":224.403,"end":250.757,"text":"很多的一個改善 但是缺貨還是在啊署長你的因應措施是什麼跟委員報告 有一些是屬於到地板價的我們在健保上都有保護的措施不在下調那這些所謂到達地板價的多屬於這個學民藥或者是OTC或者是在國內生產為主所以我們有相對的這個政策那你允許他們有一些申訴的管道嗎"},{"start":251.357,"end":278.833,"text":"有有有我们都可以来提高这个像我们过去的这个发生者点滴的事件那么我们也调高了他的要价你说我保护他但是事实上相对他们的感受呢就是说我们都有调整要价的机制不是只有往下调也有往上调我们过去这一年就调高了200项所以他是你只要合理的成本提出来之后呢我们是可以调整的"},{"start":279.133,"end":298.447,"text":"我知道你也允許他們來申請條帳如果是因為這些尤其是關稅這些影響那你知道要多少時間嗎從他的申請到共理會然後到生肖你估大概要多少時間如果他有我們應該這樣講在我們的這個基本的藥品裡面呢我們都有預警制度說如果你要"},{"start":299.147,"end":316.081,"text":"可能会有缺药的情形你六个月之前就应该要来通报所以他要提前来提那么另外一个当然就是你调整要提高药价我们有的程序所以这个应该我们都会试他的这个紧急情形跟必要情形"},{"start":316.641,"end":334.657,"text":"那你目前有簡單的數據說這些申請調漲的廠商他被通過 允許通過的我們也有一些特殊的情形下他可以跳過這個共理會我們上次在點滴的處理的事情都是當周就決定了"},{"start":335.697,"end":364.443,"text":"點滴實在是太一個沉痛的教訓了這是第一個 砍價的問題第二個 全球供應的優先次序台灣處比劣勢吧 你同意吧因為當跨國藥廠面臨美國的降價壓力他可以有其他方法他其他國家漲價或是說他減量供應減量供應台灣為什麼 台灣市場小嘛你給價又給的低啊大家台灣的藥價是有名的低啊那你常常被排在這個次次藥跟次次藥那個藥廠所謂的第三波啊"},{"start":365.323,"end":385.069,"text":"就是說這個是一個不容這個來這個否定的一個現實但是我要請問健保署你知道藥品他要經歷所謂MBAMBA就是收窄這個價量的一個協議嘛那又有PVA用量高你又要跟他跟他要求他有一些的這個回饋還有今年的藥價差這個藥價差已經高達30%那未來你要依據國際最低價來去調整它"},{"start":390.791,"end":405.416,"text":"那請問署長你有信心台灣的市場藥品市場不會被邊緣化嗎國外人會不會將來用不到先進的藥品我想跟委員報告我們也不需要太我們當然要戒慎恐懼但是也不需要妄自菲薄"},{"start":406.056,"end":429.121,"text":"那麼台灣在相對於許多的國家還是相當具有競爭力那麼以在整個亞洲來講呢那我們的全民健保明年呢就已經趨近兆元所以在這個健保的支出上具有相當的這個一致性的溢價能力啦跟當初是不一樣我講的是先進藥品國產的是一個基礎"},{"start":430.422,"end":444.42,"text":"對 那先進藥品也是一樣我們很多的先進藥品在亞洲很多國家沒有禁我們也禁了所以這個是健保因為這個全民健保的是一個單一的保險人的制度所以它具有這樣的"},{"start":445.061,"end":464.779,"text":"我们是第三波先要发明我们是第三波才引进那两位首长就药价差的问题一直百烂不处理现在每年700亿我现在要谈的就是说医师开方如果跟药价差扣连在一起其实这是很不恰当之前我有提到中部的一些医学中心它已经开始有所谓的索药"},{"start":467.322,"end":478.615,"text":"鎖黨 正是在開放的時候提醒醫師就是某些是藥價差 利潤比較好的藥品這件事情部長你怎麼看這個是好的醫療行為嗎利用藥價差來扣連醫師處方那這個會影響病人權益啊"},{"start":481.638,"end":499.966,"text":"我想我們非常非常不同意的一個用管理的機制來影響到病人的權益跟醫療的專業部長他存在啊 他存在啊而且越來越多人效法因為沒有去處理啊我想我們是不容許這樣的情況"},{"start":501.787,"end":521.173,"text":"醫學中心是表率醫院的醫學中心率先這麼多其他醫院當然效仿啊如果讓民眾都知道原來是靠藥價差的利率因為你給付的不夠嘛有一些可以檢討的我是相信協大多數的醫院是不會去影響到醫師的專業的一個潛力啦這個部分很容易被醫師法定出來"},{"start":522.133,"end":542.207,"text":"今年6月6號有給工協會寫函第4點提到因為美國對等關稅政策以盤點相關的健保用藥廠商若因為關稅問題依法可以提出價格調整建議必要時本署將爭取額外你剛才有提到額外的預算來指引來及時反映市場價格調整這個要價這是針對關稅的這個部分請問這個及時部長請您回答部長這個及時是多久"},{"start":546.03,"end":568.658,"text":"您給的函啊 您說要及時反映藥品市場價格而且是因應關稅問題您覺得這個及時多久 要花多少時間我想在健保的總預算裡面我想委員長期擔任過相關的一個委員都很清楚我們有一個風險的相關的基金這個是隨時可以用因為絕對不能讓我們的國人有缺藥的現象"},{"start":574.48,"end":599.796,"text":"國家的調整過程 大家都知道嘛 專家共理會然後等等 這個他們是根據過去財務的狀況來分析嘛這個署長 如果您自己不到這個委員會裡面說按照法規的一個從寬來處理或是說 因為他們習慣 我在那邊太久了嘛習慣用這個財務衝擊嘛總共我要花多少錢來決定要不要這個速度跟委員報告 我們都在做改善你發了這個文"},{"start":601.737,"end":626.956,"text":"這個我們現在是這樣子今年呢我們在要價正式調整是4月1號所以我們在3月初就會發函給所有的這個廠商有調價的廠商廠商如果提出他有要價不符我們就會凍結所以在4月1號就不會調然後之後我們在審視他的合理成本之後才正式做最後的調整所以我們這個就是所謂的即時反應的"},{"start":627.196,"end":648.25,"text":"我才請教您說到底最後通過多少專家還是不給啊因為你們過去就是教專家要怎麼看預算啊你從來不會去看關稅銀行現在都是在看成本我們看成本你現在有改變一點點做法嗎您的向前一直沒有下達據我瞭解哦您的向前沒有下達你在這邊承諾我的常常都沒有出現在真正審議的委員會哦好那我想說這次我們對於關稅還在未以籌謀幾個點請再跟首長分享供應鏈的這個"},{"start":658.197,"end":675.285,"text":"評估跟預警剛剛你有提到是不是報告你已經有盤點了嗎國內用藥仰賴跨國供應你不能否認這一塊那這個關鍵藥品你有做了什麼處置嗎有提前通報嗎就是關鍵藥品過去比較沒有處理這一塊那避免出現突發性的缺藥這是第一點"},{"start":677.546,"end":696.234,"text":"那第二點 要價差的部分我還是請大家不要我是希望署長您要根據這個不同生命週期的譬如說它是單元 單一來源的譬如說它是必要藥品譬如說它已經靠近這個地板價還有過專利商品你可以有不同的類型的藥品它的要價差"},{"start":697.194,"end":715.876,"text":"我希望你已經有這個數字我希望你兩週內給我這個數字可以嗎你有要價差你有強大的電腦你一直在收集這個採購價格我想知道說這不同類別不同類別的要價差有什麼樣的不同樣態不同那我們再來研究討論怎麼來處理這些事情署長你可以給我這個資料嗎"},{"start":718.659,"end":731.787,"text":"我剛剛提到的是很中性的東西這個我們把整個因為這裡有些會涉及到廠商的商業機密你又來了所以我們可以把整體的統計的資料大概沒有辦法給個別的item"},{"start":733.908,"end":750.498,"text":"两周可以吗两周到办公室可以因为我们可以制定根据不同类型去制定不同的管制力道这个是你管理对这个很重要避免那个要价被边缘化那国产药品的部分我觉得不只是考虑那个价格你要考虑那个量你如果平常没有给他那个量"},{"start":751.218,"end":771.094,"text":"那到時候有缺的時候他也供應不來嘛生理食鹽水永風的就是一個非常慘痛的這個教訓所以到底這個部分給量的部分你要怎麼處理所以是不是要考慮這個過專利企業品在醫院是要並存的就是說他平常要有一些市場的一些保障那當然定型化企業或許可以保障量而不是重點"},{"start":771.414,"end":799.383,"text":"不只是保障價格因為它沒有量到時候就沒有辦法配合國家的政策來供應所以我覺得這個是一個非常重要的時機所以你一旦不但要保護國產藥品那當然你要兼顧輸入藥的一些公平性當然剛剛也提到要鼓勵本土廠商要做一些比較研發性的一些產品那我要講說兩位署長江署長跟石署長您在這個國會殿堂上你們已經握過手了"},{"start":800.163,"end":823.414,"text":"手牽手了對不對 我一直說上游跟下游要合作嘛你們手牽手了應該有進一步的關係發展吧有 他們兩個有繼續做嗎兩個非常密切的合作進一步發展是什麼那我最後再提一個就是讓部長也一起瞭解台灣有幾家藥廠我們要鼓勵本土 保護本土 台灣有幾家本土藥廠你現在說出來 等一下說不出來"},{"start":826.638,"end":851.565,"text":"報告委員我們這邊現在國內的製劑廠300家然後我們的原料廠呢有將近有40家左右那整體來講剛才委員特別提到工藝任性任性的部分我們其實在今年度特別針對二月份做所謂的必要藥品的部分我們其實有做幾百家藥廠你可以想台灣這麼小他在國內就自己在那邊競爭就自相殘殺嘛"},{"start":852.845,"end":879.088,"text":"所以一定要做一些事情有時候我們要去做一些比較長遠的事情嘛大家都沒有辦法走出去所以我們也希望我們台灣的藥廠可以打國際盃啊不是在台內 國內搶市場啊這也是我們在省醫療法的精神啊你如果生技產業都集中在台灣那你應該讓他出去嘛 走出去嘛我們其實在二月份我on board之後其實跟學名藥廠 原廠藥廠生物利用藥廠各類的其實做了很多的公協會的"},{"start":880.149,"end":893.658,"text":"陸陸續續extension下去 我們持續在努力當中兩位要牽手的署長相對年輕我想你們在這個你們職場上還很有可為啦希望你們做的事情是比較長遠的一些事情啦好 謝謝 謝謝主席好 謝謝陳委員 謝謝部長"}]}}},"gazette":{"lineno":175,"blocks":[["陳委員昭姿：（9時16分）謝謝主席，有請邱部長。"],["主席：部長請。"],["邱部長泰源：委員早。"],["陳委員昭姿：部長早。川普總統已經宣布針對進口藥品他要分階段來課徵最高達250%的關稅，他也要求17家跨國的藥廠在美國市場要提供全球最低價，即所謂最惠國藥價。根據陽交大的康照洲教授分析，關稅本身未必直接會衝擊臺灣藥品的藥價，但是剛剛你也報告到，會衝擊到出口美國的學名藥廠商，尤其是在臨床上比較容易取代的，相對也是低價的品項。當然你也提到原料藥，其實臺灣的原料藥品質很好，但是因為它的相對價格高一點，而且又不是經濟規模的生產，敵不過印度、中國原料藥大廠，所以大部分90%大概以外銷為主，美國又排在前幾名，其實還是有很大的影響。","臺大醫院余忠仁院長也提醒，高關稅可能造成並加速全球「碎片化」，藥廠會針對不同的市場做獨立的定價跟供貨策略，臺灣是小市場，很難獲得優先供應。雖然我國目前對藥品是採取零關稅，但是美國政策本身可能會改變各個藥廠在全國的布局、全世界的布局，間接就會影響在臺灣的藥價或供貨穩定性，因為這個是牽一髮動全身。"],["邱部長泰源：是。"],["陳委員昭姿：部長，我上述這些觀點，您同意嗎？對於藥品要加上關稅的部分，針對美國關稅的部分，您做了影響的評估嗎？"],["邱部長泰源：我想我們一直都在做影響評估，也謝謝委員提供這麼專業跟精闢的分析，我們在確保臺灣的藥品穩定供應的策略，因為隨著關稅可能的變化，也都有相對應的對策。"],["陳委員昭姿：部長，這樣好了，我們具體來談幾個點，我知道也許您不是很喜歡聽，但是我還是要講，臺灣藥品供應的脆弱點並不一定在於國際供應鏈的變動。事實上，健保還是有一些相當的影響，長期是壓低藥價的，當然也是來自財務的問題。長期壓低藥價、缺乏韌性的管理，我們一點一點來討論，第一個，健保砍價跟缺藥其實是個惡性循環，藥價長期往下修，導致國內外廠商其實都會退出低價市場，已經達到地板價的藥品很容易缺貨。請問健保署，你有因應措施嗎？我先就這一點來談，砍價和缺藥其實是惡性循環。"],["邱部長泰源：委員所關心的這些事情也是大家所關心的，因為我們一定要讓我們的藥廠能夠在地製造，而且要有鼓勵的措施。"],["陳委員昭姿：部長，不好意思，我的重點是因為藥價一直砍，這是全世界都……"],["邱部長泰源：對，所以這一年其實健保署也做了很多的措施來扶持，在藥價的合理性有做了很多的改善。"],["陳委員昭姿：但是缺貨還是在。"],["邱部長泰源：是不是請石署長實簡要跟……"],["陳委員昭姿：署長，你的因應措施是什麼？"],["石署長崇良：好，跟委員報告，有一些是屬於到地板價的，我們在健保上都有保護的措施，不再下調，這些所謂到達地板價的多屬於學名藥或者是OTC，或者是在國內生產為主，所以我們有相對的政策。"],["陳委員昭姿：你允許他們有一些申訴的管道嗎？"],["石署長崇良：有、有、有，我們都可以來提高，像過去發生點滴的事件，我們也調高它的藥價……"],["陳委員昭姿：你從你的觀念說你保護它，但是事實上相對他們的感受呢？"],["石署長崇良：就是說我們都有調整藥價的機制，不是只有往下調，也有往上調，我們過去這一年就調高了200項，所以只要合理的成本提出來之後，我們是可以調整的。"],["陳委員昭姿：署長，我知道你也允許他們來申請調漲，如果是因為這些，尤其是關稅的影響，你知道要多少時間嗎？從它的申請到共擬會、到生效，你估大概要多少時間？"],["石署長崇良：應該這樣講，在我們的基本藥品裡面都有預警制度，如果可能會有缺藥的情形，六個月之前就應該要來通報，所以它要提前來提。另外一個當然就是針對提高藥價我們也有一個程序，我們都會視其緊急情形及必要情形來處理。"],["陳委員昭姿：那你目前有簡單的數據可以說明這些申請調漲的廠商被允許通過的比率有多少嗎？"],["石署長崇良：也有在一些特殊的情形下，它可以跳過共擬會，我們上次處理點滴的事情，都是當周就決定了。"],["陳委員昭姿：點滴實在是太沉痛的教訓，這是第一個砍價的問題。第二個是全球供應的優先順序臺灣處於劣勢，這你同意吧！當跨國藥廠面臨美國的降價壓力，它可以有其他方法，它對其他國家漲價或是減量供應臺灣，為什麼？因為臺灣市場小嘛，而且給價又給得低，臺灣的藥價是有名的低，所以就常常被排在次要或次次要，也就是藥廠所謂的第三波，這是一個不容否定的現實。但是我要請問健保署，你知道藥品要經歷所謂的MEA，MEA就是收載價量的協議；另外也有PVA，用量高你就要求他有一些回饋。還有今年的藥價差已經高達30%，未來你必須依據國際最低價來調整，請問署長，你有信心臺灣的藥品市場不會被邊緣化嗎？將來國人會不會用不到先進的藥品？"],["石署長崇良：我想跟委員報告，我們當然要戒慎恐懼，但是也不需要妄自菲薄，相對於許多國家，臺灣還是相當具有競爭力，以整個亞洲來講，我們的全民健保明年就已經趨近兆元，所以在健保的支出上具有一致性的議價能力，跟當初是不一樣……"],["陳委員昭姿：你沒有to the point，我講的是先進藥品，國產的是一個基礎，但是我們需要研發，我們要活著，而且要活得更好。"],["石署長崇良：先進藥品也是一樣，很多先進藥品在亞洲很多國家都沒有進，但是我們也進了，因為全民健保是單一保險人的制度，所以我們具有這樣的議價能力。"],["陳委員昭姿：我還是要說對於藥界而言我們是第三波啦！新藥發明我們是第三波才引進。請問兩位首長，藥價差這個問題一直擺爛不處理，現在每年700億，我現在要談的是醫師開處方如果跟藥價差扣連在一起，其實這很不恰當，之前我有提到中部的一些醫學中心已經開始有所謂的鎖藥、鎖檔，就是在開放的時候提醒醫師某些是藥價差利潤比較好的藥品，這件事情部長你怎麼看？這是好的醫療行為嗎？用藥價差來扣連醫師處方，這會影響病人權益啊！"],["邱部長泰源：我們非常不同意用管理的機制來影響病人的權益及醫療的專業。"],["陳委員昭姿：但是它存在啊！而且越來越多人效法，因為沒有去處理啊！"],["邱部長泰源：這個我們會來瞭解，我們不容許這樣的情況。"],["陳委員昭姿：尤其不應該出現在醫學中心，醫學中心是表率醫院，如果醫學中心率先這麼做，其他醫院當然仿效啊！如果讓民眾知道原來是靠藥價差的利潤，因為你給付的不夠，有一些可以檢討的，但是這種扣連在處方……"],["邱部長泰源：我相信絕大多數醫院不會影響到醫師專業的權利，這個部分很容易被醫師反映出來。"],["陳委員昭姿：我記得你今年6月6號有給公協會一些函，第四點提到，因應美國之對等關稅政策，已盤點相關健保用藥，廠商若因為關稅問題，依法可以提出價格調整建議，必要時本署將爭取額外預算來支應，以即時反映市場價格，調整藥價。這是針對關稅的部分，部長，請您回答所謂的「即時」是多久？這是您給的函啊，你說要即時反應藥品市場價格，而且是因應關稅問題，您覺得這個「即時」是多久？要花多少時間？"],["邱部長泰源：針對健保的預算，陳委員您也長期擔任過相關的委員，應該都很清楚我們有風險的相關基金……"],["陳委員昭姿：部長，因為這是你發的函，所以我根據你所發的函……"],["邱部長泰源：這個是隨時可以用，因為絕對不能讓我們的國人有缺藥的現象。"],["陳委員昭姿：但是藥價的調整過程，大家都知道要經過專家共擬會等等，而他們是根據過去財務的狀況來分析，署長，如果您自己不到這個委員會裡面說按照法規從寬來處理，我在那邊太久了，我知道他們習慣用財務衝擊、總共要花多少錢來決定要不要調整，這個速度……"],["石署長崇良：跟委員報告，我們都在做改善。"],["陳委員昭姿：你發了這個文。"],["石署長崇良：現在是這樣子，今年藥價正式調整是4月1號，所以我們在3月初就會發函給所有有調價的廠商，廠商如果提出它有藥價不符，我們就會凍結，所以在4月1號就不會調，之後我們再審視它的合理成本之後，才正式做最後的調整，這個就是所謂的即時反應。"],["陳委員昭姿：所以我才請教您到底最後通過多少，專家還是不給啊！因為你們過去就教專家要怎麼看預算，你從來不會去看關稅影響，也不會看實際影響……"],["石署長崇良：現在都是在看成本，我們看成本。"],["陳委員昭姿：你現在有改變一點點作法嗎？"],["石署長崇良：有，有改變。"],["陳委員昭姿：你的下情一直沒有上達，據我了解，您的下情沒有上達，你在這邊承諾我的常常都沒有出現在真正審議的委員會當中。這次我們對於關稅還是要未雨綢繆，有幾個點再跟各位首長分享一下，關於供應鏈的評估跟預警，剛剛你的報告裡頭是不是有提到你們已經有盤點了？國內用藥仰賴跨國供應，你不能否認這一塊，針對關鍵藥品你有做了什麼處置嗎？有提前通報嗎？也就是針對關鍵藥品，過去比較沒有處理這一塊，但我們必須避免出現突發性的缺藥，這是第一點。第二點針對藥價差的部分，我還是請大家不要……我是希望署長您要根據不同生命週期的藥品，譬如它是單一來源的，譬如它是必要藥品，譬如它已經靠近地板價，還有過專利期藥品，針對不同類型藥品的藥價差，我希望你已經有數字，請在兩週內給我相關數字可以嗎？你有藥價差，你有強大的電腦，你一直在蒐集採購價格，我想知道不同類別的藥價差有什麼樣的不同樣態，然後我們再來研究討論怎麼來處理這些事情。署長，你可以給我這個資料嗎？我剛剛提到的是很中性的東西喔！"],["石署長崇良：因為這裡面有些會涉及到廠商的商業機密……"],["陳委員昭姿：你又來了！"],["石署長崇良：所以我們可以給整體的統計資料，大概沒有辦法給個別的item。"],["陳委員昭姿：兩週可以嗎？兩週內送到我辦公室可以嗎？"],["石署長崇良：可以。"],["陳委員昭姿：我們可以根據不同類型去制定不同的管制力道，這是你管理時很重要的方式，避免藥價被邊緣化。至於國產藥品的部分，我覺得不只是考慮價格，你還要考慮那個量，你如果平常沒有給它那個量，那屆時有缺的時候，它也供應不來嘛！永豐的生理食鹽水就是一個非常慘痛的教訓，到底給量的部分你要怎麼處理？所以是不是要考慮過專利期藥品在醫院是要並存的，就是說它平常要有一些市場的保障，當然定型化契約或許可以保障量，重點不只是保障價格，因為它沒有量，到時候就沒有辦法配合國家的政策來供應，所以我覺得這是一個非常重要的時機。你不但要保護國產藥品，另外也要兼顧輸入藥的一些公平性，當然剛剛也提到要鼓勵本土廠商做一些比較研發性的產品。姜署長和石署長在國會殿堂上已經握過手了，兩位署長已經手牽手了，對不對？我的意思是上游跟下游要合作，既然你們已經手牽手了，應該有進一步的關係發展吧！"],["邱部長泰源：有，他們兩個……"],["陳委員昭姿：有嗎？有繼續做嗎？"],["邱部長泰源：有，他們兩個署非常密切的合作。"],["陳委員昭姿：那進一步的發展是什麼？我最後再提一個問題讓部長也一起了解，請問臺灣有幾家藥廠？我們要鼓勵本土藥廠、保護本土藥廠，但臺灣有幾家本土藥廠？"],["邱部長泰源：我請姜署長來說明。"],["陳委員昭姿：你現在說得出來了，上次說不出來。"],["姜署長至剛：報告委員，現在國內的製劑廠接近300家，原料廠將近40家。"],["陳委員昭姿：幾百家嘛。"],["姜署長至剛：整體來講，剛才委員特別提到供應韌性的部分，我們其實在今年度2月份特別針對必要藥品的部分，我們其實有做了。"],["陳委員昭姿：部長，幾百家藥廠，你可以想，臺灣這麼小，它在國內就自己在那邊競爭，就自相殘殺嘛，所以一定要做一些事情，有時候我們要去做一些比較長遠的事情嘛，大家都沒有辦法走出去，所以我們也希望我們臺灣的藥廠可以打國際盃，而不是在國內搶市場，這也是我們再生醫療法的精神啊！如果生技產業都集中在臺灣，那你應該要讓它走出去嘛！"],["姜署長至剛：簡單跟委員報告，我們在2月份on board之後，跟學名藥廠、原廠藥廠、生物相似藥藥廠，各類的，其實做了很多公協會的……陸陸續續extension下去，我們持續在努力當中。"],["陳委員昭姿：兩位要手牽手的署長相對年輕，我想你們在職場上還大有可為，希望你們做的是比較長遠的一些事情。好，謝謝三位，謝謝主席。"],["邱部長泰源：好，謝謝。"],["主席：好，謝謝陳委員，謝謝部長。","接續我們請林月琴委員質詢。"]],"agenda":{"page_end":328,"meet_id":"委員會-11-3-26-24","speakers":["蘇清泉","陳昭姿","林月琴","陳菁徽","邱鎮軍","王育敏","廖偉翔","盧縣一","林淑芬","黃秀芳","王正旭","葉元之","陳瑩","劉建國","楊曜","涂權吉"],"page_start":267,"meetingDate":["2025-08-14"],"gazette_id":"1147202","agenda_lcidc_ids":["1147202_00007"],"meet_name":"立法院第11屆第3會期社會福利及衛生環境委員會第24次全體委員會議紀錄","content":"邀請衛生福利部、經濟部、財政部就「美國針對進口藥品、原料藥課稅對我國產業造成影響」進\n行專題報告，並備質詢","agenda_id":"1147202_00006"}}}