What is the current medical insurance reimbursement rate for pomalidomide (2025 version)

Pomalidomide, as an immunomodulatory anti-tumor drug, is mainly used to treat multiple myeloma, especially for relapsed and refractory patients who have failed treatment with lenalidomide (Lenalidomide) and bortezomib (Bortezomib). As its efficacy continues to be verified by international clinical studies, pomalidomide has been officially approved for marketing in China in recent years, and was included in the National Reimbursement Drug Catalog (2025 version) at the end of 2024, which means that its clinical accessibility has been significantly improved. This is undoubtedly important good news for the majority of patients with multiple myeloma.

According to2025 national medical insurance policy adjustment plan, pomalidomide is included in the Category B medical insurance catalog. The medical insurance reimbursement ratio varies from region to region, usually 60%-80%. The reimbursement ratio of urban employee medical insurance is relatively higher, while the reimbursement ratio of urban and rural residents may be slightly lower. It should be noted that this drug also has a deductible and reimbursement limit in most cities. At the same time, patients must obtain a prescription from a designated hospital doctor and meet specific medication indications before they can be reimbursed. The implementation details are not completely consistent in different places. It is recommended that patients consult the official website of the medical insurance bureau or hospital pharmacy in their city for specific reimbursement ratios and procedures.

Although it has been included in medical insurance, the market price of pomalidomide is still in the category of high-priced drugs. At present, the price of a single box of the domestic version of pomalidomide is generally around 10,000 yuan. Even after medical insurance reimbursement, patients still have to bear a certain proportion of self-pay, and the financial burden cannot be ignored. Because this drug is a long-term treatment, patients should make financial preparations in advance and find out whether there are charitable assistance programs or in-hospital clinical programs that can reduce the burden.

In addition, some patients are concerned about overseas alternatives. At present, Laos's generic version of pomalidomide is circulating in the international market, priced at about 300 yuan per box, which is much cheaper than the domestic original drug. Although the price advantage of this type of drugs is obvious, there are still many uncertainties in terms of purchase channels, quality supervision and customs clearance legality. Patients should consider carefully when choosing and give priority to purchasing through formal channels to ensure medication safety and efficacy.

Reference materials:https://www.drugs.com/