医保买药比自费更贵？国家医保局发布专项治理方案

Core Viewpoint - The National Medical Insurance Administration has issued a notice to address 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 potential price fraud and a violation of service agreements [1][4]. Group 1: Regulatory Actions - The notice emphasizes the need for local medical insurance departments to strengthen the management of drug prices in designated pharmacies and to monitor "dual pricing" practices as a key focus [4][5]. - Local medical insurance departments are required to conduct self-inspections and investigations into pharmacies suspected of "dual pricing," particularly those with significant price discrepancies [5][6]. - The administration plans to implement ongoing monitoring of drug prices to ensure compliance and protect the integrity of the medical insurance fund [6][7]. Group 2: Causes and Influences - The phenomenon of "dual pricing" is influenced by both pharmacies and upstream pharmaceutical companies, with pharmacies facing financial pressures due to delayed reimbursements and transaction fees [3][8]. - Pharmaceutical companies may set different prices for insured and uninsured patients, complicating the pricing landscape and contributing to the prevalence of "dual pricing" [2][3]. Group 3: Monitoring and Compliance - The administration has introduced tools such as a drug price comparison app to facilitate consumer awareness and encourage fair pricing practices among pharmacies [6][7]. - There is a recognition that monitoring the prices of non-insured medications is challenging, and pharmacies may use various strategies to circumvent price regulations [4][6]. - The focus on "dual pricing" aims to protect the rights of insured individuals and ensure the sustainable use of medical insurance funds [7][8].