National Health Insurance Bureau: further improve the integration of designated retail pharmacies into outpatient overall management

2023-02-16

According to the National Health Insurance Bureau, in order to better promote the reform of the medical insurance out-patient co-care security mechanism for employees, the National Health Insurance Bureau recently issued the Notice on Further Improving the Integration of Designated Retail Drug Stores into the Overall Management of Outpatients (hereinafter referred to as the Notice). The Notice requires that medical insurance departments at all levels should take effective measures to encourage qualified designated retail pharmacies to voluntarily apply for the opening of out-patient coordination services, and provide the insured with out-patient coordination drug protection. In principle, the medical insurance agency shall complete the medical insurance settlement within 30 working days from the date of receiving the settlement application from the designated retail pharmacy, and timely allocate the settlement fee. The designated retail drugstore shall upload the "purchase, sales and inventory" data of drugs, details of medical insurance expenses and other information to the medical insurance department as required to ensure that the uploaded data are comprehensive, accurate and timely. With regard to the payment scope of the outpatient pooling fund, the Notice specifies that the expenses incurred by the insured personnel in purchasing the drugs in the medical insurance catalogue at the designated retail pharmacy with the prescription of the designated medical institution can be paid by the pooling fund according to the regulations. The minimum payment standard, payment proportion and maximum payment limit of the outpatient plan of the designated retail drugstore can implement the same medical insurance treatment policy as that of the designated primary medical institutions in the planned area. The designated retail pharmacy can provide distribution services according to the needs of the insured, and the distribution fee is not included in the scope of medical insurance payment. The Notice also requires that relying on the national unified medical insurance information platform, the implementation and application of the medical insurance electronic prescription center should be accelerated, and the electronic prescription of designated medical institutions should be smoothly transferred to designated retail pharmacies. Designated medical institutions can issue long-term prescriptions for eligible patients for up to 12 weeks. According to the provisions of the Interim Measures for the Administration of Medical Security of Retail Drugstores, designated retail pharmacies refer to physical retail pharmacies that voluntarily sign medical insurance agreements with regional agencies to provide medical services for the insured. (Xinhua News Agency)

Edit:Ying Ying    Responsible editor:Shen Chen

Source:People.cn

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