Medical Network News, August 13: On August 12, the Medical Administration and Hospital Administration of the National Health Commission issued the "Notice on Printing and Distributing Long-term Prescription Management Standards (Trial)" (hereinafter referred to as "standards"). The "Specifications" clarify the subject of application of long-term prescriptions, medical institutions that issue long-term prescriptions, and the main procedures for issuing long-term prescriptions. According to the needs of patients for diagnosis and treatment, the amount of prescriptions for long-term prescriptions is generally within 4 weeks; according to the characteristics of chronic diseases, the condition is stable. The patient is appropriately extended, no more than 12 weeks.

It is worth noting that the "Specifications" specifically requires primary medical and health institutions to be well connected with higher-level hospitals, and establish patient prescription information sharing and circulation mechanisms through informatization methods; if they do not meet the qualifications for reviewing parties, the higher-level medical associations Pharmacists in the hospital remotely conduct prescription review or provide medication guidance services through the Internet.

　　 While the "Specifications" point out specific directions for the development of long-term prescriptions, it also provides opportunities for the development of Internet medical remote consultation and medical information.

　　 Biological agents are not excluded, and online follow-up consultations can also be prescribed

　　Medical institutions issue long-term prescriptions, and still encourage priority selection of national essential drugs, centralized procurement and use of drugs by national organizations, and drugs on the national medical insurance catalogue. Medical institutions shall provide long-term prescription services to eligible patients in accordance with the long-term prescriptions for diseases and the scope of long-term prescription drugs formulated by the health administrative department.

　　 Compared with the "Long-term Prescription Management Regulations (Trial Draft for Soliciting Comments)" (hereinafter referred to as the "Opinion Draft") released in April this year, the "Code" has the following changes that are worth noting:

Clearly stipulate medical toxic drugs, radiopharmaceuticals, precursor drugs, narcotic drugs, Class I and Class II psychotropic drugs, antimicrobial drugs (except drugs for the treatment of chronic bacterial and fungal infectious diseases such as tuberculosis), and the storage conditions Drugs with special requirements shall not be used for long-term prescriptions. Biological agents are classified in the 8 categories of drugs that cannot be used for long-term prescriptions in the "Draft of Opinions", and the "Specifications" have deleted them and changed the psychotropic drugs to the first and second categories of psychotropic drugs, which means medication The scope has been relaxed.

　　 In addition, the "Regulations" clarify that local health administrative departments and medical institutions shall not influence the issuance of long-term prescriptions on the grounds of cost control, drug proportion, performance evaluation, etc. At the same time, it is emphasized that local health administrative departments should strengthen long-term prescription review, comment, and rational drug use assessment. Drug costs generated by long-term prescriptions are not included in the assessment of average outpatient cost and average outpatient drug cost. Other assessments should also be based on the situation. Manage long-term prescriptions individually.

　　 At the same time, the primary medical and health institutions are encouraged to issue long-term prescriptions. If the primary medical and health institutions do not have the corresponding conditions, they can use remote consultations, Internet follow-up consultations, hospital consultations, etc. to prescribe them under the guidance of qualified higher-level medical institutions in the medical consortium. Among them, "Internet follow-up" is a new content.

　　 In the original drug receiving method, “encourage the use of distribution logistics extension and other methods to solve the problem of patients’ difficulty in obtaining drugs”. Encourage areas with conditions to open WeChat official accounts, patient clients and other Internet interaction methods or channels to facilitate patients' inquiries about long-term prescription information, drug usage and dosage, and precautions. Among them, "Internet interactive methods or channels" are new content.

The "Specifications" also added new clauses in the appendix: "Internet hospitals providing long-term prescription services should combine the conditions of the physical medical institutions they rely on, and comply with the relevant regulations on pharmaceutical management of medical institutions, Internet diagnosis and treatment management and this specification, and strengthen the quality of medical care. And safety supervision."

　　 In general, the "Draft of Opinions" has 6 chapters and 35 articles, and the "Code" has 7 chapters and 43 articles. It is worth noting that Chapter VI of the "Specifications" "Long-term prescription medical insurance payment" is a new part of the whole, including 3 articles, respectively clarifying that medical insurance departments in various regions do not limit the number and amount of single long-term prescriptions in the payment link. All localities should fully consider long-term prescription factors when formulating regional total budget management, and require local medical insurance departments to improve their handling and service capabilities.

　　 Internet + medical + medicine press "accelerator"

　　 The above-mentioned new content points out the specific direction for the development of long-term prescriptions, and will also help accelerate the development of the big health ecology of chronic disease management, Internet hospitals, and medical technology development.

　　 Under the catalysis of the 2020 epidemic, the number of online consultations has greatly increased, the health code is "connected" across the country, and the "Internet + medicine + medicine" is developing rapidly while also showing new development trends. The National Health Commission and the National Medical Security Administration successively issued multiple documents, and even pressed the "accelerator key" for the Internet + medicine + medicine. According to the new statistics released by the Internet Society of China, the number of Internet users in China has exceeded 989 million. The total size of the Internet medical and health market will reach 283.1 billion yuan in 2021, a year-on-year increase of 45%.

　　 Despite the rapid development of the Internet medical industry, in addition to the current good profit models of medical information and medical e-commerce, profit models in other fields still need to be explored. Even the leading companies are still in the dilemma of losses. In 2020, Ping An Good Doctor achieved a net loss of 948 million yuan, an increase of 27% year-on-year; JD Health's net loss in 2020 was as high as 17.234 billion yuan, and a loss of 1 billion yuan in 2019; WeDoctor's net loss from 2018 to 2020 was 40.52. The three-year losses totaled nearly 8 billion yuan, 1.937 billion yuan and 1.914 billion yuan.

　　 Although Internet healthcare is also facing development difficulties and transformation, policy encouragement has released many benefits. In June of this year, the General Office of the State Council issued the "Opinions on Promoting the High-quality Development of Public Hospitals", which clearly explored the interconnection of prescription information and drug retail consumption information in public hospitals. The "Measures for the Supervision and Administration of Online Drug Sales", which has attracted the attention of the industry, will also be issued. .

　　 A few days ago, the National Medical Insurance Administration issued "Opinions on Optimizing the Convenience of Medical Insurance Fields", which emphasized the promotion of Internet + medical services, the realization of prescription drug circulation, online payment and settlement, and home-to-door integrated services to promote the development of Internet medical care. This time, the National Medical Insurance Bureau officially proposed to open up an integrated chain of “online order-in-store delivery” medical insurance payment for prescribing, payment, and delivery of medicines, so that O2O medical insurance payments are truly supported by top-level payment policies, and it is expected to be promoted quickly across the country in the future.

　　In the eyes of industry insiders, as an important part of the "fourth terminal" of the pharmaceutical market, O2O is becoming the general trend of new pharmaceutical retail. With the integration of the three medicines to promote the upgrade of smart medical care, the opening of the circulation of electronic prescriptions, the gradual liberalization of online medical insurance payments in the 5G era, and the upgrading of consumption patterns triggered by the Internet, it will empower the deep restructuring of the online and offline layout of pharmaceutical retail.

　　 Long-term prescription management practices

　　 (Trial)

　　 Chapter One General Provisions

Article 1 In order to standardize long-term prescription management, promote hierarchical diagnosis and treatment, promote rational drug use, and ensure medical quality and safety, in accordance with the "Practicing Physician Law", "Drug Administration Law", "Medical Institution Management Regulations", "Narcotic Drugs and Psychotropic Drugs Management Regulations" "Prescription Management Measures", "Regulations on Pharmaceutical Affairs of Medical Institutions" and other relevant regulations, formulate this specification.

　　 Article 2   The term “long-term prescriptions” as used in this specification refers to the prescriptions prescribed by qualified physicians in accordance with regulations to appropriately increase the amount of prescriptions prescribed by qualified patients with chronic diseases.

　　 Article 3   Long-term prescriptions are applicable to patients with chronic diseases with clear clinical diagnosis, stable medication regimen, good compliance, stable disease control, and long-term drug treatment.

　　Article 4  Generally used drugs for the treatment of chronic diseases can be used for long-term prescriptions.

Article 5: Toxic drugs for medical use, radiopharmaceuticals, precursor drugs, narcotic drugs, Class I and Class II psychotropic drugs, antimicrobial drugs (except drugs for the treatment of chronic bacterial and fungal infectious diseases such as tuberculosis), and the storage of Medicines with special requirements shall not be used for long-term prescriptions.

　　Article 6  The local health administrative department shall, based on the actual situation, formulate long-term prescriptions for the types of diseases and long-term prescription drugs.

　　 Article 7   This specification applies to the long-term prescription management work of various medical institutions at all levels across the country.

　　 It is encouraged to issue long-term prescriptions by primary-level medical and health institutions. Long-term prescriptions for chronic diseases that are not suitable for primary-level treatment should be issued by medical institutions above the secondary level.

　　 Article 8: The National Health Commission is responsible for the supervision and management of long-term prescriptions throughout the country.

　　The local health administrative department at or above the county level is responsible for the supervision and management of long-term prescriptions within the administrative area.

　　 Chapter 2 Organization Management

　　Article 9 Medical institutions shall perform their main responsibility for long-term prescription management, establish and improve their long-term prescription management work system, ensure medical quality and medical safety, and meet the needs of patients for medication.

　　 Article 10   Medical institutions that issue long-term prescriptions shall be equipped with physicians who have the ability to assess the patient’s condition, pharmacists who can review and adjust long-term prescriptions (including other pharmaceutical technicians, the same below), and corresponding equipment and facilities.

　　 If the primary medical and health institutions do not have the corresponding conditions, they can be issued under the guidance of qualified higher-level medical institutions in the medical consortium through remote consultations, Internet follow-up consultations, and hospital consultations.

　　 Article 11   According to the patient's diagnosis and treatment needs, the prescription amount for long-term prescriptions is generally within 4 weeks; according to the characteristics of chronic diseases, patients with stable conditions should be appropriately extended, no more than 12 weeks.

　　 For long-term prescriptions exceeding 4 weeks, physicians should strictly evaluate, strengthen patient education, and record in medical records, and patients should confirm by signing and other means.

　　Article 12  Medical institutions shall provide long-term prescription services to eligible patients in accordance with the long-term prescriptions applicable to diseases and the scope of long-term prescription drugs formulated by the health administration department.

　　Article 13  Medical institutions can provide "one-stop" long-term prescription services for elderly patients with multiple diseases in general internal medicine, geriatrics, general medicine and other departments, so as to solve the problem of elderly patients seeking medical treatment and medicine in multiple departments.

　　Article 14  Medical institutions issue long-term prescriptions to encourage priority selection of national essential drugs, national organizations to centrally purchase selected drugs and drugs in the national medical insurance catalogue.

　　 Article 15   Primary medical and health institutions shall strengthen the provision of long-term prescription medications to ensure that patients' long-term medications are accessible and stable.

　　 Article 16   Local health administrative departments and medical institutions shall not influence the issuance of long-term prescriptions on the grounds of cost control, drug proportion, performance evaluation, etc.

Local health administrative departments should strengthen long-term prescription review, reviews, and rational drug use assessment. The cost of drugs generated by long-term prescriptions is not included in the assessment of the average outpatient cost and the average cost of outpatient drugs. Other assessments should also consider long-term prescriptions as appropriate. Individual management.

　　 Chapter 3 Long-term prescription issuance and termination

　　 Article 17   For patients who apply for a long-term prescription, the physician must check in person and make a judgment on whether they meet the long-term prescription conditions.

　　During the diagnosis and treatment activities, doctors can proactively propose long-term prescription recommendations to eligible patients.

　　Article 18  Physicians should explain to patients the precautions for using long-term prescriptions and choose whether to use them voluntarily; for patients who do not meet the conditions, they should explain the reasons to the patients.

Article 19   Before issuing a long-term prescription for the first time, the physician shall conduct a comprehensive assessment of the patient’s past history, current medical history, medication regimen, compliance, disease control, etc., and formulate a prescription when it is determined that the current medication regimen is safe, effective, and stable. Long-term prescriptions can be prescribed for patients. When a long-term prescription is issued for the first time, relevant information should be recorded in detail in the patient's medical record.

Article 20   In principle, the first long-term prescription should be issued by a doctor with an intermediate or higher qualification for a disease-related professional in a medical institution above the second level, or by a doctor with an intermediate or above professional qualification in a primary medical and health institution Issued. When a long-term prescription is issued again, it should be issued by a doctor from a disease-related professional in a medical institution above the second level, or a doctor from a primary medical and health institution. Encourage patients to sign long-term prescriptions with family doctors through primary medical and health institutions.

　　 Outlying areas or areas where conditions do not meet the requirements may be appropriately relaxed, and the specific requirements shall be separately stipulated by the provincial health administrative department according to the actual situation.

　　 Article 21 Physicians should evaluate the patient based on the long-term prescription information and health file issued for the first time in the patient’s medical record. After evaluation, if the patient's condition is stable and the long-term medication management goal is reached, the long-term prescription can be issued again and recorded in the patient's medical record; if the conditions are not met, the long-term prescription can be terminated. If the long-term prescription is used again after stopping, it shall be managed according to the long-term prescription issued for the first time.

　　 Article 22   When the following situations occur, it is necessary to reassess the patient’s condition and determine whether to terminate the long-term prescription:

　　 (1) The patient's long-term medication management has not reached the expected goal;

　　 (2) Suffering from other diseases requires other medication;

　　 (3) The patient is hospitalized for any reason;

　　(4) Other situations where the long-term prescription needs to be terminated.

　　 Article 23   Primary medical and health institutions that issue long-term prescriptions and higher-level hospitals must do a good job of linking up, and establish a patient prescription information sharing and circulation mechanism through informatization methods.

　　 Article 24: The form and content of long-term prescriptions shall comply with the requirements of ordinary prescription management in the "Prescription Management Measures".

　　 Chapter 4 Long-term prescription dispensing

　　 Article 25   After a doctor has issued a long-term prescription, the patient can independently choose to dispense the medicine at a medical institution or social retail pharmacy.

　　 Article 26: Pharmacists review long-term prescriptions, provide medication guidance and medication education to patients, and distribute medication education materials. If the primary medical and health institutions do not have the conditions, the pharmacists of the higher-level hospitals in the medical association shall remotely conduct prescription review or provide medication guidance services through the Internet.

Article 27: When pharmacists review long-term prescriptions, provide consulting services, or dispense drugs, if they discover drug treatment-related problems or patients have potential drug safety risks, and need to carry out long-term prescription adjustments, drug reorganizations and other interventions, they should immediately contact the physicians Communicate for processing.

　　 Article 28: In principle, long-term prescription drugs shall be collected by the patient himself. Under special circumstances, due to inconvenience and other reasons, personnel who are familiar with the basic situation of the patient can pick it up on their behalf with valid identity documents of the patient and the patient, and cooperate with the preparation of corresponding registration records for taking medicine. Encourage the use of distribution and logistics extensions to solve the problem of patients' difficulty in getting medicines.

　　 Chapter 5 Long-term prescription drug management

　　 Article 29  Medical institutions shall regularly carry out rationality evaluation work on long-term prescriptions, and continuously improve the level of rational use of long-term prescriptions.

　　 Article 30   Primary medical and health institutions shall incorporate the long-term prescription information issued by the institution into the patient’s health file, and record the patient’s diagnosis, treatment and medication records in detail. The family doctor team shall conduct regular follow-up management of patients, evaluate changes in the patient's condition, medication compliance, and adverse drug reactions, adjust or terminate long-term prescriptions in time if necessary, and indicate in the patient's health files and medical records.

　　Article 31  Medical institutions shall establish safe medication monitoring and reporting systems