What percentage of ensartinib can be reimbursed after it is included in medical insurance?

Ensartinib (trade name: Bemena) has been officially included in China's National Medical Insurance Category B Drug List since January 1, 2025. It is used for patients with ALK positive locally advanced or metastatic non-small cell lung cancer (NSCLC), and must be in a medical insurance designated hospital and have an ALK positive gene test report before it can be reimbursed.

The specific reimbursement ratio varies slightly depending on the region and the type of medical insurance (employee medical insurance, resident medical insurance or critical illness pooling), but it is usually at the level of 50%–70% nationwide. For example, a box of 100 mg After medical insurance, the actual out-of-pocket amount of the patient is approximately 596 yuan to 994 yuan. In some pilot areas or based on local medical insurance policies, the individual advance payment ratio may be set to an upper limit of 20%, which means the reimbursement ratio can reach 80% or even more.

The materials required for reimbursement generally include a doctor's prescription, ALK positive genetic test report, drug purchase invoice and patient identity certificate. After the pharmacy is approved, the medical insurance fund will pay the fee to the designated account according to the prescribed proportion, and the patient will only pay the remaining portion. Some regions also allow for higher reimbursement levels through outpatient special disease protection or critical illness insurance, especially for employee medical insurance participants.

It should be reminded that specific policies vary from place to place, and the reimbursement process and ratio may also change with the annual adjustment of the medical insurance catalog. It is recommended that before use, patients must consult the local medical insurance department or the hospital pharmacy to obtain the latest reimbursement ratio, deductible, cap line, applicable case conditions and other information in order to accurately estimate personal financial burden and arrange treatment reasonably.

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