Bulletin board of medical insurance in retail pharmacies

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On the issuance of "Guangzhou medical insurance designated"

Notice of the measures for the administration of retail pharmacies

District, county-level city labor and social security bureau, food and drug administration, retail pharmacies and relevant units:

The measures for the administration of designated retail pharmacies of medical insurance in Guangzhou are hereby printed and distributed to you, please follow them. Please report the problems found in the implementation process in time.

Guangzhou Municipal Bureau of Labor and Social Security Guangzhou American Food and Drug Administration

April 2006 17

Measures of Guangzhou Municipality on the Administration of Designated Retail Drugstores of Medical Insurance

Article 1 In order to strengthen and standardize the management of designated retail pharmacies of medical insurance in this Municipality, according to the Decision of the State Council on Establishing the Basic Medical Insurance System for Urban Employees (Guo Fa [1998] No.44) and the Notice of the General Office of the State Council on Retaining Some Non-administrative Licensing Examination and Approval Items (Guo Ban Fa [2004] No.62), The Interim Measures for the Administration of Designated Retail Drugstores with Basic Medical Insurance for Urban Employees (No.of Ministry of Labor and Social Security 1999) and the Trial Measures for Basic Medical Insurance for Urban Employees in Guangzhou (No.of Guangzhou Municipal People's Government [2001]17) are formulated in light of the actual situation of this Municipality.

Article 2 The municipal labor security administrative department shall be responsible for the assessment and evaluation of the designated retail pharmacies in this Municipality, and supervise and manage the implementation of medical insurance policies and service agreements by the municipal medical insurance agencies and designated retail pharmacies.

The municipal medical insurance agency shall be responsible for the daily management of the audit and evaluation of the designated retail pharmacies in this Municipality, and assist the municipal labor security administrative department to supervise, manage and evaluate the designated retail pharmacies in this Municipality.

The municipal food and drug supervision and administration department shall participate in the audit, evaluation, supervision and inspection of designated retail pharmacies.

Article 3 The term "designated retail pharmacies" as mentioned in these Measures refers to retail pharmacies that have been examined and evaluated by the municipal labor and social security administrative department in conjunction with the municipal food and drug supervision and management department, confirmed by the municipal labor and social security administrative department, meet the conditions of designated retail pharmacies, and signed a service agreement with the municipal medical insurance agency to provide drug sales services for medical insurance participants.

Article 4 Principles for determining designated retail pharmacies:

(a) choose the best among the best, reasonable layout, so that it can not only meet the needs of medical insurance development, but also facilitate the insured to buy drugs, and facilitate supervision and management.

Ensure the variety and quality of basic medical insurance drugs.

(three) the introduction of fair competition mechanism, reasonable control of drug service costs and drug prices, improve the quality of drug sales services.

Article 5 Retail pharmacies that have obtained the Pharmaceutical Trading License, the Certificate of Quality Control of Pharmaceutical Trading and the Business License according to law in the basic medical insurance co-ordination area of this Municipality may apply to the municipal labor and social security administrative department for the qualification of designated retail pharmacies.

A chain-operated retail pharmacy shall submit an application for the qualification of designated retail pharmacies to the chain company.

But retail pharmacies or chain companies in any of the following circumstances, since the date of confirmation by the municipal labor and social security administrative department, within three years does not belong to the scope of medical insurance designated retail pharmacies qualification application:

(1) submitting the application materials by any improper means such as fiction or tampering.

(2) Being disqualified as a designated retail pharmacy due to violation of medical insurance regulations.

Retail pharmacies that have administrative affiliation or business interests with the designated medical institutions of medical insurance in this Municipality do not belong to the scope of applying for the qualification of designated retail pharmacies.

Article 6 To apply for the qualification of designated retail pharmacies, the following conditions shall be met:

(1) Abide by the Drug Administration Law of People's Republic of China (PRC) and relevant laws and regulations, strictly regulate the channels for purchasing drugs, and have a sound drug quality assurance system and facilities.

(2) The display of drugs conforms to the regulations on drug classification management, with clear functional classification and clear classification labels and price labels.

(three) the geographical location conforms to the regional layout planning of designated retail pharmacies. The new designated retail pharmacy is at least 200 meters away from the original designated retail pharmacy specializing in similar drugs. In the secondary and tertiary medical institutions designated by the city's medical insurance, the secondary can be selected at close range.

(four) drug sales service facilities and information management system can meet the basic medical insurance participants' demand for drug sales service and drug expense settlement requirements.

(5) The drug price is not higher than 1 10% of the average price of similar drugs in retail pharmacies in this city.

(six) there are more than two pharmacists or pharmacists in the field; Can provide 24-hour drug sales service.

(seven) the layout of the business premises is reasonable; The use area of the site is more than 80 square meters; The remaining validity period of the right to use the premises or the lease contract is more than 2 years from the date of submission of the application materials.

(8) There are more than 1500 kinds of drugs in the list of drugs for basic medical insurance and industrial injury insurance in Guangdong Province, or more than 300 kinds of Chinese herbal pieces that meet the payment scope of basic medical insurance; And can ensure the timely supply of basic medical insurance drugs for the insured.

(9) There is no problem of distributing counterfeit and inferior drugs due to illegal business within 1 year before submitting the application report.

(ten) retail pharmacies and their employees have participated in the basic medical insurance in this Municipality as required, and paid the basic medical insurance premium in full and on time.

(eleven) Yamatonokusushi, the business director, has been trained in the basic medical insurance policies and regulations and passed the examination.

Seventh in the same area (200 meters apart), there are a number of retail pharmacies that meet the conditions stipulated in Article 6 of these Measures, and those that meet the following conditions will be given priority:

(1) The prices of similar drugs are relatively low;

(2) In recent years 1 year, the average number of drug sales and the average daily drug business income were more;

(3) A large number of drugs;

(4) The place for dealing in drugs has a large area and a relatively beautiful and comfortable environment;

Article 8 To apply for the qualification of designated retail pharmacies, the following materials shall be truthfully submitted and stamped with the official seal of the unit:

Application for qualification of medical insurance designated retail pharmacies in Guangzhou.

(II) Fill in the Application Form for Qualification of Designated Retail Drugstores of Medical Insurance in Guangzhou, the Catalogue of Drug Varieties and the Registration Form for Pharmacists (including resident pharmacists) compiled by the municipal labor and social security administrative department (65438+ 0 written copies and 0 electronic copies).

(3) The original and photocopy of the Drug Business License and the Certificate of Good Quality Management of Drug Business; Original and photocopy of business license and organization code certificate; Original and photocopy of the legal representative's certificate and ID card; Original and photocopy of pharmacist title certificate. Retail pharmacies that are required to participate in basic medical insurance should also provide a copy of the Approval Form for the Collection and Payment of Medical Insurance Funds and a certificate for the transfer of medical insurance premiums.

(four) the confirmation certificate issued by the municipal food and drug supervision and management department that there is no problem of distributing counterfeit and inferior drugs due to illegal business within 1 year.

(five) a copy of the property right of the service place where the drugs are sold or the relevant materials of the lease contract.

Ninth designated retail pharmacies qualification review work once a year. The municipal labor and social security administrative department shall strictly control the number of designated retail pharmacies according to the number and regional distribution of medical insurance participants and the ratio of every 20,000 participants 1 home.

Tenth designated retail pharmacies qualification according to the following procedures:

(1) Acceptance of application: Retail pharmacies that meet the scope stipulated in Article 5 and the conditions stipulated in Articles 6 and 7 of these Measures shall submit a written application and relevant materials to the municipal labor and social security administrative department.

(2) Data review: After receiving the application from the retail pharmacy, the municipal labor and social security administrative department shall complete the data review within 30 working days, make a preliminary decision and notify the retail pharmacy in writing.

(III) On-site inspection: The municipal labor and social security administrative department shall, jointly with the municipal food and drug supervision and administration department, the municipal medical insurance agency and the labor and social security information management department, conduct on-site inspection on the retail pharmacies that have passed the preliminary examination, and the inspection results shall be signed and confirmed by the responsible persons of both the inspection and the inspected.

(4) Evaluation: The departments participating in the evaluation will collectively evaluate the evaluation results of retail pharmacies applying for designated qualifications according to the conditions stipulated in these Measures, and the heads of all departments will sign and confirm the evaluation results.

(V) Examination and approval: The competent leader of the municipal labor and social security administrative department shall examine and approve the collective evaluation results.

(6) Training, installing medical insurance information system, and signing service agreement: for retail pharmacies confirmed by the municipal labor and social security administrative department to meet the qualifications of designated retail pharmacies, the municipal social insurance agency will organize medical insurance policy training and assessment; At the same time, the construction of medical insurance information system, after the acceptance of the labor security information management department, signed a service agreement with the municipal medical insurance agency.

(VII) Qualification: For retail pharmacies that meet the qualifications of designated retail pharmacies and sign service agreements with municipal medical insurance agencies, the municipal labor and social security administrative department shall identify the qualifications of designated retail pharmacies, issue the qualification certificates and signs of medical insurance designated retail pharmacies, and make an announcement to the public.

Eleventh designated retail pharmacies service agreement text and supplementary agreement content by the municipal medical insurance agencies in accordance with the provisions and requirements of medical insurance, submitted to the municipal administrative department of labor and social security for approval before implementation. The service agreement shall specify the rights, obligations and responsibilities of both parties, and include the following contents: service scope and service quality requirements, requirements for examination and control of drug expenses, payment methods and standards for drug expenses, liability for breach of contract and punishment standards, assessment methods and other contents determined by both parties through consultation.

Twelfth designated retail pharmacies shall strictly abide by the following provisions, and provide high-quality drug sales services for medical insurance participants:

(a) the implementation of medical insurance and drug supervision and management policies and related regulations, fulfill the service agreement, abide by the "Drug Administration Law of People's Republic of China (PRC)" and related regulations, and ensure the quality of drugs.

(two) the implementation of drug price regulations stipulated by the competent pricing department, and the implementation of price tag, to provide detailed drug list to the insured.

(3) Establish an internal management system and medical insurance management institution that are suitable for the management of medical insurance, designate a unit leader to be responsible for and be equipped with full-time (part-time) management personnel, and cooperate with the supervision, management and assessment work of the administrative department of labor security and the medical insurance agency.

(four) business hours to ensure that at least 1 pharmacists on duty, other business personnel must be certified according to regulations.

(five) medical insurance prescriptions must be issued by doctors in designated medical institutions, and the prescriptions should be signed by pharmacists in designated retail pharmacies and stamped with the special seal for outpatient service of designated medical institutions. Manage foreign prescriptions and establish separate accounts, and keep them for more than 2 years for future reference.

(6) Hanging the pharmaceutical business license, business license, certificate of quality control of pharmaceutical business, qualification certificate of pharmaceutical professional and technical personnel, service commitment or service convention in a prominent position in the business place.

(VII) Check the medical insurance certificate of the insured, and if it is found that it has been altered, forged or fraudulently used, it shall refuse to use it and be detained, and promptly report to the municipal medical insurance agency for handling.

(eight) to publicize the provisions of the medical insurance policy to the insured, and set up a publicity column for the contents of the medical insurance policy and service agreement in a prominent position in the drug sales and service places; Post publicity materials about the operating procedures, and set up eye-catching drug sales guidelines for the insured.

(nine) to do a good job in the self-inspection of the insured's drug purchase expenses, truthfully fill in the relevant settlement statements, and provide all the materials required for reviewing the drug purchase expenses and the list of charging accounts according to the requirements of the municipal labor and social security department when necessary. Otherwise, the municipal medical insurance agency has the right to refuse to pay the drug procurement expenses involved.

(ten) cooperate with the municipal medical insurance agency and the labor security information management department to implement computer management of drug sales and expense settlement of the insured.

Article 13 The municipal labor and social security administrative department shall supervise and manage the service and management of designated retail pharmacies according to the relevant policies and regulations of medical insurance, and organize relevant departments such as drug supervision and price control to supervise and inspect the service and management of designated retail pharmacies from time to time.

Fourteenth designated retail pharmacies in any of the following circumstances, the municipal labor and social security administrative department to cancel the qualification of designated retail pharmacies, and social insurance agencies to terminate the service agreement. All the expenses involved in the violation shall not be paid by the medical insurance fund, and the paid illegal expenses shall be fully recovered by the municipal medical insurance agency:

(1) defrauding the medical insurance fund by illegal means such as forging medical insurance prescriptions.

(two) by the administrative punishment of industry and commerce, drug administration, price and other departments. However, it does not conform to the provisions of Article 81 of the Regulations for the Implementation of the Drug Administration Law of People's Republic of China (PRC).

(three) to provide the medical insurance drug expense settlement system to other retail pharmacies, collect funds from the insured's personal medical account or apply to the municipal medical insurance agency for payment of the medical insurance fund.

(four) the food and drug supervision and management department revoked the "drug business license", "drug quality management standard certification certificate" and the administrative department for Industry and commerce revoked the business license.

Fifteenth designated retail pharmacies have one of the following acts, if the circumstances are minor, the municipal labor and social security administrative department shall order it to make rectification within a time limit, and suspend its sales of drugs and services to social insurance insured persons during the rectification period; If the circumstances are serious, the qualification of designated retail pharmacies will be cancelled, and the service agreement will be terminated by the social insurance agency. All the expenses involved in the violation shall not be paid by the medical insurance fund, and the paid illegal expenses shall be fully recovered by the municipal medical insurance agency:

(1) Failing to prescribe drugs and dosages other than those prescribed, or changing the prescribed drugs into other drugs or non-drugs.

(two) in violation of the price policy, increase the price of drugs without authorization, or charge the insured a higher fee than others.

(3) Using the medical insurance pooling fund or individual account funds to pay the expenses outside medical insurance coverage, or the medical insurance pooling fund to pay the medical expenses that should be paid by individual medical account funds (or cash), or the insured to pay the medical expenses that should be paid by the medical insurance pooling fund.

(four) refusing to provide drug sales services for medical insurance participants in this Municipality without justifiable reasons.

(five) without justifiable reasons, the supervision and inspection of the municipal medical insurance agency does not cooperate, or false certificates are issued.

(six) mistakes and accidents in providing drug promotion services for the insured, resulting in adverse social impact.

Article 16 If the name, legal representative and business scope of a designated retail pharmacy are changed, it shall apply to the municipal labor and social security administrative department for change within 30 days after the municipal food and drug supervision and administration department handles the registration of change, with the written application for change and the original and photocopy of the change information and other relevant supporting materials.

The address of designated retail pharmacies is transferred, divided, merged, closed for more than 3 months or revoked or closed. , cancel the qualification of designated retail pharmacies and terminate the service agreement.

If the above situation is not declared in the designated retail pharmacies, the medical insurance fund will not pay the expenses incurred during the period of drug purchase by the insured.

Seventeenth medical insurance designated retail pharmacies qualification and service agreement is valid for 2 years. Within 30 days before the expiration of the validity period, the municipal medical insurance agency and the designated retail pharmacies shall negotiate to renew the service agreement.

In the renewal of the new annual service agreement, the designated retail pharmacies have one of the following circumstances, and the municipal labor and social security administrative department cancels the qualification of the designated retail pharmacies, and the municipal medical insurance agency will not renew the service agreement:

(a) the number of insured persons purchasing drugs in the year is lower than 30% of the average number of designated retail pharmacies in the same area of this city.

(two) random sampling comparison, the price of drugs sold is higher than the average price of retail pharmacies in this city 1 10% or more.

(three) the annual comprehensive assessment is unqualified.

(four) the designated retail pharmacies are unwilling to continue to undertake the designated drug sales service or fail to perform according to the terms of the service agreement.

Eighteenth designated retail pharmacies qualification certificates and signs by the municipal administrative department of labor security commissioned by the municipal medical insurance agencies unified production, management and distribution. Designated retail pharmacies shall be properly kept and maintained, and shall not be copied, forged, transferred or damaged. If there is any loss or accidental damage, it shall promptly report to the municipal medical insurance agency and make corresponding treatment.

Within 10 working days after the termination or termination of the agreement between the municipal medical insurance agency and the designated retail pharmacies, the designated retail pharmacies should take the initiative to return the qualification certificates and signs to the municipal medical insurance agency for handling.

Nineteenth municipal medical insurance agencies should formulate assessment and scoring methods for designated retail pharmacies according to these measures, and report to the municipal labor and social security administrative department for approval before implementation. The evaluation contents shall include:

(a) the implementation of medical insurance policies and regulations and the performance of service agreements.

(two) the implementation of national, provincial and municipal regulations on drug supervision and management.

(three) the establishment of medical insurance management system and other basic management in designated retail pharmacies.

(four) the use and management of medical insurance funds and personal medical account funds.

(5) Fees for drug sales.

Variety and quality of drug sales service.

(seven) publicity and training of medical insurance related knowledge.

Construction and maintenance of medical insurance information system.

9. Medical insurance information management and data statistics.

(10) Satisfaction evaluation of the insured.

(eleven) other information related to the supervision and management of medical insurance.

Article 20 These Measures shall be valid for five years.

Twenty-first districts and county-level cities not included in the overall planning area can be implemented with reference to these measures.

Twenty-second the implementation since June 6, 2006. The Notice on Printing and Distributing (Sui Lao She Yi [2001]18) shall be abolished at the same time.

Keywords: Notice of Measures for the Administration of Social Insurance Retail Pharmacy

CC: Municipal Legislative Affairs Office, Provincial Labor and Social Security Department and Provincial Health Department.

The office of Guangzhou Labor and Social Security Bureau was issued on May 2006 1 1.

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