国家医保局：对定点药店“阴阳价格”问题严肃核查处置

Core Viewpoint - The National Medical Insurance Administration (NMI) is addressing the issue of "dual pricing" in designated retail pharmacies, where the same medication is sold at a higher price to insured patients compared to uninsured patients, indicating a violation of regulations and potential exploitation of the medical insurance fund [1][2][5]. Group 1: Regulatory Actions - The NMI has issued a notification to enhance monitoring of "dual pricing" practices in designated pharmacies, emphasizing the need for data screening and on-site verification [1][3]. - The notification categorizes "dual pricing" as a violation of the use of medical insurance funds, urging local medical insurance departments to recognize the infringement of insured individuals' rights and the negative impact on the insurance fund [2][4]. - Local medical insurance departments are required to include "dual pricing" behavior in their key monitoring items and to conduct thorough investigations based on pricing discrepancies and public complaints [3][4]. Group 2: Consumer Impact - Reports from various regions indicate that consumers are increasingly avoiding physical pharmacies due to the "dual pricing" issue, which has been highlighted by media coverage [2][5]. - The phenomenon of "dual pricing" is not isolated, with multiple consumers in cities like Chongqing and Wuhan reporting significant price differences when using insurance versus cash payments [2][5]. Group 3: Expert Insights - Experts suggest that the "dual pricing" issue arises partly from delayed reimbursements from the insurance system, leading pharmacies to pass costs onto consumers [5][6]. - The practice of "dual pricing" is seen as a violation of both the Medical Insurance Service Agreement and various laws, including the Price Law and Social Insurance Law of the People's Republic of China [6][7]. - Experts emphasize that while regulatory oversight is challenging due to the complexity of the retail drug market, the NMI's recent measures are a step towards addressing these issues effectively [7][8]. Group 4: Future Measures - The NMI plans to implement a smart regulatory system to recover losses from the insurance fund and will conduct regular analyses of suspicious data to combat fraudulent practices [8]. - Designated pharmacies will be subject to flying inspections, and any violations will be dealt with according to the law, ensuring accountability and compliance [8].