Impact on members and retail pharmacies of China's Urban Employee Basic Medical Insurance medicine purchasing reforms: Case studies in Wuhan

Abstract Background In 2023, local health authorities implemented prescription medicine purchases from retail pharmacies by urban employee basic medical insurance (UEBMI) members. Using case studies from Wuhan, we assess the impact of the 2023 medicine purchasing reform on the medicine buying behavior; evaluate the benefits of the changes to UEMBI members; and provide insights into China’s retail pharmacies’ business model. Methods Daily UEBMI claim data was collected at two Wuhan pharmacies from March 2022 to December 2023, including data on customer age, sex, employment state and claim type before and after the implementation of the 2023 policy. The impact of the new retail pharmacy purchasing policy on medicines purchasing behavior, such as the number of medicine purchasers, the total expenditure per capita, and the medical savings accounts expenditure per capita, were quantitatively evaluated using descriptive statistics and interrupted time series analysis (ITSA). Results The characteristics of medicine purchasers were not significantly affected by the new policy. Retired UEBMI members benefited more from allowing UEBMI funds for prescription purchases from retail pharmacies than currently employed UEBMI members. The number of UEBMI member medicine purchasers from retail pharmacies showed a significant upward trend, increasing the benefits to UEBMI members, without medicine over-use or risk of fraud. The benefit to members was measured by the absence of any significant upward per capita total expenditure trend and a significant decrease in the proportion of medicine expenditures from members personal medical savings accounts. Conclusions The 2023 reforms allowed UEBMI members to purchase medicine from retail pharmacies, providing medicine accessibility and affordability for members, especially retired members; did not trigger an increase in members’ medicine consumption; attenuated the over-use of hospital pharmacies; and transformed pharmacies’ business model away from a singular focus on price competition towards a combination of price competition and health services.