20240421-国联证券-医药生物_门诊统筹有望带动处方外流至零售药店_14页_544kb

行业报告：门诊统筹政策对零售药店的影响分析

1. 政策背景

2023年国家医保局发布《关于进一步做好定点零售药店纳入门诊统筹管理的通知》，鼓励符合条件的定点零售药店申请开通门诊统筹服务。2021年起，职工医保个人账户改革逐步推进，药店纳入门诊统筹支付范围，有利于推动处方外流至零售药店。

2. 政策特点

• 政策红利显著：截至2024年3月，全国124个城市已实施药店门诊统筹政策。多数地区的起付线低于500元，支付限额超1000元，整体报销额度较高。
• 报销比例宽松：31%的地区按基层医疗机构或一级医院标准报销，药店报销比例优于三级医院，促进处方流出。

3. 对零售药店的影响

• 短期挑战与机遇并存：医保支付结构调整可能导致药店收入短期波动，但个人账户结余资金可部分补充。
• 长期利好：随着门诊统筹政策完善，统筹基金将增强药店医保支付能力，吸引医院处方持续外流，提升药店客流量和销售额。

4. 投资建议

推荐关注头部连锁药店，如益丰药房、老百姓、健之佳等，因其具备高效管理和合规优势，有望在政策中获得更多收益。建议关注大参林、一心堂等连锁企业。

5. 风险提示

• 处方外流不及预期。
• 政策变动或市场竞争加剧影响盈利能力。

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### Industry Report: Analysis of Outpatient Consolidation Policies' Impact on Retail Pharmacies

#### 1. Policy Background
In 2023, the National Healthcare Security Administration issued a notice encouraging designated retail pharmacies to voluntarily apply for outpatient consolidation services. Since 2021, reforms to individual accounts have gradually included retail pharmacies in outpatient payment scope.

#### 2. Key Features of Policies
- **Significant Policy Benefits**: By March 2024, 124 cities nationwide had implemented outpatient consolidation policies for retail pharmacies. Most regions have low deductibles (below 500 RMB) and high payment limits (above 1,000 RMB), offering generous reimbursement.
- **Lenient Reimbursement**: 31% of regions reimburse at rates similar to primary-level hospitals, making pharmacy reimbursements generally more favorable than tertiary hospitals, thus encouraging prescription diversion.

#### 3. Impact on Retail Pharmacies
- **Short-term Challenges and Opportunities**: Adjustments in medical insurance payments may temporarily affect pharmacy revenue, but surplus funds in personal accounts can partially offset this.
- **Long-term Benefits**: With policy improvements, consolidation funds will enhance pharmacy payments, attract continuous prescription diversion from hospitals, and increase customer traffic and sales.

#### 4. Investment Recommendations
Focus on leading chain pharmacies like Yifeng Pharmacy, Lianghao Pharmacy, Jianzhijia, etc., as they benefit more from policy changes due to their operational efficiency and compliance advantages. Also, monitor Dashenlin and Yixintang.

#### 5. Risk Factors
- Delayed prescription diversion (ODD) compared to expectations.
- Market competition intensification and policy changes affecting profitability.