The scope of what can and cannot be purchased with personal medical insurance accounts at retail pharmacies has received a systematic regulatory response at the institutional level.
On May 19th, the National Healthcare Security Administration, in conjunction with the Ministry of Finance, issued a "Notice on Further Strengthening the Supervision and Management of the Use of Personal Accounts for Employee Basic Medical Insurance at Designated Retail Pharmacies" (hereinafter referred to as the "Notice"). It explicitly requires provincial-level healthcare security departments to issue a unified provincial-level "whitelist" for payments from employee medical insurance personal accounts at designated retail pharmacies by the end of September this year.
The "Notice" directly addresses the misuse of personal accounts at retail pharmacies. Previously, some pharmacies included "medical device-registered" products such as toothbrushes, dental floss, facial masks, and smartwatches as eligible for personal account payment, sparking widespread controversy over the "medical insurance card becoming a shopping card."
This new policy clarifies the approach to "opening the front door and blocking the side doors." It includes medications, basic medical devices, and common medical consumables in the whitelist, while explicitly excluding cosmetics, health products, daily necessities, "medical device-registered" daily chemical products, and smart communication/timing devices. The whitelist will be formulated by each province based on local conditions and will be dynamically adjusted according to public needs and developments in medical technology.
Several experts pointed out that, as a crucial supporting policy for the reform of medical insurance personal accounts, the implementation of the whitelist system will lead to more standardized industry development, provide clearer rules for fund supervision, and promote industry transformation and upgrading. For over 400,000 designated retail pharmacies nationwide, an industry reshuffle centered on compliance has already begun.
**Establishing Regulatory Boundaries**
Employee medical insurance personal accounts are an important component of the medical insurance fund, intended to meet the basic medical consumption needs of insured individuals. However, the use of personal account funds at retail pharmacies to pay for non-medical goods like daily necessities and cosmetics has long been a persistent issue, with违规 methods constantly evolving in recent years.
In November 2025, multiple media outlets exposed that some designated retail pharmacies were selling "medical device-registered" products such as toothbrushes, toothpaste, dental floss, facial masks, and sun-protective masks to insured individuals. While seemingly compliant with policy on the surface, these products were often marketed and sold as daily-use items, exceeding their intended medical device purposes. This created a situation of superficial compliance that deviated from the fundamental positioning of basic medical insurance.
To systematically address such issues, the National Healthcare Security Administration, together with the Ministry of Finance, formulated and issued the "Notice" to further strengthen the supervision and management of personal account use at designated retail pharmacies.
Shao Qing, CEO of Yaofuneng, stated in an interview that many boundaries were unclear in the past, leaving room for some pharmacies to exploit loopholes. The whitelist system clarifies the boundaries for medications, devices, and consumables, defining what is eligible for medical insurance payment and what is not, which is the most important aspect.
The "Notice" outlines the principles and scope of the whitelist. Products eligible for inclusion should be those formally approved or registered for sale by the drug regulatory department, available for sale in retail pharmacies, and closely related to treatment, possessing strong medical attributes, and reasonably priced—including medications, medical devices, and medical consumables.
Specifically, the following categories of products meeting the above conditions can, in principle, be included in the whitelist. First, medications: chemical drugs, biological products, proprietary Chinese medicines, and prepared slices of Chinese crude drugs approved for sale in China and available in pharmacies, including those produced domestically, imported, or from Hong Kong, Macao, and Taiwan. Second, medical devices: such as thermometers, blood pressure monitors, blood glucose monitoring systems, and rehabilitation assistive devices. Third, medical consumables: including general consumables like medical masks, cotton swabs (balls), and adhesive bandages; in vitro diagnostic reagents like pathogen detection kits and pregnancy test strips; and device consumables for long-term treatment, such as disposable lancets and ostomy care bags.
Furthermore, the "Notice" explicitly "allows the use of employee medical insurance personal accounts to pay for influenza vaccine expenses incurred at designated medical institutions." This breakthrough reflects the policy orientation of integrating medical care with prevention.
Simultaneously, the "Notice" clearly delineates prohibited areas:
First, non-medical products: food items like rice, flour, and oil, health products, daily necessities, and other non-medical goods.
Second, "medical device-registered" products similar to those previously reported in the media, such as "toothpaste, toothbrushes, dental floss, facial masks, sun protection products, and feminine care pads," including some "shell products" designed merely to fit医保 payment criteria but lacking substantial or having minimal actual medical value.
Third, certain medical devices that do not align with the basic medical insurance's function of "ensuring basic needs," such as contact lenses, massage devices, and smart communication/timing devices.
It is worth noting that in early 2025, news that "Huawei WATCH D2 can be purchased using medical insurance personal accounts" became a trending topic, sparking widespread discussion. The National Healthcare Security Administration clarified this time that some smart communication/timing devices with medical device registration certificates, while equipped with auxiliary monitoring functions for blood pressure and heart rate, primarily serve daily functions like timekeeping, communication, and networking. Moreover, their higher prices do not align with the "ensuring basic needs"定位 of basic medical insurance.
The "Notice" requires each province to issue a unified whitelist by the end of September this year. It must fully solicit opinions from industry regulatory authorities, designated retail pharmacies, and insured individuals, and be dynamically adjusted based on public needs and developments in medical technology.
**What Are the Impacts?**
The implementation of the new policy coincides with the full launch of the 2026 National Medical Insurance Fund On-site Inspection Program.
On May 14th, the 2026 National Medical Insurance Fund On-site Inspection Hunan Site Launch Meeting and Warning Education Conference was held in Changsha. According to the arrangement, this year's on-site inspections will continue to cover all provincial-level administrative regions nationwide, focusing on five types of entities including designated medical institutions and designated retail pharmacies. It specifically lists seven types of common违法违规 behaviors at designated retail pharmacies as key inspection targets.
Senior healthcare reform expert Xu Yucai stated that after the policy takes effect, on-site inspections will certainly follow this whitelist, potentially making it a专项 inspection content. In the past, many issues were identified but lacked standardization; with the whitelist in place, there is now a basis for enforcement.
Additionally, the "Five-Year Action Plan for Medical Security Fund Supervision and Inspection (2026-2030)" released on May 13th proposes that by 2030, a comprehensive, multi-level, and立体化的 medical insurance fund supervision system will be基本建成, with on-site inspections covering all designated医药机构 nationwide within five years.
For pharmacies, compliant operation is no longer a临时 measure for应对 inspections but a fundamental criterion for daily operations. Shao Qing believes that the impact of the whitelist is the same across the entire industry; large chains do not necessarily have an advantage over small and medium-sized pharmacies. Some listed chain pharmacies, facing stronger financial pressures, might have a greater impulse for insurance fraud,反而 posing higher risks. "Recent interviews with chain pharmacies like老百姓大药房 and益丰 serve as evidence," he added.
Data shows that as of the end of August 2023, the total number of designated retail pharmacies nationwide was 484,000. Furthermore, according to the National Healthcare Security Administration's "2025 Medical Security Development Statistical Bulletin," as of the end of 2025, the number of designated retail pharmacies with cross-province network结算 capabilities nationwide was 414,000. In recent years,多项 policies have明确 supported the diversified and专业化 development of retail pharmacies.
"For future business model design, retail pharmacies should gradually reduce their operational reliance on medical insurance business and坚守 the bottom line of compliant operation," Shao Qing建议. He suggested that pharmacies推进多元化转型 should first布局 online business. "Online operations primarily rely on personal consumption and have较低关联度 with medical insurance business, and online pharmacy growth is currently rapid." Data indicates that from January to August 2025, online O2O sales for retail pharmacies increased by 29.6% year-on-year, while B2C growth remained stable at around 10%.
Secondly, pharmacies can actively diversify payment channels and proactively engage with commercial insurance-related services. Regarding new offline便民 service formats like health stations, their development prospects are good, but sustainable and profitable business models still need to be深耕, and past transformation experiences should not be blindly copied. Previously, most pharmacies followed trends in diversifying into categories like药妆 and home medical devices, but most failed to establish stable profitability. These lessons are值得借鉴.
Xu Yucai emphasized the urgency of technological upgrades: "If信息化建设 cannot keep up,监管难度 will remain significant. Currently, most retail pharmacies still operate on independent information systems. It is necessary to integrate information from the healthcare security administration and drug regulatory systems to achieve真正的全流程监管."
In summary, for the hundreds of thousands of designated retail pharmacies nationwide, this whitelist represents both a regulatory high-voltage line and a watershed moment for the industry's transition from粗放扩张 to规范发展. Ultimately, it aims to achieve a multi-party共赢 outcome ensuring medical insurance fund security, healthy industry development, and tangible benefits for the public.