国家医保局：进一步加强超量开药智能监管

Core Points - The article outlines a notification from the National Medical Security Administration aimed at strengthening the intelligent supervision of excessive prescription practices in the healthcare system [1][2]. Group 1: Goals and Phases - The initiative aims to establish a robust intelligent supervision system for excessive prescriptions by leveraging a unified national medical insurance information platform, with a focus on safeguarding the security of medical insurance funds [1]. - The implementation will occur in three phases: 1. Pilot programs to explore experiences by the end of December 2025, covering at least 50 types of high-risk drugs [1]. 2. Provincial rollout by the end of June 2026, expanding to at least 100 types of monitored drugs [1]. 3. Full application and mechanism formation by the end of December 2026, achieving comprehensive coverage and standardized rules [1]. Group 2: Focus Areas - The supervision will concentrate on three categories of drugs: 1. Drugs frequently involved in illegal use of medical insurance funds [3]. 2. Drugs with high payment amounts and abnormal expenditure growth [3]. 3. Drugs with high demand for resale and significant profit margins [3]. - Additionally, three types of abnormal behaviors will be monitored: 1. Excessive purchases beyond clinical needs [3]. 2. Repeated purchases across institutions without changes in medical conditions [3]. 3. Frequent or fraudulent purchases [3]. - The focus will also extend to three categories of institutions and personnel involved in excessive prescriptions [3]. Group 3: Key Actions - Strengthening data screening and analysis by constructing big data regulatory models to identify high-risk drugs and suspicious purchasing behaviors [4]. - Enhancing precise reminder and warning systems through the medical insurance information platform to improve the effectiveness of preemptive alerts [5]. - Implementing strict measures for investigation and punishment, encouraging self-correction among institutions and individuals while imposing severe penalties for serious violations [5]. Group 4: Work Requirements - Emphasizing the importance of respecting medical practices and ensuring reasonable medication needs are met while distinguishing them from fraudulent activities [6]. - Promoting pilot programs to explore and standardize intelligent supervision practices, with a focus on gathering broad consensus before implementation [7]. - Strengthening organizational leadership and support measures to ensure effective data monitoring and compliance with safety regulations [7].