If the hospital is out of stock of a national insurance-negotiated drug, ask the doctor for a prescription and purchase it at a "dual-channel" designated retail pharmacy with standard insurance reimbursement

If a hospital states that a nationally negotiated medical insurance medication is unavailable or not stocked in the hospital formulary, this does not mean the medication cannot be reimbursed. If the drug is cataloged under the provincial "dual-channel" mechanism, have the doctor issue an official prescription to fill at a "dual-channel" designated retail pharmacy, where insurance reimbursement policies apply identically to in-hospital purchases. Under national directives, hospitals are strictly barred from citing total budget caps or drug expenditure ratios (drug markups) to delay stocking or prescribing these medicines.

Free. Requires asking the prescribing physician for a prescription and making an extra trip to a designated pharmacy. Certain provinces require a one-time outpatient qualification filing.

Negotiated drugs represent high-value pharmaceuticals included in national basic medical insurance following centralized price negotiations between the National Healthcare Security Administration (NHSA) and pharmaceutical manufacturers. Due to annual catalog updates, medications frequently enter national insurance before hospital procurement committees convene, creating barriers to hospital entry. To solve this, the NHSA and National Health Commission issued Document No. [2021] 28, establishing the "dual-channel" management mechanism supplying negotiated drugs through both designated medical institutions and designated retail pharmacies under unified insurance payment policies. The reimbursement percentage and patient cost-sharing at retail pharmacies mirror those inside public hospitals. Provincial health authorities determine eligible drug lists and publicly disclose qualified dual-channel retail pharmacies. Electronic prescriptions flow securely through the national medical insurance prescription clearinghouse. Subsequent directives (NHSA Notice [2021] 182) mandated that unstocked negotiated drugs must be accessible via dual-channel pharmacies, explicitly barring healthcare institutions from using global budget caps, formulary size caps, or drug-to-total-revenue ratios to restrict negotiated drug availability. The 2025 National Drug List Notice (NHSA [2025] 33) reaffirmed these prohibitions, establishing that drugs transitioning to regular catalog status generally retain dual-channel status and requiring all dual-channel dispensing pharmacies to process orders via the national electronic prescription center.

Follow four operational steps: First, confirm with the attending clinician whether the medication is included in the provincial dual-channel directory and obtain a standardized electronic prescription. Second, look up designated pharmacies via provincial healthcare security portals, local insurance helplines, or the National Medical Insurance Service Platform App. Third, present the patient's physical national medical insurance card or QR code mobile credential at the counter; pharmacy pharmacists verify patient identity against the prescription. Fourth, verify local outpatient chronic/serious illness reimbursement parameters or standalone reimbursement policies. For cross-provincial direct billing, check local administrative procedures in advance. Outpatient chronic and special disease registration is discussed in Chapter 16, Rule 2. Financial benefit is categorized as High because target therapies (such as oncology biologics or rare disease treatments) represent tens of thousands of yuan in out-of-pocket savings per treatment cycle.

国家医保局、国家卫生健康委 (2021). 关于建立完善国家医保谈判药品“双通道”管理机制的指导意见（医保发〔2021〕28 号，第一、二、四、五、六条）. https://www.gov.cn/zhengce/zhengceku/2021-05/10/content_5605595.htm；国家医保局 (2021). 《关于建立完善国家医保谈判药品“双通道”管理机制的指导意见》政策解读. https://www.gov.cn/zhengce/2021-05/10/content_5605596.htm；国家医疗保障局、国家卫生健康委 (2021). 关于适应国家医保谈判常态化持续做好谈判药品落地工作的通知（医保函〔2021〕182 号，第二、三、五条）. https://www.gov.cn/zhengce/zhengceku/2021-09/11/content_5636762.htm；国家医保局、人力资源社会保障部 (2025). 关于印发《国家基本医疗保险、生育保险和工伤保险药品目录》以及《商业健康保险创新药品目录》（2025年）的通知（医保发〔2025〕33 号，第一部分）. https://www.gov.cn/zhengce/zhengceku/202512/content_7050533.htm