China Targets Drug Over-Prescribing to Curb Insurance Fraud
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China’s national health insurance regulator is launching a crackdown on the over-prescription of 50 high-cost medications, shifting its anti-fraud focus toward hospitals to stamp out the illegal resale of subsidized drugs.
The National Healthcare Security Administration (NHSA) recently issued a notice requiring increased intelligent supervision of high-value drugs and prescribing behaviors that exceed clinical needs. Pilot regions must incorporate at least 50 key drugs into their monitoring systems by the end of December. The program is set to expand nationwide to cover 100 drug types by June 2026, with a unified set of national regulatory rules expected to be in place by the end of that year.
Caixin has learned that the initial watchlist focuses on treatments for chronic diseases such as hypertension, diabetes and kidney disease. Specific drugs under scrutiny include Amlodipine benzenesulfonate tablets, Metformin hydrochloride tablets, Atorvastatin calcium tablets, Insulin glargine injections, and Bailing capsules.
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- China’s NHSA is targeting over-prescription and fraud involving 50 high-cost medications, expanding monitoring to 100 drugs by June 2026.
- Enhanced surveillance focuses on chronic disease drugs, using intelligent algorithms and pilot programs in regions like Shanghai and Guizhou to flag abnormal behavior.
- The crackdown aims to stop subsidies abuse while avoiding rigid quotas, promising flexibility for genuine long-term or travel prescription needs.
- In 2025：
- Shanghai will flag abnormal dispensing for situations such as 15 or more outpatient visits in a single month, visiting more than 3 hospitals in a single day with 3 or more cumulative occurrences, or accumulating pharmacy costs exceeding 8,000 yuan in a month.
- In 2025：
- Guizhou province establishes a graded warning system that alerts doctors in real-time if a patient’s cumulative drug purchases cross a set threshold.
- In 2025：
- The NHSA promises to maintain flexibility for legitimate prescription needs, such as long-term prescriptions for stable conditions or travel requirements.
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