来源：中国医疗保险 2025年是很不平凡的一年，我国医疗保障体系在服务人口高质量发展和中国式现代化中向新向优发展， 展现强大的制度韧性和民生温度。站在岁末回望，这一年涌现的众多热词，如一个个生动的切片，记录 下医保改革的进程、治理水平提升的风向，共同"拼"绘出一幅以人民健康为中心的奋斗图景。以 下，"中国医疗保险"为您解读2025年医疗保障领域的十大热词。 热词1："1+3+N" 国家医保局一直强调要健全"1+3+N"多层次医疗保障体系。具体来说，"1"是构建以全国统一的医保信 息平台、医保大数据为核心的医保基础设施及服务能力；"3"是完善基本医疗保险、大病保险、医疗救 助三重梯次减负的基本医疗保障制度体系；"N"是引导支持商业健康保险、慈善捐赠、医疗互助、工会 职工互助等其他保障力量发挥作用。 近年来，国家医保局持续推进"1+3+N"多层次医疗保障体系建设，基本医保、大病保险、医疗救助三重 基本医疗保障制度进一步巩固提升。职工医保、居民医保政策范围内住院费用报销比例分别达到80%和 70%左右，普遍开展普通门诊统筹和门诊慢性病、特殊疾病保障，减轻参保人员门诊医疗费用负担。大 病保险进一步减负，城乡居民大病保 ...

不久前，外市一家医保定点药店涉及药品追溯码的违规问题被曝光。该药店负责人通过非法渠道获取了 大量已售出药品的追溯码信息，并利用这些"旧码"伪造销售记录。在实际并未购入和销售相应药品的情 况下，系统内却显示这些"高端药品"已被合规售出，并以此向医保基金申请报销。这就好比将已经"注 销"的身份证反复使用，凭空捏造出根本不存在的交易，恶意套取宝贵的医保资金。 这种行为危害巨大。它直接盗取了本应用于民众看病的"救命钱"，破坏了医保支付的精准性与公平性。 更令人担忧的是，若假药、劣药凭借伪造的追溯码流入医保体系，将对患者的健康构成直接威胁。 为了斩断伸向追溯码的黑手，筱智注意到医保和市场监管部门迅速行动。一方面，监管部门升级了追溯 码系统，强化加密与验真技术，使"一码多用"和伪造变得极其困难。另一方面，加强了数据监控与实地 稽核的联动，当系统发现某批次追溯码报销频率异常时，执法人员便能快速锁定目标，进行现场核查。 守护医保基金安全，科技是盾牌，但每个人的意识才是基石。作为参保人，我们应养成核对药盒追溯 码、查询购买记录的习惯，对异常现象保持警惕并积极举报。药店和医疗机构更应恪守诚信，严守规 范。 点击收听： 那就让我们 ...

今天是12月26日，星期五，中国青年报"青年早新闻"来了——"青年关注、关注青年"！ 几分钟速览最新热点，带你走近"宝藏学校"、触达"青春团讯"、学习"榜样人物"、了解"服务动态"。 国防部回应福建舰航经台湾海峡：今后根据需要还会继续组织 就福建舰12月16日首次航经台湾海峡一事，国防部新闻发言人张晓刚25日在例行记者会上表示，今后根 据需要还会继续组织。 会上有记者提问，台湾防务部门称，福建舰12月16日首次航经台湾海峡，将持续严密监控，请问对此有 何评论？ 张晓刚表示，这是福建舰开展的正常训练，今后根据需要还会继续组织。我们奉劝"台独"武装，认清现 实，不要做无谓的挣扎和幻想。 海南全岛封关首周新增外贸备案企业同比增长2.3倍 据中国新闻网，海南自贸港正式启动全岛封关首周，政策红利持续释放，产业发展动能持续增强。海口 海关25日披露，封关首周(12月18日至24日)，海南新增外贸备案企业1972家，同比增长2.3倍。 封关后，海南自贸港实施了一系列新的开放政策并落地见效。海口海关统计，封关首周海关共监管"一 线"进口"零关税"享惠货物超4亿元(人民币，下同)，监管"二线"内销加工增值免关税货物超2000万 ...

Core Insights - The National Medical Insurance Administration has revealed typical cases of drug tracing codes to combat the issue of returned drugs, highlighting the effectiveness of digital technology in regulatory enforcement and the government's firm stance against this illegal practice [1][2] Group 1: Overview of Returned Drugs - Returned drugs refer to pharmaceuticals that have been illegally retrieved from the legitimate medical distribution channels and reintroduced into the market, posing significant risks to public health and disrupting market order [1] - Illegal activities include enticing insured individuals to resell medical insurance drugs and repackaging expired drugs for resale, which undermines the integrity of the pharmaceutical market and threatens the safety of drug use [1] Group 2: Technological Advancements in Regulation - The implementation of drug tracing codes is changing the landscape of drug regulation, allowing for the identification of multiple sales scan records for a single drug package, which may indicate returned or counterfeit drugs [1] - A societal consensus has emerged around the necessity of scanning drugs before purchase and sale, further reducing the space for returned drugs to operate [1] Group 3: Challenges and Solutions in Governance - Addressing the issue of returned drugs requires a multifaceted approach, including increasing the legal consequences for offenders and enhancing collaboration among various regulatory bodies [2] - Establishing a unified data standard and a data-sharing mechanism among departments such as medical insurance, health, and market regulation is essential for improving oversight and governance efficiency [2] - Active participation from pharmacies and consumers in reporting returned drugs is crucial for fostering a safe and compliant pharmaceutical distribution environment [2]

Core Viewpoint - The article emphasizes the importance of combating the illegal trade of "recycled drugs" to ensure public health and safety, highlighting the government's commitment to innovative regulatory measures to trace and monitor drug sales [2][3]. Group 1: Definition and Risks of Recycled Drugs - Recycled drugs refer to pharmaceuticals that are illegally collected, repackaged, or have their information altered before being resold, often lacking proper regulatory oversight [2]. - These drugs pose significant health risks to patients and disrupt market order, as they are often sourced from dubious channels [2]. Group 2: Regulatory Measures - Starting from July 1, all medical insurance designated institutions are required to scan the unique "electronic ID" traceability code on each box of drugs sold, enhancing the ability to track drug origins and movements [2]. - This initiative aims to expose and eliminate the illegal practices associated with recycled drugs and related insurance fraud [2]. Group 3: Collaborative Efforts Required - A comprehensive approach is necessary to eradicate the illegal drug trade, involving strict management of drug sales by pharmaceutical companies, medical institutions, and retail pharmacies [3]. - Public awareness and responsibility are crucial, as individuals must refrain from participating in the illegal sale of medical insurance drugs [3].

Group 1: National Healthcare Administration Updates - The National Healthcare Security Administration has announced the preliminary review results for the 2025 medical insurance directory and the commercial insurance innovative drug directory, with 534 out of 633 drug names passing the initial review [1] - A total of 121 drug names were approved for the commercial insurance innovative drug directory, which includes high-innovation drugs not yet included in the basic medical insurance directory [1] - The review results are a preliminary step, and the approved drugs will undergo further evaluation and negotiation before being officially included in the directories [1] Group 2: Drug Traceability in Qingdao - Qingdao has implemented a drug traceability code system, with 10.1 billion data entries collected, accounting for 26.5% of the total in the province [2] - The city has connected 4,268 retail pharmacies and 5,946 medical institutions to the traceability system, achieving over 99% and 90% scanning rates, respectively [2] - The traceability system aims to enhance drug safety and improve the supervision of medical insurance funds [2] Group 3: Drug Approvals and Clinical Trials - Heng Rui Medicine's application for the marketing license of Haqubopam Ethanolamine Tablets has been accepted by the National Medical Products Administration [3] - Fosun Pharma's application for the registration of Nadaplatin Injection has also been accepted, targeting various types of cancer [4] - Xingqi Eye Medicine has completed the first patient enrollment for the Phase II clinical trial of Voriconazole Eye Drops, aimed at treating fungal keratitis [5] - Haishi Ke has received approval for clinical trials of HSK47977 Tablets, a potential first-in-class drug for non-Hodgkin lymphoma [6] Group 4: Mergers and Acquisitions - Nanhua Biological is planning to acquire a 51% stake in Hunan Huize Biological Pharmaceutical Technology Co., which will become a subsidiary [7] - The acquisition aims to enhance Nanhua's capabilities in drug research and clinical evaluation [7] Group 5: Strategic Partnerships and Collaborations - East China Pharmaceutical's subsidiary has signed an exclusive commercialization agreement with Jiangsu Weikail, acquiring rights for the VC005 oral formulation in mainland China [8] - The agreement includes an upfront payment of 50 million RMB and potential milestone payments up to 180 million RMB [8] - KQ Bio plans to sign a collaborative research agreement with Huazhong Agricultural University, involving four projects with a total payment of 4.9 million RMB [9]

Macro Dynamics - The State Administration for Market Regulation issued the "Compliance Guidelines for Charging Behavior of Online Trading Platforms," aiming to standardize the fees charged by platforms to operators, advocating for reduced burdens on operators and enhanced compliance self-discipline [2] Healthcare Sector - The National Healthcare Security Administration reported a case of illegal resale of medical insurance drugs, where a community health service station was found to have repeated billing for drugs, leading to the recovery of 3,678 yuan from the insurance fund and a fine of 7,356 yuan [3] Financial Sector - The Guangdong Provincial Financial Management Bureau and five other departments released the "Implementation Rules for Loan Interest Subsidies for Manufacturing and High-tech Enterprises," specifying a negative list for loan project approvals [4] - Shanghai Bank was fined over 29.21 million yuan by the central bank for issues arising between 2020 and 2021, which have since been rectified [7] - The Bank of Communications issued the world's first offshore bond for the Shanghai Free Trade Zone with a coupon rate of 1.85% and a term of three years [8] Market Data - As of August 1, U.S. stock indices collectively fell, with the Dow down 1.23%, the Nasdaq down 2.24%, and the S&P 500 down 1.6%, with significant declines in popular tech stocks [9] - The Nasdaq Golden Dragon China Index fell by 1.82%, with major Chinese concept stocks also experiencing declines [10] Company Dynamics - Zhang Jian was approved to serve as the general manager of China Post Insurance Asset Management Co., Ltd. [11] - Tim Cook became the longest-serving CEO of Apple, surpassing Steve Jobs with a tenure of 5,091 days [12] - Didi Chuxing collaborated with police to combat illegal ride-hailing software, leading to the arrest of a suspect involved in creating such software [13] - China FAW Group reported that in July 2025, its vehicle sales exceeded 252,400 units, a year-on-year increase of 6.5%, with significant growth in its self-owned and new energy vehicle sales [14]

Core Viewpoint - The National Healthcare Security Administration (NHSA) has launched a nationwide campaign to combat fraud and illegal activities in the pharmaceutical sector using drug traceability codes, resulting in multiple cases of illegal resale of reimbursed drugs being uncovered [1][14]. Group 1: Case Summaries - In Ulanqab City, Inner Mongolia, a community health service station was found to have sold drugs with duplicate traceability codes, leading to the recovery of 3,678 yuan in healthcare funds and a fine of 7,356 yuan [2]. - In Dezhou City, Shandong Province, a village health clinic was discovered to have sold drugs with traceability codes that had been reimbursed multiple times, resulting in a three-month suspension of its healthcare service agreement [3]. - A health clinic in Dazhu District, Chongqing, was found to have engaged in illegal drug exchanges, leading to a six-month suspension of its healthcare service agreement and penalties for the responsible personnel [4]. - A clinic in Suining City, Sichuan Province, was implicated in reselling drugs that had been previously reimbursed, resulting in penalties and recovery of healthcare funds [5]. - In Longli County, Guizhou Province, a health service was found to have resold drugs obtained through fraudulent means, leading to the recovery of 1,521.67 yuan in healthcare funds [7]. - A pharmacy in Nanyang City, Henan Province, was involved in the resale of drugs with duplicate traceability codes, resulting in the recovery of 67,200 yuan in healthcare funds and administrative penalties [8]. - In Wuzhong City, Ningxia, a pharmacy was found to have resold drugs that had been reimbursed, leading to a three-month suspension of its healthcare service agreement [9]. - Two insured individuals in Hangzhou, Zhejiang Province, were found to have illegally resold drugs, resulting in a loss of 439,854.73 yuan in healthcare funds [10]. - In Shuangyashan City, Heilongjiang Province, an individual was found to have resold drugs, leading to the recovery of 55,269.2 yuan in healthcare funds [11][12]. - An insured individual in Quanzhou City, Fujian Province, was found to have resold drugs, resulting in a loss of 5,139.45 yuan in healthcare funds [13]. Group 2: Impact of Drug Traceability Codes - The implementation of drug traceability codes has led to the collection of 53.098 billion drug traceability codes, significantly enhancing the monitoring and regulation of drug sales [13][14]. - The success of the traceability system is attributed to the collaborative efforts of regulatory bodies, pharmaceutical companies, and the active participation of the public in verifying drug authenticity [14].

Core Viewpoint - The National Healthcare Security Administration (NHSA) has announced ten typical cases of fraud and illegal activities in the pharmaceutical sector, highlighting the ongoing efforts to combat drug-related fraud through the use of drug traceability codes [1][2] Group 1: Fraud Cases - The ten typical cases involve activities such as the resale of medical insurance drugs and the swapping of drugs across various regions in China, including Inner Mongolia, Shandong, Chongqing, Sichuan, Guizhou, Henan, Ningxia, Zhejiang, Heilongjiang, and Fujian [1] - Specific cases include the resale of medical insurance drugs by community health service stations and pharmacies, with notable instances in Ulanqab, Dezhou, Dazhu, and other locations [1] Group 2: Role of Drug Traceability Codes - Drug traceability codes have played a crucial role in identifying fraudulent activities, with over 53 billion drug traceability codes collected nationwide [2] - An example includes the Ulanqab community health service station, where 72 drug traceability codes were found to have duplicate settlements, leading to an investigation that uncovered the resale of drugs by medical staff [2] Group 3: Impact on Insurance Funds - The fraudulent activities have resulted in significant losses to the medical insurance fund, with one case in Hangzhou causing a loss of approximately 439,854.73 yuan due to the illegal resale of drugs by insured individuals [2] - The NHSA emphasizes the importance of compliance with drug procurement and settlement processes to protect the integrity of the medical insurance system [2]

Core Viewpoint - The National Medical Insurance Administration, in collaboration with relevant departments, has launched a nationwide special action to combat fraud and illegal activities in the pharmaceutical sector using drug traceability codes as a key tool [1]. Summary by Sections - **Case Examples**: Eight typical cases of fraud were announced, including a significant case involving a pharmacy in Lanzhou, Gansu Province, which was found to be reselling medical insurance drugs and illegally profiting from the medical insurance fund [2][3]. - **Details of Fraudulent Activities**: The Lanzhou pharmacy was discovered to have illegally collected medical insurance cards from local residents, processed fraudulent transactions, and resold high-value drugs, including cancer treatment medications. A total of 1,124 boxes of drugs across 135 varieties were seized during the inspection [2][3]. - **Consequences for Offenders**: The pharmacy's medical insurance service agreement was terminated, and the legal representative received a penalty of 12 points against their medical insurance payment qualifications. Other cases involved similar fraudulent activities across various provinces, including Wuhan, Changsha, and Xi'an, with issues such as falsified prescriptions and excessive drug dispensing [3][4]. - **Regulatory Actions**: The cases have been referred to law enforcement and health regulatory agencies for further action. The National Medical Insurance Administration emphasized the importance of drug traceability codes as unique identifiers for each drug, urging all medical insurance institutions to comply with procurement and settlement regulations [4].