1. The pharmacy applies to the administrative department of medical insurance;
2. Review and evaluation: the medical insurance administrative department evaluates the declared retail pharmacies by reviewing written materials and field visits;
3. Publicity of results: the evaluation results are publicized in the official accounts of official website and WeChat of each medical insurance bureau;
4. Agreement signing: The medical insurance agency signed a service agreement with the newly designated retail pharmacy.
Application conditions:
1. Obtain the Pharmaceutical Trading License, the Certification Certificate for Quality Management of Pharmaceutical Trading (GSP Certificate) and the business license;
2. Normal operation 1 year or more;
3. Strictly implement the drug price and pass the supervision and inspection of the price department;
4. The drug business premises are more than 80 square meters (excluding offices, warehouses and other ancillary buildings); Have the ability to supply basic medical insurance drugs in time for 24 hours;
5. The variety (trade name) of drugs (excluding Chinese herbal pieces) shall not be less than 1000, and the drug preparation rate of basic medical insurance drugs shall not be less than 80% of the drug varieties; Drugs should be classified and placed, with obvious hints; Prescription drugs, over-the-counter drugs and non-drugs must be placed in separate cabinets and zones; Do not operate food, cosmetics, daily necessities and other items that are not covered by medical insurance in the store;
6 pharmaceutical trading enterprises must have "purchase, sale and storage" ledger, and carry out computer management according to GSP requirements; And according to the inspection needs of medical insurance agencies, timely provide the "purchase, sale and deposit" ledger;
7. Equipped with more than/kloc-0 licensed pharmacists or pharmacists (no part-time or nominal), and ensure that no less than/kloc-0 licensed pharmacists or pharmacists are on duty during business hours. Other pharmaceutical practitioners need to be trained by the food and drug supervision and administration department or the human resources and social security department, hold certificates, have regular (annual) physical examinations, and establish health records;
8. Strictly abide by the labor law and various laws and regulations, internal management norms, sign labor contracts with employees according to law, participate in various social insurances, and pay social insurance premiums in full and on time.
9. It has not been punished by human resources and social security, food and drug supervision and management, price and other departments within 0/2 months before applying for the designated place;
10. Other conditions.
To sum up, pharmacies apply for opening medical insurance cards, provide the required information, submit them to the local medical insurance office for filing and approval, and use them after installing medical insurance machines. The specific formal procedures are mainly subject to the local medical insurance office.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 29
The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.
The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.
Interim Measures for the designated management of medical security in retail pharmacies
Article 5
Retail pharmacies that have obtained the Drug Business License and meet the following conditions may apply for designated medical security:
(a) at the registered address for at least 3 months;
(2) There shall be at least 1 pharmacist who has obtained the qualification certificate of licensed pharmacist or has the professional and technical qualification certificate of pharmacy, clinical pharmacy and traditional Chinese medicine, and the registered place is the location of retail pharmacy, and the pharmacist shall sign a labor contract for more than 1 year within the contract period;
(3) At least two full-time (part-time) medical insurance managers who are familiar with medical insurance laws, regulations and related systems are responsible for the management of medical insurance expenses, and have signed labor contracts of 1 year or more during the contract period;
(four) in accordance with the requirements of the "Quality Management Standards for Pharmaceutical Trading", the implementation of drug classification and zoning management, and the establishment of clear medical insurance drug labels for drugs sold;
(5) Having a medical insurance drug management system, a financial management system, a medical insurance personnel management system, a statistical information management system and a medical insurance expense settlement system that meet the management requirements of the medical insurance agreement;
(6) Having information system technology and interface standards that meet the management requirements of the medical insurance agreement, realizing effective docking with the medical insurance information system, providing direct online settlement for the insured, establishing basic databases such as medical insurance drugs, and using national unified medical insurance codes according to regulations;
(seven) meet other conditions stipulated by laws and regulations and provincial and above medical security administrative departments.