So far, a large number of pharmacies have withdrawn from medical insurance. In September alone, Inner Mongolia has inspected 636 designated medical institutions and 1,661 retail pharmacies, imposed administrative penalties on 34, and suspended or terminated medical insurance agreements for 1,023; Xinjiang terminated the medical insurance service agreements of 162 designated medical institutions; 3 retail pharmacies in Tongling, Anhui terminated the medical insurance service agreements, and 1 medical institution in Yongxin, Jiangxi cancelled its medical insurance designated qualification...

Earlier, similar situations also occurred in pharmacies in Zhoukou, Henan, Heyuan, Guangdong, Dezhou, Shandong, Fangshan, Beijing, Shaoyang, Hunan, Kunshan, Jiangsu, etc. The reasons for pharmacies to withdraw from the medical insurance service agreement vary, most of which are "actively applying", "due to their own business reasons", "illegal and irregular", "due to failure to handle relevant procedures, no incurrence or approval of settlement expenses for more than six months", etc.

Pharmacies have been reported to withdraw from medical insurance in various places, and some large chains are also considering not doing or adjusting medical insurance-related businesses.

In recent years, many provinces have issued policies to allow centralized procurement of drugs to enter pharmacies, requiring designated medical insurance pharmacies to sell centralized procurement drugs at "zero price difference". While attracting customers, this policy also requires pharmacies to bear the operating costs of labor, rent and other operating costs of centralized procurement drugs. For small and medium-sized chain pharmacies and single pharmacies, this part of the profit is particularly compressed.

In addition, as an important role in pharmacy operations, the income of individual medical insurance accounts has declined in the past two years. According to the National Medical Insurance Administration's 2023 Medical Insurance Statistical Bulletin, the income of individual medical insurance accounts has experienced negative growth for the first time, from 763.3 billion yuan in 2022 to 635.1 billion yuan in 2023.

Individual medical insurance accounts are one of the main sources of income for pharmacies, and the reduction in funds transferred to employee accounts has led to a decrease in consumer demand for medicines. Some pharmacies are facing a situation where individual medical insurance accounts are reduced and they cannot use medical insurance unified payment, which affects their operations and financial conditions.

In addition to the amount of individual medical insurance accounts, individual medical insurance account payments may also bring some problems to pharmacy operations. For example, some pharmacies violate regulations by swiping medical insurance cards and embezzling medical insurance funds, which damages the security of medical insurance funds.

On the other hand, with the rapid development of medical e-commerce, market competition has intensified, and pharmacies have reduced their profit margins due to high price transparency and increased sales costs. In order to ease operating pressure, some pharmacies choose to voluntarily withdraw from medical insurance.

With the deepening of national unannounced inspections, the medical insurance department has strengthened its supervision of medical insurance designated pharmacies. This year, the National Medical Insurance Bureau will include designated retail pharmacies in the inspection, focusing on three aspects: false drug purchases, participation in reselling medical insurance drugs, and substitution of drugs.

According to the arrangement of the National Medical Insurance Bureau, there are only two days left for the on-site inspection of the National Medical Insurance Unannounced Inspection. Previously, the National Medical Insurance Bureau has issued multiple reports on illegal behaviors of pharmacies.

According to the relevant person in charge of the National Medical Insurance Bureau, from the perspective of medical insurance fund supervision practice, some designated retail pharmacies have violated the law and regulations in the following situations: false prescriptions; substitution of drugs; excessive prescriptions; lending medical insurance settlement systems to non-medical insurance designated retail pharmacies or designated retail pharmacies that have been suspended from medical insurance settlement, and conducting medical insurance settlement on their behalf; management problems.

In July, medical insurance departments across the country conducted a series of talks and reminders on the compliance of designated retail pharmacies, and standardized the operation, sales and use of medical insurance funds of designated retail pharmacies.

The state's supervision of pharmacies is still being upgraded. From the "Notice on Further Deepening the Intelligent Audit and Monitoring of Medical Security Funds", it is proposed that by the end of 2025, a standardized, scientific and normalized intelligent audit and monitoring system will be basically established; to the "Guiding Opinions on Establishing a Medical Insurance Payment Qualification Management System for Relevant Personnel of Designated Medical Institutions", the main person in charge of the medical services provided by designated retail pharmacies to insured persons using fund settlement will be included in the clear management objects.

The National Medical Insurance Administration has repeatedly emphasized that the application of big data supervision models should be strengthened, and the medical insurance fund use data of the inspected cities should be screened in advance through big data models. This means that once suspicious clues are locked and the inspected pharmacies are accurately designated, they can be quickly found out.

For example, in response to the recent online report that Wuxi Hongqiao Hospital was suspected of fraud and insurance fraud, the National Medical Insurance Administration sent a flight inspection team to the hospital to carry out special flight inspections. According to the agreement management regulations, the Wuxi Municipal Medical Insurance Bureau made a decision to terminate the medical insurance service agreement with Wuxi Hongqiao Hospital. Under the influence of policies such as the reform of individual medical insurance accounts and volume-based procurement, the medical insurance income on which pharmacies rely for survival is gradually decreasing. In response, pharmacies are continuously adjusting their business strategies. In 2023, the medical insurance settlement income of Jianzhijia's physical stores decreased by 228 million yuan, a decrease of 5.8%; in the first half of this year, the medical insurance settlement income of physical stores decreased by 155 million yuan, a decrease of 8.37%.

Jianzhijia said that it will actively transform from the "medical insurance-dependent" sales and drug price competition model to long-term adherence to strengthening professional pharmaceutical services, health management services, and differentiated commodity category management capabilities. Strengthen the planning, introduction and sales of prescription drugs, OTCs that are less affected by medical insurance, and non-drugs that are not affected by medical insurance; fully explore the performance improvement opportunities of existing advantageous channels such as specialist stores and O2O.

In its latest annual report, Laobaixing stated that it will actively respond to the outpatient medical insurance policy, promote the implementation of store qualifications, explore the coordinated business model, and strengthen medical insurance compliance management. As of mid-2024, Laobaixing has a total of 5,028 stores with outpatient coordination qualifications.

It is worth noting that the management of medical insurance designated pharmacies has been in and out, and has been dynamically adjusted. Overall, the number of newly added medical insurance pharmacies released by various places is greater than the withdrawal.

In July, Shanghai announced that it would add 2 new medical institutions and 22 retail pharmacies to the medical insurance designated points; in June, Shanghai planned to include 5 medical institutions and 66 retail pharmacies in the medical insurance designated points; this year, Anhui Lu'an has 70 medical insurance designated medical institutions that have been qualified for comprehensive evaluation and included in the designated management, including 16 designated medical institutions and 54 designated retail pharmacies.

According to the "Annual Data on Drug Supervision and Administration Statistics (2023)", there are about 667,000 pharmacies nationwide, 385,600 chain stores, 281,400 single pharmacies, and a chain rate of 57.81%. This data has increased again on the basis of 2022.

Pharmacies are continuing to adjust with changes in the market and policies. Whether they withdraw or enter medical insurance, they are the most suitable choices for themselves based on the current situation.