中国临床药学杂志

目的 探讨全程药学干预模式用于医保限制性药品管控的效果。方法 构建以事前实时拦截、事中互动审核以及事后针对性处方点评为一体化全程药学干预模式，对全程药学干预模式实施前（2021年11月-2022年4月）和全程药学干预模式实施后（2022年5月-2022年10月）医保局检查涉及违规药品金额、处方点评情况及医保拒付金额进行对比分析。结果 在全程药学干预模式实施后，我院涉及违规药品金额、处方点评不合理率和医保拒付金额均低于干预模式实施前（P <0.05）。结论 全程药学干预模式有利于提升医保限制性药品的合理使用，明显改善医保拒付情况，进一步规范临床用药行为。

AIM To explore the effectiveness of a full process pharmaceutical intervention model for controlling restricted drugs in medical insurance. METHODS An integrated full process pharmaceutical intervention model that included real-time interception in advance, interactive review during the process, and targeted prescription review after the implementation was build. The amount of illegal drugs, prescription reviews, and medical insurance refusal amount involved in the medical insurance bureau's inspection before the implementation of the full process pharmaceutical intervention model(November 2021 to April 2022) and after the implementation of the full process pharmaceutical intervention model(May 2022 to October 2022)were compared and analyzed. RESULTS After the implementation of the full pharmaceutical intervention model, our hospital found that the amount of illegal drugs involved, the unreasonable rate of prescription reviews, and the amount of medical insurance refusal were lower than before the implementation of the intervention model(P < 0.05). CONCLUSION The full process pharmaceutical intervention model is beneficial for improving the rational use of restricted drugs in medical insurance, significantly improving the situation of medical insurance refusal, and further standardizing clinical medication behavior.