Notice on the issuance of the "Guangzhou Municipal Medical Insurance Designated

Retail Pharmacy Management Measures"

The Labor and Social Security Bureaus and Food and Drug Administration of all districts and county-level cities , all designated retail pharmacies, and all relevant units:

The "Guangzhou Medical Insurance Designated Retail Pharmacies Management Measures" are now issued to you, please comply with them. If problems are found during execution, please report them promptly.

Guangzhou Municipal Labor and Social Security Bureau Guangzhou Municipal Food and Drug Administration

April 17, 2006

Guangzhou Municipal Medical Insurance Designated Point Measures for the Management of Retail Pharmacies

Article 1 is to strengthen and standardize the management of designated retail pharmacies for medical insurance in this city, in accordance with the "Decision of the State Council on Establishing a Basic Medical Insurance System for Urban Employees" (Guofa [1998] No. 44) , "Notice of the General Office of the State Council on Retaining Some Non-Administrative Licensing and Approval Items" (Guobanfa [2004] No. 62), "Interim Measures for the Management of Urban Employee Basic Medical Insurance Designated Retail Pharmacies" (Ministry of Labor and Social Security [1999] No. 16 ) and the relevant provisions of the "Guangzhou Urban Employees Basic Medical Insurance Trial Measures" (Guangzhou Municipal People's Government Order [2001] No. 17), and based on the actual situation of this city, these measures are formulated.

Article 2 The municipal labor and social security administrative department shall be responsible for the review and evaluation of designated retail pharmacies in this city, and shall implement the implementation of medical insurance policies and service agreements by municipal medical insurance agencies and designated retail pharmacies. Supervision and management.

The municipal medical insurance agency is responsible for the daily management of the review and assessment of designated retail pharmacies in this city, and assists the municipal labor and social security administrative department in the supervision, management and assessment of designated retail pharmacies in this city.

The municipal food and drug supervision and administration department participates in the review, evaluation, supervision and inspection of designated retail pharmacies.

Article 3 The designated retail pharmacies mentioned in these Measures refer to those that have been reviewed and evaluated by the municipal labor and social security administrative department in conjunction with the municipal food and drug supervision and administration department, and confirmed by the municipal labor and social security administrative department to meet the conditions of designated retail pharmacies. , and signed a service agreement with the municipal medical insurance agency to provide retail pharmacies with drug sales services for medical insurance insured persons.

Article 4 Principles for determining designated retail pharmacies:

(1) Select the best and make a reasonable layout, so as to meet the development needs of medical insurance and facilitate the purchasing of insured persons. Medicine, and easy to supervise and manage.

(2) Ensure the variety and quality of medicines used in basic medical insurance.

(3) Introduce a fair competition mechanism, reasonably control drug service costs and drug prices, and improve the quality of drug sales services.

Article 5 Within the city’s basic medical insurance co-ordination area, retail pharmacies that have obtained the “Pharmaceutical Business License”, “Pharmaceutical Business Quality Management Practice Certification Certificate” and “Business License” in accordance with the law may apply to the city labor Ensure administrative departments apply for the qualifications of designated retail pharmacies.

For chain-operated retail pharmacies, the chain company shall submit an application for designated retail pharmacy qualifications.

However, if a retail pharmacy or chain company has one of the following circumstances, it will not be eligible to apply for the qualification of a designated retail pharmacy within the next three medical insurance years from the date of confirmation by the municipal labor and social security administrative department:

(1) Submitting application materials by fabricating, tampering or other improper means.

(2) Being disqualified from being a designated retail pharmacy due to violation of medical insurance regulations.

Retail pharmacies that have administrative affiliations or business interests with the city’s medical insurance designated medical institutions are not eligible to apply for the qualifications of designated retail pharmacies.

Article 6: Applicants for the qualification of designated retail pharmacies must meet the following conditions:

(1) Comply with the "Drug Administration Law of the People's Republic of China" and relevant laws and regulations, and strictly regulate drugs The purchase channels have sound and complete drug quality assurance systems and facilities.

(2) The display of drugs complies with the regulations on drug classification management, and the functional classification is clear, and the classification labels and price tags are standardized and clear.

(3) The geographical location conforms to the regional layout plan of designated retail pharmacies. The newly designated retail pharmacies should be at least 200 meters away from the original designated retail pharmacies that mainly sell similar drugs. Two of the city's medical insurance-designated secondary and tertiary medical institutions can be selected in close proximity.

(4) Drug sales service facilities and information management systems can meet the needs of basic medical insurance participants for drug sales services and drug cost settlement requirements.

(5) The price of operating drugs shall not be higher than 110% of the average price of the same drug in retail pharmacies in this city.

(6) Have more than 2 pharmacists or resident pharmacists; can provide 24-hour drug sales services.

(7) The layout of the business premises is reasonable; the usable area of ??the premises is more than 80 square meters; the remaining validity period of the right to use the premises or the lease contract is more than 2 years from the date of submission of application materials.

(8) Operate more than 1,500 types of medicines within the scope of the "Guangdong Province Basic Medical Insurance and Work Injury Insurance Drug Catalog", or more than 300 types of traditional Chinese medicine pieces that meet the payment scope of basic medical insurance; and ensure timely Provide basic medical insurance drugs to insured persons.

(9) There are no problems with the distribution of counterfeit and substandard drugs caused by illegal operations within one year before submitting the application report.

(10) Retail pharmacies and their employees have participated in the city’s basic medical insurance in accordance with regulations and paid basic medical insurance premiums in full and on time.

(11) Conduct training on basic medical insurance policies and regulations for business managers and pharmacists and pass the assessment.

Article 7 When there are multiple retail pharmacies in the same area (200 meters apart) that meet the conditions stipulated in Article 6 of these Measures, the one with the largest number that meets the following conditions will be given priority:

(1) The price of similar drugs is lower;

(2) The average number of drug sellers per day and the average daily drug sales revenue in the past year are high;

(3) Drug sales The number of varieties is relatively large;

(4) The area of ??the place where pharmaceuticals are sold is relatively large, and the environment is relatively beautiful and comfortable;

Article 8 To apply for the qualification of a designated retail pharmacy, the following materials must be submitted truthfully, and Stamped with the official seal of the unit:

(1) Application form for qualification of Guangzhou Medical Insurance Designated Retail Pharmacy.

(2) Fill in the "Guangzhou Medical Insurance Designated Retail Pharmacy Qualification Application Form", "List of Operating Drug Varieties" and "Pharmacist (including resident pharmacist) Registration Form" prepared by the municipal labor and social security administrative department ( 1 copy each in written form and electronic form).

(3) Original and duplicate copies of the "Pharmaceutical Business License" and "Pharmaceutical Good Manufacturing Practice Certification Certificate"; the original and photocopies of the "Business License" and organization code certificate; statutory Original and photocopy of representative certificate, ID card; original and photocopy of pharmacist title certification materials. Retail pharmacies that are required to participate in basic medical insurance are required to provide a "Medical Insurance Fund Collection Approval Form" and a copy of the medical insurance premium transfer voucher.

(4) A confirmation certificate issued by the municipal food and drug administration department confirming that there are no problems with the distribution of counterfeit and inferior drugs caused by illegal operations within one year.

(5) Copy of property rights or lease contract related materials of the service place where drugs are sold.

Article 9 The review of the qualifications of designated retail pharmacies shall be conducted once a year. The municipal labor and social security administrative department strictly controls the number of designated retail pharmacies at the rate of one for every 20,000 insured persons based on the number and regional distribution of medical insurance enrollees.

Article 10 The qualifications of designated retail pharmacies shall be determined according to the following procedures:

(1) Acceptance of applications: retail stores that meet the scope stipulated in Article 5 and the conditions stipulated in Articles 6 and 7 of these Measures Pharmacies shall submit written applications and relevant materials to the municipal labor and social security administrative department.

(2) Document review: After receiving the application from the retail pharmacy, the municipal labor and social security administrative department will complete the document review within 30 working days, make a preliminary decision, and notify the retail pharmacy in writing if the materials are complete. .

(3) On-site inspection: The municipal labor and social security administrative department, together with the municipal food and drug supervision and management department, as well as the municipal medical insurance agency and labor and social security information management department, jointly conduct on-site inspections of retail pharmacies that have passed the preliminary review. The examination results shall be signed and confirmed by the persons in charge of both the examiner and the person being examined.

(4) Review: The departments participating in the review conduct a collective review of the review results of the retail pharmacy that applied for designated qualifications according to the conditions stipulated in these measures, and the heads of each department will sign and confirm the review results.

(5) Approval: The leaders of the municipal labor and social security administrative department shall approve and confirm the collective review results.

(6) Training, installation of medical insurance information system, and signing of service agreements: For retail pharmacies that are confirmed by the municipal labor and social security administrative department to meet the qualifications of designated retail pharmacies, the municipal social insurance agency will organize medical insurance policies Training and assessment; at the same time, a medical insurance information system will be built. After passing the inspection and acceptance by the labor and social security information management department, a service agreement will be signed through negotiation with the municipal medical insurance agency.

(7) Determination of qualifications: For retail pharmacies that meet the qualifications for designated retail pharmacies and have signed a service agreement with the municipal medical insurance agency, the municipal labor and social security administrative department will determine the qualifications of designated retail pharmacies and issue them Qualification certificates and signs for medical insurance designated retail pharmacies shall be announced to the public.

Article 11 The service agreement text and supplementary agreement content of designated retail pharmacies shall be drawn up by the municipal medical insurance agency in accordance with the medical insurance regulations and requirements, and shall be implemented after being submitted to the municipal labor and social security administrative department for review and approval. The service agreement should clarify the rights, obligations and responsibilities of both parties, and include the following contents: service scope and service quality requirements, drug cost review and control requirements, drug cost settlement methods and payment standards, liability for breach of contract and penalty standards, assessment methods and negotiation between the two parties. Other content to be determined, etc.

Article 12 Designated retail pharmacies shall strictly abide by the following regulations and provide high-quality drug sales services to medical insurance participants:

(1) Implement medical insurance and drug supervision and management Policies and relevant regulations, perform service agreements, comply with the "Drug Administration Law of the People's Republic of China" and relevant regulations to ensure drug quality.

(2) Implement the drug price regulations stipulated by the price authority, implement clear price tags, and provide insured persons with a detailed list of drug purchases.

(3) Establish an internal management system and medical insurance management organization that are compatible with medical insurance management, designate a unit leader to take charge and provide full-time (part-time) management personnel, and cooperate with the labor and social security administrative departments and medical Supervision, management and assessment of insurance agencies.

(4) Ensure that at least one pharmacist is on duty during business hours, and other business personnel must hold certificates to work in accordance with regulations.

(5) Prescriptions for medical insurance must be issued by a physician at a designated medical institution, and must have the signature of the physician and the outpatient seal of the designated medical institution. The pharmacist at a designated retail pharmacy must review and sign the prescription when dispensing. External prescriptions are managed separately, separate accounts are established, and kept for more than 2 years for review.

(6) Hang the "Pharmaceutical Business License", "Business License", "Pharmaceutical Business Quality Management Practices Certification", pharmacy professional and technical personnel qualification certificate, service commitment or service convention in a prominent position of the business premises .

(7) Verify the medical insurance certificate of the insured person. If it is found that it has been altered, forged or used fraudulently, it should be refused to be used and detained, and it should be reported to the municipal medical insurance agency for processing in a timely manner.

(8) Promote the medical insurance policies and regulations to the insured, set up a publicity board with the contents of the medical insurance policy and service agreement in a prominent position of the pharmaceutical service place; post relevant operating procedures promotional materials, and provide information for participants The guarantor shall set up eye-catching drug sales guide signs.

(9) Do a good job in self-examination of the insured’s drug purchase expenses, truthfully fill in the relevant settlement statements, and when necessary, provide all materials required to review the drug purchase expenses and the requirements of the municipal labor and social security department when necessary. Charge account list, otherwise, the municipal medical insurance agency has the right to refuse to pay the involved drug purchase costs.

(10) Cooperate with the municipal medical insurance agency and the labor and security information management department to implement computer management of drug sales and expense settlement by insured persons.

Article 13 The municipal labor and social security administrative department shall supervise and manage the services and management of designated retail pharmacies in accordance with relevant medical insurance policies and regulations, and organize relevant departments such as the Food Supervision and Pricing Department from time to time to inspect the services and management of designated retail pharmacies. Supervise and inspect services and management.

Article 14 If any of the following circumstances occurs in a designated retail pharmacy, the municipal labor and social security administrative department will cancel the qualification of the designated retail pharmacy, and the social insurance agency will terminate the service agreement. The medical insurance fund will not pay the expenses involved in all violations, and the paid illegal expenses will be recovered in full by the municipal medical insurance agency:

(1) Using illegal means such as forging prescriptions for medical insurance. Fraudulent medical insurance funds.

(2) Subject to administrative penalties from industry and commerce, drug administration, price and other departments. However, exceptions are made under the circumstances specified in Article 81 of the "Regulations on the Implementation of the Drug Administration Law of the People's Republic of China".

(3) Providing the medical insurance drug cost settlement system to other retail pharmacies for use, collecting funds from the insured's personal medical account or applying to the municipal medical insurance agency for payment of the medical insurance overall fund.

(4) The "Pharmaceutical Business License" and "Pharmaceutical Business Quality Management Practice Certification" have been revoked by the food and drug administration department, and the "Business License" has been revoked by the industrial and commercial administration department.

Article 15 If any of the following acts occurs in a designated retail pharmacy, and the circumstances are relatively minor, the municipal labor and social security administrative department shall order it to make rectifications within a time limit, and during the rectification period, its sales of pharmaceutical services to social insurance participants shall be suspended; if the circumstances are serious, , cancel the qualification of designated retail pharmacies, and terminate the service agreement by the social insurance agency. The medical insurance fund will not pay the fees involved in all violations, and the paid violation fees will be recovered in full by the municipal medical insurance agency:

(1) Failure to dispense drugs and dosages according to external prescriptions Or exchange prescription drugs for other drugs or non-drugs.

(2) Violating price policies, raising drug prices without authorization, or charging insured persons higher than other groups for purchasing drugs.

(3) Use medical insurance pooling funds or personal account funds to pay for expenses beyond the scope of medical insurance, or pay drug costs that should be paid with personal medical account funds (or cash) from the medical insurance pooling fund, Or the cost of drugs that should be paid by the medical insurance pooling fund will be paid by the insured.

(4) Refusing to provide drug sales services to the city’s medical insurance participants without justifiable reasons.

(5) Failure to cooperate with the supervision and inspection work of the municipal medical insurance agency without legitimate reasons, or issuing false certificates.

(6) When providing drug sales services to insured persons, errors or accidents occur, causing adverse social impact.

Article 16 If the name, legal representative, business scope, etc. of a designated retail pharmacy change, it shall submit a written change application and changed information to the municipal food and drug supervision and administration department within 30 days after handling the change registration. Originals, copies and other relevant certification materials should be submitted to the municipal labor and social security administrative department to apply for change procedures.

If a designated retail pharmacy moves its address, splits up, merges, ceases operations for more than three months, or is revoked or closed, its qualifications as a designated retail pharmacy will be cancelled, and the service agreement will be terminated.

If the designated retail pharmacy fails to report the above situation within the time limit, the medical insurance fund will not pay for the expenses incurred by the insured person in purchasing drugs during the period.

Article 17 The validity period of the qualification and service agreement for designated retail pharmacies is 2 medical insurance years.

Within 30 days before the expiration date, the municipal medical insurance agency and the designated retail pharmacy shall negotiate to renew the service agreement.

When renewing the service agreement for a new year, if a designated retail pharmacy has any of the following circumstances, the municipal labor and social security administrative department will cancel the qualification of the designated retail pharmacy, and the municipal medical insurance agency will not renew the service agreement:< /p>

(1) The number of times an insured person purchases medicine during the year is 30% lower than the average number of times at designated retail pharmacies in the same area of ??the city.

(2) Random sampling comparison shows that the price of drugs sold is more than 110% higher than the average price of designated retail pharmacies in this city.

(3) Those who fail the annual comprehensive assessment.

(4) The designated retail pharmacy is unwilling to continue to undertake designated sales of pharmaceutical services or does not perform in accordance with the terms of the service agreement.

Article 18 The qualification certificates and signs of designated retail pharmacies shall be uniformly produced, managed and issued by the municipal medical insurance agency entrusted by the municipal labor and social security administrative department. Designated retail pharmacies should be properly kept and maintained, and should not be copied, forged, transferred or damaged. Loss or accidental damage should be reported to the municipal medical insurance agency in a timely manner and handled accordingly.

Within 10 working days after the municipal medical insurance agency terminates or dissolves the agreement with the designated retail pharmacy, the retail pharmacy should proactively return the qualification certificate and sign to the municipal medical insurance agency for processing.

Article 19 The municipal medical insurance agency shall formulate assessment and scoring methods for designated retail pharmacies in accordance with these Measures, and submit them to the municipal labor and social security administrative department for review and approval in conjunction with the municipal food and drug supervision and administration department before implementation. The assessment content should include:

(1) Implementation of medical insurance policies and regulations and performance of service agreements.

(2) Implementation of relevant national, provincial and municipal regulations on drug supervision and management.

(3) Establishment of medical insurance management system and other basic management within designated retail pharmacies.

(4) Management of the use of medical insurance pooling funds and personal medical account funds.

(5) Charges for selling drugs.

(6) The variety and quality of pharmaceutical sales services provided.

(7) Publicity and training of medical insurance related knowledge.

(8) Construction and maintenance of medical insurance information system.

(9) Information management and statistics related to medical insurance.

(10) Evaluation of the satisfaction of insured persons.

(11) Other situations related to medical insurance supervision and management.

Article 20 The validity period of these Measures is five years.

Article 21 District and county-level cities that are not yet included in this overall planning area may refer to these measures for implementation.

Article 22 These Measures will come into effect on June 1, 2006. The "Notice on Issuing the Measures for the Administration of Designated Retail Pharmacies of the Basic Medical Insurance for Urban Employees in Guangzhou" (Suilao Sheyi [2001] No. 18) was abolished at the same time.

Subject headings: Social Insurance, Retail Pharmacy Management Measures, Notice

Cc: Municipal Legislative Affairs Office, Provincial Department of Labor and Social Security, Provincial Department of Health.

Issued by the Guangzhou Municipal Labor and Social Security Bureau Office on May 11, 2006