For a long time, the collection of payments by pharmaceutical companies has been called a "big and difficult" problem
.
Generally, the payment collection period is quite long, sometimes more than 6 months in hospitals and more than 3 months in commercial companies
.
For example, in 2021, the Shandong Provincial Medical Insurance Bureau and the Shandong Provincial Health Commission issued a circular saying that after verification and supervision by various cities, as of March 17, 2021, 89 primary medical and health institutions in 14 counties (cities and districts) in 7 cities, including Jinan, Zibo, Jining, Tai'an, Linyi, Liaocheng and Heze, still owed drug payments
to pharmaceutical enterprises before March 31, 2020.
Therefore, it is good for pharmaceutical companies that medical insurance can directly settle the payment of the drug company
.
It is understood that in recent years, under the background of the continuous compression of corporate profit margins by centralized procurement of drugs and consumables, in order to solve the problem of payment collection, many places are accelerating the promotion of direct settlement of medical insurance
.
For example, recently, the Hainan Provincial Medical Insurance Bureau issued the Notice on the Implementation Plan for Drug Listing Procurement in Hainan Province (hereinafter referred to as the "Notice"), Article 12 of which mentions that it is necessary to explore the settlement of drug payments through direct payment by medical insurance funds, establish a drug settlement mechanism suitable for the construction of Hainan Free Trade Port, and gradually solve the problem
of difficulty in collecting payments by pharmaceutical enterprises.
According to the notice of the Hainan Medical Insurance Bureau, Hainan may establish a new drug settlement mechanism
.
Different from the idea of many places first to solve the problem of payment collection of selected drugs in centralized procurement, Hainan proposed to explore the direct settlement of drug payments by the medical insurance fund, without limiting the scope of
drugs.
The industry believes that in the future, whether it is centralized procurement of drugs or non-centralized procurement of drugs, it is possible to achieve "one-hand delivery, one-hand payment"
.
At present, in addition to Hainan Province, many places are also exploring direct settlement
.
In August this year, the Ningxia Medical Insurance Bureau publicly solicited opinions
on the Implementation Plan for the Negotiation and Procurement of Pharmaceutical and Medical Consumables Alliance of Medical Institutions in Ningxia Hui Autonomous Region (Trial).
It is understood that the plan clarifies that according to the evaluation of the pilot of direct settlement between the medical insurance fund and enterprises, it will explore the timely inclusion of medical consumables in the medical insurance catalogue purchased by the alliance into the scope of
direct settlement.
For medical consumables not included in the medical insurance catalog, medical institutions and enterprises shall settle the payment in a timely manner, and the settlement time shall not exceed the end of the month after the
delivery is qualified.
Earlier, Shandong Province issued the Notice on Printing and Distributing the Implementation Plan for Direct Settlement between Medical Insurance Funds for Drugs and Medical Consumables in Designated Public Medical Institutions and Pharmaceutical Enterprises, which also proposed that by the end of September 2021, a unified drug and device settlement supervision platform should be established in the province, realize the supervision platform and the provincial centralized procurement platform for drugs and devices, and complete the development of online monitoring functions for self-settlement by medical institutions and pharmaceutical enterprises for the direct settlement of medical insurance funds for the procurement of drug consumables with volume, and non-volume procurement of
drug consumables 。 At the same time, we will gradually promote online monitoring of self-settlement between medical institutions and pharmaceutical enterprises, and fully implement the direct settlement between medical insurance funds and pharmaceutical enterprises in 2025
.
According to data disclosed by Shandong Province in June 2022, the scope of direct settlement of drug payments has covered 2,622 public medical institutions in the province, fully realizing the direct settlement
of centralized procurement of drugs.
At the same time, 8 cities including Dezhou have realized direct settlement
of centralized procurement consumables in 221 medical institutions.
The payment settlement cycle has been shortened from an average of 8-12 months to an average of 30 days
.
It is worth mentioning that recently, the Shandong Medical Insurance Bureau issued the Notice on Further Strengthening the Supervision of Centralized Procurement of Pharmaceuticals, further clarifying the comprehensive implementation of direct settlement
of medical insurance funds.
The Notice points out that public medical institutions at all levels should fully implement the direct settlement between the medical insurance fund and pharmaceutical enterprises for centralized procurement of pharmaceutical goods, and resolutely put an end to arrears in payment to pharmaceutical enterprises
.
All localities should achieve as soon as possible the goal
of zero medical institutions that have not carried out direct settlement between the medical insurance fund for centralized procurement of drugs and pharmaceutical enterprises.
In addition, according to the reply of the National Health Insurance Administration to Recommendation No.
5262 of the Fifth Session of the 13th National People's Congress in July this year, Shanghai, Fujian and other places have also achieved positive results
in exploring the direct settlement of payments between medical insurance funds and suppliers through the platform.
Analysts believe that under the background of the state and various localities strictly rectifying the difficulty of medical institutions to collect payments, and continuously promoting the connection between collection and medical insurance, it will better open up the landing chain of centralized procurement drugs, help optimize the business environment, reduce the burden on enterprises, protect the enthusiasm of pharmaceutical enterprises to participate in centralized procurement negotiations, and further stimulate the market vitality
of centralized procurement drug supply.
At the same time, this will also be more conducive to the healthier and orderly development of
China's pharmaceutical and medical equipment industries.
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