External prescriptions are included in the management of the hospital, and a provincial health commission issued a document

In order to promote the implementation of national medical insurance negotiation drugs and expand the drug purchase channels for insured patients, the National Health Insurance Administration and the National Health Commission issued the "Guiding Opinions on Establishing and Improving the "Dual Channel" Management Mechanism for National Medical Insurance Negotiated Drugs (Yi Bao Fa [2021] No. 28) in 2021.

For example, Shenzhen stipulates that in the circulation of external prescriptions and the management of drug purchases, the designated physicians of designated medical institutions shall issue "dual-channel" drug prescriptions, and the external prescriptions shall be issued separately, in accordance with the prescription management regulations, and the drug dosage shall comply with the diagnosis and treatment specifications and the payment regulations of medical insurance drugs, and shall be circulated through the electronic prescription circulation center. Designated medical institutions, "dual-channel" pharmacies and the province's unified electronic prescription circulation center do a good job of information docking, so as to realize the "one-stop" settlement of prescription circulation and purchased drugs. Designated medical institutions and "dual-channel" pharmacies should establish a review system for external prescriptions, strengthen the review of external prescriptions, and regularly carry out special reviews of external prescriptions.

At the end of October 2023, Beijing launched a pilot project of "dual channel" management, and the public can purchase "Guotan Medicine" through two channels: designated hospitals and designated pharmacies.

Tsinghua Changgung Hospital in Changping District and Beijing Tong Ren Tang Tiantong Huayuan Pharmacy became the first batch of "dual-channel" pilot hospitals and pharmacies.

In order to allow the masses to "buy, use, and report" the "life-saving and emergency medicines" at their doorsteps, the Changping District Medical Insurance Bureau organized the pilot hospitals and pilot pharmacies to connect with each other as soon as possible, complete the upgrading of the information system and sign a tripartite medical insurance service agreement, supervise the pilot hospitals to improve the internal management system, strengthen the training of clinicians, standardize medical service behaviors, and ensure that the insured personnel standardize the use of foreign drugs.

According to reports, up to now, the pilot hospital in Changping District has taken the lead in promoting the implementation of 483 kinds of "Guotan medicines" in Beijing to benefit the people, so as to meet the public's demand for Guotan drugs to the greatest extent. The insured people can go to the pilot pharmacy to purchase drugs with the prescription and social security card or medical insurance electronic voucher through the pilot hospital, and can be reimbursed in real time in accordance with the provisions of the medical insurance. The Changping District Medical Insurance Bureau continues to promote the "expansion of the scope of "Guotan Medicine", and relevant departments guide the pilot institutions to implement the work of "matching as much as possible" according to the clinical needs of insured patients, so as to further improve the accessibility of "Guotan Medicine".

Throughout the country, the pilot work of "national medicine" and "dual channel" has been steadily promoted in various places and has achieved certain results. As a supplement to patients' treatment plans, out-of-hospital prescriptions are designed to meet patients' needs for personalized and rational drug use, and also help break the pattern of "medicine for medical care" and cut off the economic interest relationship between hospitals, medical staff and drug suppliers at the source.

However, after prescription dispensing has become the norm, the possible interest relationship between doctors and pharmacies has become a new integrity risk point, and poor management and use of prescription dispensing may lead to medication risks and business risks. In addition, some patients have not yet developed the habit of buying medicines from pharmacies with prescriptions, and have doubts about the hospital's practice of "prescribing only medicines but not dispensing".

In order to further strengthen the management of out-of-hospital prescription allocation in medical institutions, standardize the practice behavior of physicians, improve the level of rational drug use, and standardize the management of pharmaceutical affairs in medical institutions, the Sichuan Provincial Health Commission recently issued the "Notice on Further Strengthening the Management of Out-of-hospital Prescription Dispensing in Public Medical Institutions" (hereinafter referred to as the "Notice").

Issuance via HIS is encouraged

External prescriptions that are not included in the management directory

In terms of standardizing the management of pharmaceutical affairs in medical institutions, the health community has noticed that the "Notice" has put forward new requirements for the construction of hospital informatization. The "Notice" points out that public medical institutions should uniformly incorporate external prescriptions into the management of hospital pharmacy, in accordance with the drug selection system and procedures of medical institutions, while taking into account factors such as medical insurance policies, the application of clinical departments, the review of pharmaceutical affairs and medical affairs and other management departments, and the final approval of the Pharmaceutical Administration and Therapeutics Committee, and establish a management catalog of external prescription drugs and adjust them dynamically.

Medical institutions should maintain and regularly update the list of prescription drugs in the hospital information management system (HIS) to support the function of prescribing prescriptions.

All external prescriptions in medical institutions should be issued using the HIS system or integrated into the HIS system, and after being reviewed and approved by the hospital's pharmacists with prescription review qualifications, they should be printed using the prescription standards and formats specified in the "Prescription Management Measures".

Strengthen the management of the whole process of external prescriptions, and the issuance, review, use, medical records and other related content of external prescriptions should be traced back in the HIS system.

The "Notice" emphasizes that, in principle, except for the original drugs and the "dual-channel" drugs of medical insurance, the types and specifications of drugs that have been equipped by the medical institution should not be prescribed for external prescriptions. For drugs that are not included in the management catalogue of external prescription drugs, medical institutions must establish strict approval processes and management measures, and encourage the issuance of external prescriptions that are not included in the management catalogue through HIS.

The brand name must not appear on the prescription

Informed consent should be signed with the patient

In terms of standardizing the management of medical personnel, the "Notice" points out that physicians should follow the principles of safety, effectiveness, economy, simplicity and appropriateness in prescribing external prescriptions, and strictly grasp the indications, contraindications and dosages. The medical record should be made for the prescription of external prescriptions, detailing the diagnosis and treatment, the reason for issuance, the name of the drug, the specification of the drug dosage form, the dosage and dosage, the possible adverse reactions, the follow-up of the condition and other specific contents.

When prescribing external prescriptions, physicians should fully communicate with patients, make informed notices, sign informed consent forms, and respect patients' right to choose.

Physicians shall not require patients to purchase drugs from designated drug retail enterprises with external prescriptions, shall not write or label information unrelated to diagnosis and treatment on external prescriptions, strictly implement the requirements for issuing prescriptions according to the generic name of drugs, and shall not appear on the prescription except in special circumstances.

By the end of February, the hospital should improve the system

Formulate a management catalogue of external prescriptions

In terms of administrative supervision of external prescriptions, the "Notice" pointed out that public medical institutions should strengthen the daily management of external prescriptions and establish a monitoring, evaluation, early warning and intervention mechanism for the use of external prescriptions. Regularly implement dynamic monitoring and abnormal early warning for clinical departments and physicians who issue external prescriptions, as well as the specifications, quantities, and amounts of drugs prescribed.

Hospitals should carry out prescription reviews on the indications, selection, dosage, safety and effectiveness, and alternative drugs of external prescriptions, and regularly report on the use of external prescriptions.

For external drugs that are frequently prescribed or used in large quantities, the clinical needs are assessed on the premise that the prescription issued by the physician meets the diagnosis and treatment standards and the provisions of the external prescription, and the drugs with reasonable needs can be adjusted by the basic supply catalogue of the hospital to optimize the drug structure after the approval of the medical institution, so as to better meet the clinical needs.

For clinical departments and individuals who use external prescriptions unreasonably, timely warning and intervention in irrational drug use, it is strictly forbidden to use external prescriptions to seek improper benefits, and the physicians concerned who violate the relevant provisions of pharmaceutical administration of medical institutions shall be dealt with in accordance with relevant regulations.

The "Notice" points out that public hospitals at level 2 and above should improve the management system of external prescriptions by the end of February 2024, formulate a catalog of external prescription management, establish corresponding information systems and functional support, and train physicians on standardizing the issuance of external prescriptions as required. Other public medical institutions should complete the relevant work by the end of April 2024.

The Sichuan Provincial Health Commission plans to include external prescriptions in the management of the Provincial Pharmaceutical Quality Control Center in 2024 and carry out on-site quality control guidance, and notify and criticize medical institutions that find that the management of external prescriptions is chaotic.

In addition, in terms of regulating the management of pharmacies in medical institutions, the "Notice" emphasizes that public medical institutions shall not contract, lease or indirectly contract or lease pharmacies, shall not host pharmacies to for-profit enterprises, and shall not open for-profit pharmacies inside or outside the hospital in any form. If a public medical institution cooperates with an enterprise to carry out logistics extension services, it shall pay the relevant fees according to the services provided by the enterprise, and the enterprise shall not participate in any pharmaceutical related work of the medical institution in any form.