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广西实行定点零售药店“无码不结”
Guang Xi Ri Bao· 2025-05-08 01:51
Core Viewpoint - Guangxi has officially implemented a "no code, no settlement" policy for designated retail pharmacies under the medical insurance system, requiring pharmacies to scan traceability codes for medical insurance drug sales to ensure safety and prevent counterfeit drugs [1][2] Group 1: Implementation Details - All designated retail pharmacies in Guangxi must scan traceability codes and upload information to the medical insurance information platform for drug settlement [1] - The traceability code acts as an "electronic ID" for each drug, assigned from production to sales, allowing for quick identification of counterfeit or substandard drugs [1] - As of now, Guangxi has collected 940 million traceability codes covering 19,000 medical institutions [1] Group 2: Consumer Protection Measures - The "no code, no settlement" policy will not affect the purchasing process for insured individuals or the normal reimbursement of medical insurance [1] - For drugs that have not yet been assigned codes, they can be temporarily included in a "no code library" for real-time data collection and review [1] - Consumers can verify their purchase information through the National Medical Insurance Bureau's official app by scanning the traceability code [2] Group 3: Impact on Drug Safety and Fraud Prevention - The implementation of this policy is expected to effectively curb the influx of counterfeit and "returned" drugs into the market, enhancing public safety [2] - It will also utilize big data analysis to combat various fraudulent activities related to medical insurance funds, ensuring safer and more efficient use of these funds [2]
判了!上海首例由医保中心起诉的追偿案获胜 从个案到机制守护医保基金安全
Core Viewpoint - The case marks the first successful lawsuit initiated by the Shanghai Medical Insurance Center for the recovery of medical insurance funds, highlighting the importance of safeguarding public health funds and improving their utilization efficiency [1][5][8]. Group 1: Case Background - The case involves a traffic accident where a taxi driver was found fully responsible for injuring a pedestrian, leading to medical expenses of nearly 150,000 yuan, of which over 40,000 yuan was covered by the medical insurance fund [3][4]. - The pedestrian subsequently sued the taxi company and the insurance company for compensation, resulting in a court ruling for the insurance company to pay over 160,000 yuan, but the recovery of the medical insurance fund was not addressed in the initial ruling [4][5]. Group 2: Legal Framework and Implications - The ruling is based on the newly implemented Shanghai Medical Insurance Regulations, which clarify the rights of the medical insurance agency to pursue recovery of funds paid out for medical expenses that should be covered by third parties [6][7]. - The regulations specify the scope of medical insurance fund usage and establish the medical insurance agency's role as the recovery entity, which is crucial for ensuring accountability and effective fund management [6][7]. Group 3: Future Directions - The case is expected to serve as a precedent for future similar cases, aiming to clarify the rights and responsibilities related to the recovery of medical insurance funds [8][9]. - The local authorities plan to enhance the efficiency of fund recovery through improved information sharing and non-litigation mechanisms, promoting a societal consensus on the return of funds paid by the medical insurance [9].