In Harbin City, Heilongjiang Province, a patient purchased prescription drugs worth over 1 million yuan from a pharmacy, with a unit price of 7,140 yuan, far exceeding the clinically reasonable dosage for short-term treatment. Moreover, the purchase of prescription drugs worth millions of yuan did not require a prescription. How did this happen?
According to the Daily Economic News on October 15th, during a recent screening of data by the National Medical Insurance Administration of the Chinese Communist Party, it was discovered that at a pharmacy in Harbin City, Heilongjiang Province, 96 insured individuals made unusually large purchases of medications, with the highest amount spent by one insured person exceeding one million yuan over a period of two years.
Upon checking the medical insurance drug catalog at the patient’s home, it was revealed that the patient was taking a drug called Aflibercept, belonging to the national Class B reimbursable category. This drug is used for outpatient treatment of chronic liver disease-related platelet deficiencies in adult patients scheduled for diagnostic procedures or surgeries. It is typically taken short-term before interventional treatment.
Based on the recommended dosage of 3 tablets per day for 5 days, this patient would only need one box to suffice for the pre-operative medication required. However, the patient claimed to be taking three tablets of this drug daily on a long-term basis.
Upon investigation, it was found that the patient was taking a limited-quantity drug intended for short-term treatment on a long-term basis, resulting in medication expenses far exceeding the reasonable range.
Over a period of two years, the patient purchased approximately 160 boxes (totaling 2,400 tablets) of Aflibercept priced at 7,140 yuan per box, amounting to over one million yuan. The patient consumed the drug for a total of 800 days, significantly surpassing the clinically reasonable dosage.
Experts explained that after taking Aflibercept for interventional surgery, the need for continued medication treatment, as well as the duration and dosage of usage, should be determined periodically by a doctor based on the patient’s condition and prescribed accordingly, instead of prolonged self-administration.
How then were prescriptions for medication dosages exceeding the clinical limits issued? According to the patient, for the past three years of illness, it had been their son who had been going to the pharmacy to purchase and pick up the medication.
The investigation revealed that there were doubts about the source of this patient’s prescriptions, and that the pharmacy violated regulations when selling “special medications” by not strictly adhering to prescription management, with some prescriptions being forged.
Furthermore, multiple pharmacies were found to possess a large number of handwritten prescriptions, involving amounts ranging in the tens of millions of yuan, with these forged prescriptions bearing different doctor’s signatures.
Many of these handwritten prescriptions were labeled as originating from medical institutions such as Harbin Medical University Cancer Hospital. However, it was confirmed that these handwritten prescriptions were not issued by the hospital.
The responsible person from the implicated pharmacy eventually admitted that some prescriptions were fake and provided by pharmaceutical representatives, while others were even purchased online and then falsified.
This incident exposed a serious problem of medical insurance fund loss, leading to involvement of public security in handling the related pharmacies, as well as implicating two listed companies, including Shuyu Pingmin and Shanghai Pharmaceuticals.
This incident also highlighted loopholes in drug sales and medical insurance management, leading to misuse and fraudulent practices in the medical insurance fund.