Interpretation of specific conditions for medical insurance reimbursement of Dacomitinib

Dacomitinib (also known as dacomitinib), as a second-generation EGFR inhibitor, has been officially launched in China and has been included in the national medical insurance directory. This drug is mainly used to treat patients with non-small cell lung cancer (NSCLC) with positive epidermal growth factor receptor (EGFR) gene mutations, especially as a first-line treatment. Due to its excellent performance in prolonging the progression-free survival of patients, the National Medical Insurance Administration included it in the scope of reimbursement, which greatly reduced the financial burden on patients. However, medical insurance reimbursement is conditional, and patients need to meet specific clinical use standards.

One of the prerequisites for medical insurance to reimburse dacomitinib is that the patient must be diagnosed with EGFR sensitive mutation-positive locally advanced or metastatic non-small cell lung cancer by a professional institution or hospital. Common EGFR sensitive mutation types include 19 exon deletion or 21 exon L858R point mutation. Medical insurance will refer to molecular testing reports when evaluating the rationality of medication. Therefore, patients should complete corresponding genetic testing before taking medication to ensure that their condition meets the medication standards.

In terms of the details of medical insurance reimbursement, dacomitinib is included in the Category B medical insurance drug list. The reimbursement ratio varies from region to region, but is generally around 70%-80%. Taking the specification of 15mg*30 tablets as an example, the original price of the drug is 5,680 yuan, and the patient’s out-of-pocket cost after reimbursement by medical insurance is about 1,300 yuan. This price has certain advantages over patients purchasing foreign original drugs or generic drugs at their own expense, and it also provides higher medication protection. It should be noted that medical insurance in some areas may have additional requirements for the duration of medication, doctor's prescription authority, and hospital level. Patients are advised to consult the local medical insurance bureau or hospital medical insurance department for detailed consultation.

Although dacomitinib is covered by medical insurance, some patients still choose to purchase the drug abroad for special reasons. For example, the price of the original European version (45mg*30 capsules) is as high as 24,000 yuan, while the price of generic drugs from Lucius Pharmaceuticals in Laos is only about 1,000 yuan, and the ingredients of the drugs are basically the same. Generic drugs have become an economically viable option for patients who are not covered by medical insurance, or who need to continue treatment after their medical insurance medication cycle has expired. However, patients need to be extra cautious when choosing purchasing agents to ensure that the source of drugs is regular and the safety of medication is ensured.

Reference materials:https://www.pfizer.com/products/product-detail/vizimpro