Construction and application of a system for rational drug use for prescriptions from internet hospitals and external prescriptions and medical insurance fund control based on a pre-review prescription system
- VernacularTitle:基于前置审方系统的互联网医院处方、外配处方合理用药及医保基金管控体系构建与应用
- Author:
Yi GE
1
;
Xiaolan WANG
1
;
Junping HAN
1
;
Bo LYU
1
;
Yu GUAN
1
;
Feng XU
1
;
Aiming SHI
1
Author Information
1. Dept. of Pharmacy，the Second Affiliated Hospital of Soochow University，Jiangsu Suzhou 215000，China
- Publication Type:Journal Article
- Keywords:
pre-prescription review;
medical insurance
- From:
China Pharmacy
2026;37(5):584-588
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE To ensure the safety of patients’ drug use and control the risk of medical insurance expenditure by upgrading the pre-prescription review system to conduct pre-review on prescriptions from internet hospitals and external prescriptions， as well as to review the payment methods of drugs （including in-hospital and external drug dispensing）. METHODS The data interfaces of prescriptions from internet hospitals and external prescriptions were integrated to achieve real-time rational drug use intervention. Additionally， an intelligent review project for payment method was added to precisely intervene in the medical insurance payment methods of drugs. The effect of the system upgrade was evaluated by comparing the qualification rates of prescriptions from internet hospitals and external prescriptions and the suspected amounts of drug violations from January to April 2025 （before the system upgrade） and May to August 2025 （after the system upgrade）. RESULTS After the upgrade of the pre-prescription review system， the qualification rates of prescriptions from internet hospitals and external prescriptions increased by 3.5% [95% confidence interval （CI）＝0.3%-6.7%， P ＝0.037 ] ； the suspected amounts of drug violations decreased to 52.9% of the pre-upgrade level （95%CI＝31.6%-88.5%， P ＝0.026）， and the average monthly sequential decrease was 29.5% （95%CI＝12.2%-43.4%， P ＝0.012）. Moreover， the addition of the intelligent review project for payment methods promoted the management of off-label drug use in our hospital. After the upgrade， a total of 79 filling valid applications for off-label drug use were received and archived. CONCLUSIONS The upgrade of the pre-prescription review system effectively improves the review qualification rates of prescriptions from internet hospitals and external prescriptions and the accuracy of medical insurance payment for drugs， and strengthens the supervision of off-label drug use， achieving dual guarantees of clinical rationality and medical insurance compliance.
