Has trametinib been included in the scope of medical insurance payment?

The original drug of Trametinib/Megenin was developed by Novartis and has been approved for marketing in China. It is mainly suitable for the treatment of unresectable or metastatic melanoma with BRAF V600E or V600K mutations and in combination with dabrafenibBRAF V600E mutated non-small cell lung cancer (NSCLC) and anaplastic thyroid cancer (ATC), etc.

In terms of medical insurance policy, trametinib has successfully entered China's national medical insurance directory, but the scope of medical insurance payment is limited to patients who meet the indications. For example, melanoma patients need to be confirmed by standardized genetic testing to have the BRAF V600E/K mutation, and the lesions are unresectable or have metastasized; patients with non-small cell lung cancer need to be tested to confirm the BRAF V600E mutation and meet the conditions for the combined treatment regimen recommended by the guidelines. For anaplastic thyroid cancer, medical insurance reimbursement also requires clear evidence of BRAF V600E mutation.

After being covered by medical insurance, the out-of-pocket proportion of patients with trametinib is significantly reduced, which can significantly reduce financial pressure, especially when long-term combined medication is used. The reimbursement ratio varies depending on the region and medical insurance policies. It is generally between 50% and 70%. In some areas, a higher proportion of secondary reimbursement can be achieved for participants of critical illness medical insurance or supplementary commercial insurance.

It should be noted that medical insurance payment usually requires the prescription to be from a regular source, the diagnostic data to be complete, and the genetic testing to be compliant. Patients should confirm the preparation of relevant materials with the attending doctor and the medical insurance department in advance when seeing a doctor, so as not to affect the reimbursement progress.

In general, the inclusion of trametinib in medical insurance not only improves its clinical accessibility, but also provides long-term and sustainable treatment guarantee for more patients with BRAF mutation-related tumors, and promotes the popularization of precision targeted therapy in China.

Reference materials:https://go.drugbank.com/drugs/DB08911