《三门峡市医疗保障局关于重特大疾病医疗保障门诊特定药品“双通道”保障定点药店管理工作的通知（征求意见稿）》公开征求意见的

公告

为确保国家医保谈判药品顺利落地，更好满足广大参保患者合理用药需求，优化我市营商环境，我局起草了《三门峡市医疗保障局关于重特大疾病医疗保障门诊特定药品“双通道”保障定点药店管理工作的通知（征求意见稿）》，现向社会公开征求意见，公众可于2021年8月8日前提出意见建议。

邮    箱：smxsyyfwglk@126.com

通讯地址：三门峡市湖滨区上官路与五原路交叉口西南角 三门峡市医疗保障局

三门峡市医疗保障局

2021年7月8日

三门峡市医疗保障局

关于重特大疾病医疗保障门诊特定药品

“双通道”保障定点药店管理工作的通知

（征求意见稿）

为确保国家医保谈判药品顺利落地，更好满足广大参保患者合理用药需求，优化我市营商环境，根据国家医保局、国家卫生健康委《关于建立完善国家医保谈判药品“双通道”管理机制的指导意见》（医保发〔2021〕28号）、《零售药店医疗保障定点管理暂行办法》（国家医疗保障局令第3号）、《三门峡市医疗保障局关于进一步规范完善三门峡市重特大疾病医疗保障门诊特定药品使用工作的通知》（三医保〔2021〕32号）等文件要求，在我市实施重特大疾病医疗保障门诊特定药品（以下简称“特药”）“双通道”管理。按照“总量控制、公平公正、方便服务、自愿申请、择优选择、能进能出、动态调整”的原则，选择具备相应资格与条件的零售药店承担特药定点零售服务。现就有关工作要求通知如下：

一、工作原则

    1.按照属地管理原则，各县（市、区）医疗保障部门负责属地零售药店的申请受理、专业评估、协议订立、协议履行和日常监管工作；

    2.市区零售药店可自主选择向湖滨区医疗保障部门或市社会医疗保险中心提交申请，接受申请的医疗保障部门负责材料审核、专业评估、协议订立、协议履行和日常监管工作；

    3.各级医疗保障行政部门在定点申请、申请受理、专业评估、协议订立、协议履行和解除等环节对经办机构、定点零售药店进行监督。（《零售药店医疗保障定点管理暂行办法》第一章第三条、第六章第四十三条）

二、申报条件

申请特药供应单位(以下简称“申请单位”)应具备以下条件：　

    1.申请单位应为在我市行政区域内已承担基本医疗保险服务的定点零售药店；

2.近三年无药品经销、医保管理重大违规或失信行为,且无重大药品质量事故；

3.具有与所经营药品、医用耗材相适应确保质量的物流、仓储等“冷链系统”设备条件的专业DTP药店，并具备对所售药品实现电子追溯等条件；

4.具有与特药供应业务相适应的医保管理服务能力;

5.具有与特药供应业务相适应的经营管理能力和药品保障供应能力，并至少配备2名执业药师；

6.取得特药生产厂家或总代理授权代理资格的药店以及与制药企业慈善赠药项目合作的药店优先纳入。

三、申报材料

1.《三门峡市基本医疗保险特药定点零售药店申请表》；

2.提供基本医疗保险定点零售药店资质材料及DTP专业药店的相关资料；

3.提供本年度工作人员参保缴费票据复印件以及劳务合同签订记录；

4.提供申请单位物流、配送条件的书面报告，包括具有符合市场监督管理部门要求的24小时冷藏药品存储设备、温湿度实时监测设施设备和冷藏药品运输设备;

5.店面为独立结构，地理位置应方便参保群众购药。店内特药销售功能区域要求功能独立（四区分开：特药存储区、档案管理区、宣教服务区、药品包装回收区）、相对集中，存储区不能摆放其他任何与特殊药品无关的药品、物品，确保专区专用（附平面图）。

6.至少配备2名具有同等素质要求的执业药师，提供执业药师资格证书、注册证复印件;

7.诚信建设情况。提供近三年间接受市场监管部门及医保管理部门检查的相关材料或记录，查看是否存在药品违规违法经销行为、重大药品质量事故及医保管理重大违规或失信行为；

8.特药医保管理内控管理流程，应满足对所销售的特药进行可电子追溯管理；

9.提供药品保障供应能力的报告，包括取得重特大疾病特殊药品厂家或总代理的授权代理资格的相关材料；二级授权代理视为有效，必须标明代理品种，否则视为无效；以及其他相关材料；

10.与特药慈善机构有合作的单位，应提供与特邀慈善机构签署的合作协议原件及复印件；

11.提供做好“双通道”服务工作及所提交材料真实性承诺书。                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                

四、工作流程

（一）申请受理。符合申请条件的单位可填写《三门峡市基本医疗保险特药定点零售药店申请表》，向属地医疗保障部门提交相关材料，申请材料齐全的予以受理，材料不齐全或不符合要求的，医疗保障部门自收到材料之日起5个工作日内，一次性告知需补充的内容；不符合申请条件的不予受理，并当面告知不受理理由。对提供虚假材料的申请单位，一经核实，三年内不得提出申请。  

（二）现场评估。由属地医疗保障部门组织评估小组，按照相关要求对申请单位所申报的材料和信息进行现场评估，评估应自受理申请材料之日起30个工作日内完成，申请单位补充材料时间不计入评估期限。评估结果包括合格和不合格，对于不合格的应以书面形式告知其理由。（《零售药店医疗保障定点管理暂行办法》第二章第七条、第八条）

（三）材料备案。各级医疗保障部门应在完成现场评估后10个工作日内，将申请材料、评估结果报市级医疗保障行政部门备案。（《零售药店医疗保障定点管理暂行办法》第二章第八条）

（四）公示公告。经市级医疗保障行政部门备案通过后，各级医疗保障部门将拟定为特药定点零售药店的名单在单位门户网站进行公示，公示期为5个工作日,接受社会监督。（《零售药店医疗保障定点管理暂行办法》第二章第八条）

（五）签约公布。经公示无异议的，由属地医疗保障部门与特药定点零售药店签订《基本医疗保险特药定点零售药店服务协议》,并将签约特药定点零售药店信息向社会公布，供参保群众选择。原则上每次协议签订期限为1年。（《零售药店医疗保障定点管理暂行办法》第二章第九条、第十条）

五、监督管理

(一)实行“双通道”管理。享受重特大疾病医疗保障门诊特定药品保障待遇的参保患者购取特药采取定点医疗机构和定点特药零售药店“双通道”管理。患者既可选择在定点医疗机构购取特药,也可凭定点医疗机构责任医师处方、《三门峡市重特大疾病医疗保障门诊特定药品申请表》等有关资料,同时持社保卡（或电子社保卡）及有效身份证件到特药定点零售药店购药。

(二)实施定点协议管理。各级医疗保障部门将特药定点零售服务纳入定点零售药店协议管理范围,作为日常监管、年度考核的重要依据。服务协议应明确双方职责、权利和义务,具体应包括服务人群、服务范围、服务质量、费用结算、违约处理等内容，建立健全“双通道”定点零售药店退出机制，适度竞争、有进有出、动态调整。作出中止或解除医保协议处理时，应及时将相关材料报同级医保行政部门备案。（《零售药店医疗保障定点管理暂行办法》第六章第四十六条）

(三)实施医疗费用直接结算。享受重特大疾病门诊病种保障待遇的参保患者在特药定点零售药店购买特药产生的医疗费用,享受直接结算服务,参保患者个人只需交纳现金支付部分,医保基金支付部分由经办机构与特药定点零售药店按期结算。

本通知自2021年  月  日起实施，之前与本通知不一致的相关规定，按照本通知规定执行。

                          2021年   月   日