Interim Measures for the Management of Retail Pharmacies for Medical Insurance Designation

Chapter I General Provisions Article 1 In order to strengthen and standardize the management of retail pharmacy medical insurance designation, improve the efficiency of the use of medical insurance fund, and better protect the rights and interests of the majority of insured persons, these measures are formulated in accordance with the Social Insurance Law of the People's Republic of China (PRC), the Law of the People's Republic of China (PRC) on Promotion of Basic Medical Care, Health Care and Health Promotion, and the Pharmaceutical Administration Law of the PRC. Article 2 The designated management of retail pharmacies for medical insurance shall adhere to the people's health as the center, follow the principles of guaranteeing basic, fairness and impartiality, clarity of rights and responsibilities, and dynamic balance, strengthen the fine management of medical insurance, give full play to the vitality of the market of retail pharmacies, and provide appropriate pharmaceutical services for the insured. Article 3 The administrative department of medical insurance is responsible for formulating policies on the management of designated retail pharmacies, and supervising the medical insurance management organization (hereinafter referred to as the "management organization") and designated retail pharmacies in the areas of designated application, professional assessment, consultation and negotiation, conclusion of the agreement, fulfillment of the agreement, and termination of the agreement. The Agency is responsible for determining the designated retail pharmacies, signing medical insurance service agreements (hereinafter referred to as "medical insurance agreements") with the designated retail pharmacies, providing administrative services, and carrying out management and assessment of the medical insurance agreements. The designated retail pharmacies shall comply with the health insurance laws, rules, regulations and relevant policies, in accordance with the provisions of the insured persons to provide pharmaceutical services. Chapter II fixed-point retail pharmacies to determine Article 4 the integrated area of medical insurance administrative department according to the public health needs, management service needs, medical insurance fund income and expenditure, the demand for medication of the insured to determine the integrated area of the fixed-point retail pharmacy resource allocation. Article 5 A retail pharmacy that has obtained a drug license and meets the following conditions can apply for medical insurance designation:

(1) it has been officially operating at its registered address for at least 3 months;

(2) it has at least one pharmacist who has obtained a licensed pharmacist's qualification certificate or a pharmacist with a professional and technical qualification certificate of pharmacy, clinical pharmacy and traditional Chinese medicine, and its registered address is in the place where the retail pharmacy is located. (c) at least two full-time (part-time) health insurance management personnel who are familiar with the laws and regulations of medical insurance and related systems are responsible for the management of health insurance expenses, and have signed a labor contract for more than one year and within the contract period;

(d) in accordance with the requirements of the Pharmaceutical Quality Management Standard for Drug Operation, carry out the management of the classification of drugs in zones, and set up a clear identification of medicines for health insurance use for the drugs sold. (e) have a medical insurance drug management system, financial management system, medical insurance personnel management system, statistical information management system and medical insurance fee settlement system in line with the requirements of the medical insurance agreement;

(f) have the information system technology and interface standards in line with the requirements of the medical insurance agreement, and realize effective docking with the medical insurance information system to provide direct network settlement for the insured, and establish a medical insurance fee settlement system for the insured;

(g) have the information system technology and interface standards in line with the requirements of the medical insurance agreement, realize effective docking with the medical insurance information system, and provide direct network settlement for the insured. Provide direct network settlement for the insured, establish the basic database of medical insurance drugs, etc., and use the national unified medical insurance code according to the regulations;

(7) meet the laws and regulations and other conditions stipulated by the provincial and above administrative departments of medical insurance. Article 6 A retail pharmacy shall submit an application for medical insurance designation to the coordinating regional agency, providing at least the following materials:

(1) application form for designated retail pharmacy;

(2) copy of drug business license, business license and ID card of legal representative, principal person in charge or person under actual control;

(3) certificate of practicing pharmacist or relevant certificates of pharmaceutical technician and copy of their labor contract;

(4) copy of certificate of pharmacy technician; and certificates and copies of their labor contracts;

(iv) copies of the labor contracts of full-time (part-time) managers of medical insurance;

(v) texts of internal management systems and financial systems corresponding to medical insurance policies;

(vi) materials related to the information system related to medical insurance;

(vii) a predictive analysis of the use of the medical insurance fund after incorporation into the fixed-point report;

(viii) other materials required by the provincial medical insurance administrative department in accordance with relevant regulations. Article 7 When a retail pharmacy submits an application for fixed-point, the co-ordinating regional agency shall accept the application immediately. If the application materials are incomplete, the agency shall inform the retail pharmacy to supplement the application within five working days from the date of receipt of the materials. Article 8 The coordinating regional agency shall organize an assessment team or entrust a third party agency that meets the requirements to carry out the assessment in written and on-site forms. Members of the assessment team shall be composed of professionals in medical insurance, medicine and health, financial management, and information technology. The assessment will take no more than three months from the date of acceptance of the application materials, and the time for the retail pharmacy to supplement its materials will not be counted as part of the assessment period. The assessment includes:

(i) verification of the drug business license, business license and ID card of the legal representative, business person in charge or de facto controller;

(ii) verification of the licensed pharmacist's qualification certificate or the qualification certificate of the pharmacy technician and the labor contract;

(iii) verification of the labor contract of the full-time (part-time) managerial staff of the medical insurance;

(iv) Verification of the internal management system and financial system corresponding to the medical insurance policy;

(v) Verification of whether the information system related to the medical insurance has the conditions to carry out direct network settlement;

(vi) Verification of the identification of medicines under the medical insurance.

The assessment results include pass and fail. The coordinating regional administrative organization shall report the assessment results to the medical insurance administrative department at the same level for the record. For the assessment of qualified, included in the proposed signing of the health insurance agreement retail pharmacy list to the public. Those that fail the assessment shall be informed of the reasons and suggestions for rectification shall be made. From the date of delivery of the results of the notification, rectification of 3 months after the assessment can be re-organized, the assessment is still unqualified, 1 year shall not re-apply.

Provincial medical insurance administrative departments can, on the basis of this approach, according to the actual situation, to develop specific assessment rules.