Can adagrasib be reimbursed by medical insurance? Analysis of reimbursement conditions

Adagrasib is an oral targeted drug that specifically targets KRAS G12C mutations. As one of the representative drugs of KRAS inhibitors, it has been approved for marketing in the United States in 2022 and is used to treat non-small cell lung cancer (NSCLC) and other malignant tumors. However, currently in mainland China, adagrasib has not yet received marketing approval from the National Medical Products Administration (NMPA), and therefore has not yet entered the National Medical Insurance Drug List. This means that mainland patients are temporarily unable to obtain reimbursement through medical insurance channels. The use of the drug depends entirely on self-pay, and usually needs to obtain it through Hong Kong, the United States or third-party overseas drug purchase services.

Currently in Hong Kong, the original drug of adagrasib has entered the pharmacy system of some hospitals. The specifications are 200mg × 180 tablets packaged in the market, but it is expensive, with a single bottle selling for tens of thousands of yuan. The specific price may fluctuate depending on the exchange rate, procurement channels and supply conditions. Although some private insurance or high-end medical insurance plans in Hong Kong may cover some costs, mainland medical insurance does not currently apply. If patients purchase the medicine through regular pharmacies or authorized pharmaceutical companies in Hong Kong, although the quality of the medicine is relatively reliable, they still need to follow the doctor's guidance to ensure the safety of the medicine.

From the perspective of medical insurance policy, the inclusion of targeted drugs in the medical insurance catalog usually needs to go through two stages: first, approval by the State Food and Drug Administration for marketing, and second, through the medical insurance negotiation process. Once adagrasib obtains domestic approval for marketing and passes medical insurance negotiations in the future, it will be possible to be included in the medical insurance reimbursement system. The reimbursement ratio usually varies depending on whether it is included in the Category A or Category B catalog. In addition, there are "Clinical Assistance for Orphan Drugs" projects in some regions, which may provide assistance to patients with financial difficulties under special conditions, but this drug is not currently in the assistance directory.

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