"Dual Channels" of Medical Insurance: Tibet will include all state-talked drugs; Zhuhai will include 291

Tibet and Zhuhai released work related to the "dual-channel" management of medical insurance
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Tibet pointed out that all drugs negotiated by the state will be included in the dual channel; after the publication of the new version of the medical insurance catalogue, hospitals must purchase and supply as needed; the price of negotiated drugs sold by "dual channel" designated retail pharmacies shall not be higher than the medical insurance negotiated by the state.
payment standard
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Zhuhai will implement the new national medical insurance negotiation drugs (275) and "dual-channel" drug list (291) from January 1, 2022
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On January 1, the Tibet Autonomous Region Medical Insurance Bureau and the Health and Health Commission issued a notice on the establishment of a "dual channel" management of drugs for national medical insurance negotiation
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It is clear that all negotiated drugs during the agreement period announced by the state are included in the "dual-channel" management
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The negotiated drugs included in the "dual-channel" management of our district shall comprehensively consider factors such as clinical value and reasonable medication needs of patients.
During the agreement period, all negotiated drugs are included in the "dual-channel" management of our district, and the insured personnel use negotiated drugs in designated medical institutions and designated retail pharmacies, and implement a unified payment policy
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The autonomous region adjusts the negotiated drugs included in the "dual-channel" management in our region according to the transfer-in and transfer-out of the negotiated drugs in the national medical insurance drug catalog
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All localities should do a good job of linking the "dual-channel" management of state-controlled drugs with the current policies for inpatient, outpatient special diseases, and outpatient coordination to ensure that benefits are not reduced
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After the official publication of the new catalog, the designated medical institutions are the first responsible for negotiating the rational use of drugs in clinical practice
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All designated medical institutions should implement the main responsibility for rational drug use, and establish a linkage mechanism between the allocation of drugs in the hospital and the adjustment of the medical insurance drug catalog
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Since the official announcement of the new catalog, it is necessary to coordinate the holding of the pharmacy meeting in a timely manner according to the clinical drug needs, and the centralized drug procurement platform in the autonomous region must be purchased and matched as needed
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At present, medical institutions that have clinical needs but have not yet equipped them should be equipped with one-time equipment before the end of the year.

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For the negotiated drugs that cannot be included in the supply catalog of this medical institution for the time being, but there is real clinical demand, they can be included in the scope of temporary procurement, establish a green channel, simplify the procedure, shorten the cycle, and purchase in a timely manner
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For drugs that cannot be prepared temporarily, it is necessary to establish and improve the prescription circulation mechanism, and improve the availability of drugs through "dual channels" and other channels
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It is necessary to improve the internal management system, strengthen the supervision of clinical drug use behavior, standardize medical service behavior, and ensure the rational use of negotiated drugs
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The provision and use of negotiated drugs are included in the annual assessment of the hospital.
The medical insurance department should strengthen the management of agreements, and include the reasonable allocation and use of negotiated drugs in designated medical institutions into the content of the agreement and link it with the annual assessment
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The total amount of medical insurance should be scientifically set, and the negotiated drugs should not be included in the total amount of designated medical institutions
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For diseases subject to the reform of payment methods, the weight of the diseases should be adjusted reasonably according to the actual use of the negotiated drugs in a timely manner
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The health department should adjust and improve the evaluation mechanism for the use of drugs in medical institutions, separate the negotiated drugs for rational use, and exclude them from the scope of evaluation indicators such as the proportion of drugs in medical institutions and the average cost per time that affect their implementation
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Strengthen the guidance and management of clinical drug use behaviors in designated medical institutions, urge medical institutions in the jurisdiction to reasonably allocate and use negotiated drugs, and must not use the total amount of medical insurance, the limit on the number of medical institutions' drug catalogues, and the proportion of drugs to affect the landing of negotiated drugs
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Include qualified fixed-point retail pharmacies into "dual-channel" management Before the end of December 2021, in principle, there should be at least one "dual-channel" pharmacy in eligible prefectures (cities), and they should take the initiative to disclose to the public in a timely manner
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Establish and improve the dynamic adjustment mechanism for "dual-channel" fixed-point retail pharmacies, with moderate competition, both in and out
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Designated retail pharmacies that are included in the "dual-channel" management should be equipped with negotiated drugs according to supply capacity and agreement requirements.

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"Dual-channel" designated retail pharmacies must be directly connected to the national unified medical insurance information platform in accordance with the interface specifications for designated medical institutions of the national medical security information platform to realize the circulation and traceability of electronic prescriptions, or self-built functionally complete and capable of unified national medical insurance information The platform is directly connected to the "incoming, selling, and depositing" system, which uploads true, comprehensive, accurate, and real-time drug "purchasing, selling, and depositing" data and settlement costs; the negotiated drug prices sold shall not be higher than the medical insurance payment standards negotiated by the state
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Accelerate the realization of electronic prescription circulation The Autonomous Region Medical Security Bureau uses the prescription circulation center of the Tibet platform of the national medical security information platform to realize the information exchange between medical insurance agencies, designated medical institutions, and "dual-channel" designated retail pharmacies
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After a designated medical institution issues an electronic prescription (except for psychotropic drugs), it is uploaded to the medical insurance information platform through the designated medical institution interface of the national medical security information platform, and is transferred to a "dual-channel" designated retail pharmacy according to the needs of the insured personnel.
After taking the medicine, complete the medical insurance information settlement
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The medical insurance information platform conducts settlement with the "dual-channel" designated retail pharmacies to realize the full-process payment of medical insurance settlement, and the insured personnel only need to pay the expenses borne by themselves
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All localities should focus on the circulation of prescriptions to realize the whole-process supervision of the drug use behavior of insured persons
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Ensuring medication safety Designated medical institutions must strictly abide by the clinical medication management policies and norms to ensure the safety of clinical medication
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"Dual-channel" designated retail pharmacies should establish a full-process traceability mechanism for the quality and safety of negotiated drugs, and implement safety responsibilities in storage, distribution and other links to ensure the quality and safety of negotiated drugs
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For drugs with special requirements such as storage, institutions with corresponding qualifications and capabilities should be selected to undertake storage and distribution tasks
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If there is a quality problem in the negotiated drugs sold by the "dual-channel" designated retail pharmacies, the "dual-channel" medical insurance service agreement will be immediately terminated, and the clues about the problem will be handed over to the relevant departments for strict accountability.

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Benefits and Expense Settlement During the period of hospitalization and outpatient treatment of special diseases in designated medical institutions, the insured persons purchase medicines at designated retail pharmacies according to the "dual channel", and enjoy the same medical insurance treatment according to the policies for inpatient and outpatient special diseases
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When medical insurance physicians in designated medical institutions issue prescriptions (electronic prescriptions), they must indicate the type of medical treatment.
Among them, employee medical insurance implements the unified treatment policy of the whole region, and urban and rural residents medical insurance for hospitalization, general outpatient planning, and outpatient special diseases implement the local (city) treatment policy
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The medical insurance expenses incurred by the purchase of medicines at the "dual-channel" designated retail pharmacies through electronic prescription circulation shall be settled by the medical insurance agency and the "dual-channel" designated retail pharmacies, and shall be settled in the existing project-based settlement method
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