Can Valganciclovir be reimbursed by medical insurance?

Valganciclovir is a prescription antiviral drug mainly used for the treatment and prevention of cytomegalovirus (CMV) infection. CMV belongs to the herpesviridae family and is extremely threatening to people with low immunity, especially those who have received solid organ or hematopoietic stem cell transplantation. As the oral prodrug of ganciclovir, the bioavailability of valganciclovir is significantly improved, allowing patients to obtain efficacy close to intravenous medication through oral administration in daily management, greatly improving treatment compliance.

Regarding the medical insurance policy, the original drug of valganciclovir is currently on the market in China, but it has not yet been included in the national medical insurance directory. This means that patients need to bear a higher financial burden at their own expense during use. According to market information, a box of medicines with a specification of 0.45g*60 tablets may cost more than 10,000 yuan, which is much higher than most conventional anti-infective drugs. For transplant patients taking long-term medication, this cost is undoubtedly a heavy financial pressure. It is worth noting that commercial insurance or local supplementary medical insurance in some areas may reimburse or subsidize a certain percentage of the cost under certain circumstances, but there is still a gap in medical insurance coverage nationwide.

From the perspective of medical insurance policy, the inclusion of antiviral drugs needs to comprehensively consider the clinical urgency of the drug, treatment benefits, cost-effectiveness ratio, and patient group size. Although valganciclovir is a patented original drug, its cost may gradually decrease in the future as more generic versions are launched globally, which will also create conditions for its entry into the medical insurance catalog. In recent years, the national medical insurance negotiation mechanism has become increasingly mature, and many higher-priced anti-tumor drugs and rare disease drugs have been reduced in price through negotiation and included in the scope of reimbursement. Therefore, the industry generally believes that valganciclovir is expected to enter medical insurance in the future, especially in the context of the increasing number of organ transplants year by year and the expansion of clinical demand.

Reference materials:https://go.drugbank.com/drugs/DB01610