医保药品智能监管
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50种易倒卖回流医保药品纳入智能监管
Xin Hua She· 2025-11-04 07:30
Core Points - The National Healthcare Security Administration (NHSA) has announced a plan to implement intelligent supervision of at least 50 types of key monitored drugs that are prone to resale and return to the medical insurance system by the end of December 2025 [1][2] - By June 2026, the supervision will expand to at least 100 types of these drugs across all provinces and regions, with full coverage expected by December 2026 [1] - The focus will be on three categories of drugs: those frequently involved in illegal use of medical insurance funds, those with high payment amounts and abnormal spending growth, and those with high resale demand and profit margins [1] Drug Supervision - The supervision will target abnormal purchasing behaviors, including excessive purchases without legitimate reasons, repeated purchases across institutions without significant changes in medical conditions, and frequent or fraudulent purchases [1][2] - The NHSA emphasizes the need to distinguish between legitimate medical needs and fraudulent behaviors related to excessive prescriptions and resale of drugs [2] Key Institutions and Personnel - The plan will also monitor three categories of institutions and personnel: insured individuals suspected of abusing medical insurance for excessive prescriptions, medical institutions with concentrated excessive prescription behaviors, and medical staff suspected of assisting or inducing others in fraudulent prescription practices [2]