Hangzhou labor resources and social security bureau Hangzhou market supervision management bureau Hangzhou bureau of commodity price
Notice on printing and distributing the measures for the administration of designated retail pharmacies of basic medical insurance in Hangzhou
Hang Ren She Fa [2014] No.374
District, county (city) Human Resources and Social Security Bureau, Market Supervision Bureau, Price Bureau, relevant units of the city, and retail pharmacies:
According to the relevant provisions of the national, provincial and Hangzhou Basic Medical Security Measures (Hangzhou Zheng [2014] No.68), the revised Measures for the Administration of Designated Retail Drugstores in Hangzhou Basic Medical Insurance are hereby printed and distributed to you, please implement them carefully.
Hangzhou labor resources social security bureau
Hangzhou market supervision management bureau
Hangzhou bureau of commodity price
October 8, 2014
Measures of Hangzhou Municipality on the Administration of Designated Retail Drugstores of Basic Medical Insurance
In order to further strengthen and standardize the management of designated retail pharmacies of basic medical insurance in Hangzhou, these measures are formulated in accordance with the relevant provisions of the state, province and Hangzhou Basic Medical Security Measures (Hangzheng [2014] No.68) and Hangzhou Pharmaceutical Retail Enterprise Management Regulations (Hangzhengban [2014] No.5).
A, the measures referred to in the basic medical insurance (hereinafter referred to as medical insurance) designated retail pharmacies, refers to the pharmaceutical business license and business license issued by the administrative department of market supervision and management (hereinafter referred to as market supervision), by the social insurance administrative department qualification, to obtain designated qualifications and medical insurance agencies signed a medical insurance service agreement, to provide drug retail services for the insured.
Two, these Measures shall apply to the retail pharmacies that intend to apply for medical insurance designated or approved medical insurance designated within the administrative area of Hangzhou.
Three, Hangzhou city social insurance administrative department is responsible for the city’s medical insurance designated management; The social insurance administrative departments of Xiaoshan District, Yuhang District, Tonglu County, Chun ‘an County, Fuyang City, jiande city City and Lin ‘an City [hereinafter referred to as two districts and five counties (cities)] are responsible for the fixed-point management of medical insurance within their respective jurisdictions, and after the implementation of municipal-level overall planning of medical insurance, relevant functions will be adjusted according to needs.
Market supervision, price and other administrative departments participate in the designated management and supervision of medical insurance within their respective responsibilities.
City and two districts and five counties (cities) medical insurance agencies are responsible for signing medical insurance service agreements with designated retail pharmacies within their respective jurisdictions, inspecting and assessing the performance of medical insurance service agreements by designated retail pharmacies, and implementing corresponding treatment for their violations of medical insurance service agreements.
Four, determine the basic principles of designated retail pharmacies:
(a) overall planning, in accordance with the development requirements of urban and rural integration and the purchase demand of insured persons, rational distribution of designated retail pharmacies in the region.
(two) the selection of the best, the survival of the fittest, the establishment of a dynamic mechanism of "getting in and getting out", and giving priority to the retail pharmacies rated as honest units.
(three) to ensure the quality, to ensure the variety, quality and safety of basic medical insurance drugs.
Five, with the approval of the administrative department of market supervision, retail pharmacies that have obtained the Drug Business License, the Certificate of Quality Management Specification for Drug Business (GSP) and the Business License may apply for the designated medical insurance qualification within the validity period of the license.
Drug retail chain stores (hereinafter referred to as chain stores) should apply for designated qualifications separately.
Six, apply for medical insurance designated qualification should meet the following conditions:
(1) Abide by national, provincial and municipal laws, regulations, standards and regulations on drug management and price management, and have a sound and perfect internal guarantee system and facilities for drug quality.
(2) Having obtained the Pharmaceutical Trading License, the Certificate of Quality Management Specification for Pharmaceutical Trading (GSP) and the Business License for one year or more, and being specialized in pharmaceutical retail business (excluding drug counters). In the past year, the administrative departments of market supervision and price have no record of administrative punishment and no major drug quality accidents.
(3) It has a stable business place suitable for the scale of drug business, and the construction area of the business place of single retail pharmacies in urban areas and counties should be not less than 80 square meters; The construction area of chain retail stores in urban areas and counties, and the business premises of single retail pharmacies in towns and below shall be no less than 60 square meters; In the chain stores in villages and towns and the following areas, and pharmacies established in remote mountainous areas (without medical institutions and pharmacies), the construction area of their business premises should be no less than 40 square meters.
If a pharmacy rents a house, the remaining validity period of the right to use the place or the lease contract should be more than 2 years from the date of submitting the application materials.
(four) retail pharmacies should be equipped with a certain number of drugs, of which the varieties in the medical insurance catalogue are not less than 60%, and can ensure the timely supply of medical insurance drugs for the insured.
(5) Strictly regulate the channels for purchasing drugs. When dealing in drugs, there must be a "purchase, sale and storage" ledger, with clear account books and consistent accounts, and computer management according to GSP requirements.
(six) the person in charge of the retail pharmacy shall be a registered licensed pharmacist, and a licensed pharmacist or licensed pharmacist shall provide pharmaceutical services during business hours. Among them, the single retail pharmacy must be equipped with at least one registered licensed pharmacist (licensed pharmacist) and one licensed pharmacist (licensed pharmacist). If there is a prescription of Chinese herbal pieces in the business scope, it should be equipped with a registered licensed pharmacist; If the chain stores are included in the remote video pharmaceutical service of pharmaceutical retail chain enterprises in Hangzhou, the remote pharmaceutical service room of the headquarters of the pharmaceutical retail chain enterprises shall be equipped with at least 4 registered licensed pharmacists or licensed Chinese pharmacists to provide remote pharmaceutical services, and the chain stores shall be equipped with at least 2 pharmacists; If the chain store does not participate in the remote video pharmaceutical service of licensed pharmacists, the store where it is located shall be equipped with one registered licensed pharmacist (licensed Chinese pharmacist) and one pharmacist.
(seven) in line with the requirements of the construction of drug retail information system stipulated by the administrative department of market supervision.
(eight) retail pharmacies and their employees should participate in social insurance according to the provisions of the social insurance policy, and pay social insurance premiums in full and on time.
(9) The designated chain stores (including franchise stores) in the same pharmaceutical retail chain enterprise have not been suspended due to violation of regulations within one year, or have no record of the medical insurance service agreement being cancelled due to violation of regulations within two years.
Seven, who have the conditions listed in Article 6 of these measures, and are willing to undertake medical insurance services, can apply to the local social insurance administrative department or the medical insurance agency entrusted by the social insurance administrative department (hereinafter referred to as the social insurance department) in March or September each year, fill out the "Application for Qualification of Designated Retail Drugstores of Hangzhou Basic Medical Insurance" (in triplicate), and provide the following written materials:
(1) Copies of the Drug Business License and Business License, and original and duplicate copies, and original and duplicate copies of the Organization Code Certificate.
(2) The original and photocopy of the Certification Certificate for Good Quality Management of Pharmaceutical Trading (GSP).
(three) the list of drug varieties and prices (chain stores can be provided by the headquarters).
(four) the original and photocopy of the property right certificate or lease contract, floor plan and other relevant information of the retail pharmacy business premises (the floor plan of the business premises should indicate the location of the special medical insurance service area to be opened).
(five) the original and photocopy of the registration certificate (or qualification certificate) and title certificate of pharmaceutical technicians above pharmacists, and the post qualification certificate and post qualification certificate of business personnel.
(six) chain stores should provide proof that their headquarters has agreed to apply for a designated place. Among them, the chain stores that are included in the remote video pharmaceutical service of pharmaceutical retail chain enterprises in Hangzhou should also provide the Confirmation Letter of Remote Video Pharmaceutical Service of pharmaceutical retail chain enterprises in Hangzhou.
(seven) to provide a written explanation of no administrative punishment and no major drug quality accidents in the past 1 year.
(eight) other materials prescribed by the social insurance department.
Eight, medical insurance designated qualification review and determination, according to the following procedures.
(1) Making an announcement. The social insurance department issued an announcement on the local human resources and social security portal website, specifying the time and materials required for accepting the qualification declaration of designated retail pharmacies.
(2) Accepting applications. The social insurance department shall register the information declared by retail pharmacies. If the materials are complete, a notice of acceptance shall be issued within 5 working days from the date of receiving the application materials; If the application materials are incomplete, the applicant shall be informed of the materials that need to be supplemented at one time; Do not meet the conditions, should inform the applicant of the reasons for rejection within 5 working days.
(3) Qualification examination. The social insurance department shall, in accordance with the prescribed conditions, conduct data review and on-site investigation on the designated qualification of the applicant, and consult the opinions of market supervision, price and other departments, and put forward opinions on whether it has the designated qualification within 60 working days from the date of acceptance.
For retail pharmacies that provide false materials, once verified, they may not apply for designated medical insurance qualifications within 1 year.
(4) Qualification confirmation. The retail pharmacies that meet the designated qualifications after examination shall be publicized by the local human resources and social security portal website for 15 days and accept social supervision. If there is no objection after publicity, the local social insurance department will issue the "Qualification Certificate of Designated Retail Pharmacy for Basic Medical Insurance in Hangzhou".
Nine, the "designated retail pharmacy qualification certificate" is valid for 3 years, and it will continue to be valid upon expiration. 2 months before the expiration, the retail pharmacy shall apply to the local social insurance department for renewal, and provide relevant information according to the provisions of Article 7 of these Measures. Those who fail to apply for renewal at the expiration shall be deemed to have given up automatically.
The social insurance department shall review the retail pharmacies applying for renewal in accordance with the provisions of Article 6 of these Measures and the performance of the medical insurance service agreement, and make a decision on whether to renew the validity within 30 working days from the date of acceptance. For those who meet the conditions, the renewal shall be granted and the fixed-point qualification shall be retained; Do not meet the conditions, cancel the designated qualification, which signed a medical insurance service agreement for retail pharmacies, medical insurance agencies should terminate the medical insurance service agreement, stop its settlement of medical insurance costs.
If a retail pharmacy cancels its designated qualification, its designated retail pharmacy qualification certificate shall be cancelled.
Ten, medical insurance agencies can be based on the rational layout, the principle of preferred fixed-point, in the retail pharmacies to obtain fixed-point qualifications, to determine the medical insurance service agreement unit. The identified service unit shall establish an internal management system that is compatible with medical insurance, and be equipped with necessary full-time (part-time) medical insurance management personnel. The full-time (part-time) medical insurance management personnel shall participate in the training and examination on medical insurance policies, handling services and information management held by medical insurance agencies, and shall not sign a medical insurance service agreement if they fail the examination.
Eleven, the training of qualified retail pharmacies, should be required to do a good job in real-time networking with the medical insurance computer information management system, after acceptance, the medical insurance agency signed a medical insurance service agreement with the retail pharmacy, and announced to the public the list of medical insurance service agreement units.
Twelve, medical insurance agencies to implement agreement management of designated retail pharmacies. The contents of the agreement include: medical insurance service management, drug distribution management, catalogue management, information system management, fee settlement, supervision and management, and the rights, obligations and responsibilities of both parties, etc. The validity period of the agreement cannot exceed the validity period of the fixed-point qualification certificate at the longest.
Thirteen, designated retail pharmacies should be in a prominent position in the unit to hang the city’s unified format of designated signs, signs shall not be forged or transferred, and shall not be misleading. Lost or accidental damage should be re-applied to the local medical insurance agency in time.
The designated retail pharmacies shall return the designated signs in time when the medical insurance service agreement is cancelled or terminated.
Fourteen, retail pharmacies with designated qualifications, approved by the administrative department of market supervision, merger, reorganization or really need to change their names, can apply to the local social insurance department for change within 30 working days from the date of approval of the change, with a written application, the original and photocopy of the changed information and other relevant certification materials. If the information of the internal structure, service items, handling personnel, telephone number and bank account of the designated retail pharmacy changes, it shall, within 30 working days, apply to the local social insurance department for change with a written application for change, the original and photocopy of the changed information and other relevant certification materials. If the formalities are not completed within the time limit, the medical insurance agency may suspend its settlement of medical insurance expenses.
In addition to the changes in the basic information of designated retail pharmacies due to the needs of merger, reorganization and government public utilities construction, if the main information such as the address and legal representative of designated retail pharmacies changes, it is necessary to re-apply for the designated location.
Designated retail pharmacies may not apply for changing information during the investigation and handling of violations.
Fifteen, the designated retail pharmacies appear to be revoked, closed, etc., should be 15 working days in advance to the local social insurance department to handle the relevant procedures, 3 months or more failed to provide medical insurance services for the insured, as it automatically terminates the medical insurance service agreement, the social insurance department should cancel the medical insurance designated qualification.
Sixteen, designated retail pharmacies with the approval of the relevant administrative departments to suspend service shall, within 30 working days from the date of approval, apply to the local social insurance department to retain the service agreement. Upon approval, the medical insurance service agreement may be suspended for 6 months. If the normal service is not resumed for more than 6 months, the medical insurance service agreement shall be terminated and the designated qualification shall be cancelled. After resuming normal business services, you can re-apply for fixed points according to regulations.
Seventeen, designated retail pharmacies in the purchase (distribution) of drugs for the insured, should check their medical insurance, cards, and the prescription provided by the audit.
Eighteen, designated retail pharmacies must be provided by designated medical institutions, and the prescription signed by the pharmacist in our store can be used to allocate and sell prescription drugs, and the prescription shall not be changed without authorization. Prescriptions with incompatibility or overdose must be corrected and re-signed by the prescriber before they can be prepared and sold. Prescriptions should be kept for more than 2 years for verification.
Nineteen, non-prescription drugs prescribed by the state can be directly sold in designated retail pharmacies. The sales of over-the-counter drugs in the medical insurance drug list shall comply with the relevant provisions of medical insurance management.
Twenty, the resident pharmacists in designated retail pharmacies should provide medication guidance or suggestions for seeking medical treatment for the insured according to their illness, and explain the precautions for medication.
Twenty-one, designated retail pharmacies should manage the expenses of prescription drugs and over-the-counter drugs purchased by the insured separately, establish separate accounts, and submit relevant statements and other required materials to the medical insurance agency in a timely, accurate and complete manner according to the regulations.
Twenty-two, medical insurance agencies should strengthen the inspection of medical insurance services in designated retail pharmacies and the audit of related expenses, and can also entrust qualified intermediaries to conduct audit investigations. Designated retail pharmacies should upload relevant information according to the needs of medical insurance management, and actively cooperate with the provision of prescriptions, "dual-track" drug registration and account list and other relevant information required for audit. The medical expenses that meet the scope of medical insurance expenses shall be settled with designated retail pharmacies according to regulations; Do not meet the requirements of the cost, medical insurance agencies should not pay, have already paid to be recovered.
Twenty-three, the administrative department of social insurance may, in conjunction with the market supervision, price and other departments, regularly or irregularly supervise and inspect the medical insurance service behavior and drug management of designated retail pharmacies.
Twenty-four, designated retail pharmacies shall not have any of the following circumstances during the service period of the agreement. In case of illegal acts, they shall be handled in accordance with the Social Insurance Law of People’s Republic of China (PRC) and the Measures for Handling Violations of Basic Medical Security in Hangzhou. Retail pharmacies whose designated qualifications have been cancelled due to illegal acts shall not re-apply for designated qualifications within 1 year.
1 refused to provide medical insurance dispensing services for the insured without justifiable reasons;
2. Failing to truthfully enter all the details of drug purchase expenses of the insured into the medical insurance information system and upload them in time;
3. Failing to place prescription drugs or use fake prescriptions according to prescription management regulations;
4 there is theft, fraudulent use, empty brush, detention of other people’s medical insurance (card);
5 do not cooperate with the daily management of the social insurance department, medical expenses audit, examination, information transformation and other regulatory work, or there are delays, avoidance and other conditions that affect the relevant work;
6. Providing false materials or concealing information changes;
7. Without approval, unauthorized consent to other institutions (including branches that have not obtained the qualification of designated medical institutions) for medical insurance settlement in the name of this institution;
8. Contracting or leasing designated retail pharmacies to other units or individuals;
9 misleading and deceptive advertising of medical insurance policies and regulations;
10. Refusing to perform the decision or rectification requirements of the social insurance department;
11 have an impact on the safety behavior of the medical insurance information system or the existence of information security risks;
12 other medical insurance violations.
Twenty-five, these measures, except as expressly provided, involve the management of designated retail pharmacies for medical insurance services for other people, and can be implemented with reference to these measures.
Twenty-six, the retail pharmacies that have been designated before the implementation of these measures, the social insurance department shall, within one year after the implementation of these measures, conduct qualification examination according to the qualifications stipulated in Article 6 of these measures. To meet the designated conditions, the local social insurance department issued the "Hangzhou basic medical insurance designated retail pharmacy qualification certificate"; Do not meet the designated conditions, the deadline to complete the rectification, overdue rectification, the local social insurance department to terminate the medical insurance service agreement, and cancel the designated qualification.
Twenty-seven, two districts and five counties (cities) may, in accordance with the provisions of these measures, formulate specific implementation rules in light of local conditions.
Twenty-eight, these Measures shall come into force as of January 1, 2015. The original Notice of Hangzhou Labor and Social Security Bureau, Hangzhou Drug Administration and Hangzhou Price Bureau on Printing and Distributing the Administrative Measures for Designated Retail Drugstores of Urban Basic Medical Insurance in Hangzhou (No.190 [2003] of Hangzhou Labor and Social Security Bureau) shall be abolished at the same time.