Enhancing the Standardization of the Use of Medical Insurance Restricted Drugs through Strengthened Diagnosis and Treatment Audit and Pharmaceutical Intervention

Wei Yedong, Cui Qianqian, Zan Ying, Si Jigang, Ren Xiaojian

Chinese Pharmaceutical Affairs ›› 2025, Vol. 39 ›› Issue (4) : 479-484.

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Chinese Pharmaceutical Affairs ›› 2025, Vol. 39 ›› Issue (4) : 479-484. DOI: 10.16153/j.1002-7777.2024-11-0044
Hospital Pharmacy

Enhancing the Standardization of the Use of Medical Insurance Restricted Drugs through Strengthened Diagnosis and Treatment Audit and Pharmaceutical Intervention

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Abstract

Objective: To explore the multidisciplinary management method of restricted drugs under the national medical insurance catalog, and to establish a pharmaceutical intervention mode to control medical insurance restricted drugs by standardized diagnosis and treatment audit center. Methods: Through the establishment of the whole process intervention mode of pre reminder and interception intervention, in-process interactive audit intervention, post prescription (medical order) comment and on-site supervision intervention, the amount of delinquent medical insurance restricted drugs involved in the flight inspection of the municipal medical insurance bureau before the implementation of the intervention mode (January 1, 2020 ~December 31, 2021) and after the implementation (January 1st, 2022 - December 31st, 2023) were analyzed and compared, as well as the reasonable payment rate of medical insurance restricted drugs in the special inspection of medical insurance, and the self-examination of suspected exceed-indication drug use. Results and Conclusion: After the implementation of the intervention mode of the standardized diagnosis and treatment audit center, the amount of delinquent medical insurance restricted drugs involved in the flight inspection of the municipal medical insurance bureau, the reasonable payment rate of medical insurance restricted drugs in the special medical insurance inspection, and the suspected exceed-indication drug use were significantly improved. By the pharmaceutical intervention in the standardized diagnosis and treatment audit center, it effectively promoted the rational use of drugs and helped the management of medical insurance restricted drugs.

Key words

standardized diagnosis and treatment audit center / pharmaceutical intervention / medical insurance restricted drugs / exceed-indication drug use

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Wei Yedong, Cui Qianqian, Zan Ying, et al. Enhancing the Standardization of the Use of Medical Insurance Restricted Drugs through Strengthened Diagnosis and Treatment Audit and Pharmaceutical Intervention[J]. Chinese Pharmaceutical Affairs, 2025, 39(4): 479-484 https://doi.org/10.16153/j.1002-7777.2024-11-0044

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