Will Teclistamab-cqyv be covered by medical insurance in 2025?

Teritusumab (Teclistamab-cqyv) has been approved in Europe and the United States for the treatment of multiple myeloma (MM) and has completed registration and marketing of the original drug in China. However, there is still great uncertainty as to whether it can be included in China's medical insurance directory in 2025. Adjustments to medical insurance policies are usually based on a comprehensive evaluation based on multiple factors such as the clinical value, economics, safety, and domestic substitutability of drugs. Considering that Teritusumab has only been on the market for a short period of time and its current price is relatively high, it will face many challenges in entering the medical insurance market in the short term.

First of all, medical insurance negotiations are mainly based on large-scale real-world data and cost-benefit analysis, and teritusumab is not widely used in China, and the medical insurance department lacks sufficient data to support its economic advantages. In addition, its current price is subject to overseas pricing systems, and the possibility of entering medical insurance without significant price reductions is low. In contrast, other BCMA-targeted drugs such as CAR-T products have been partially included in medical insurance in China or have cooperated with commercial insurance to alleviate payment pressure. If teritusumab wants to enter the medical insurance system, it may also need to be promoted through a similar model.

However, considering its unique mechanism and therapeutic potential for patients who have failed multiple lines of treatment, national or local medical insurance may consider establishing a "special drug catalog" or a "limited access policy" as a transitional policy solution. Especially in the context of the country's vigorous promotion of the rare disease drug guarantee mechanism, teritusumab has the opportunity to be included in some guarantee systems in the form of special channels, such as local special needs drugs, special disease outpatient reimbursement, etc.

To sum up, it is still necessary to observe policy dynamics, price negotiation results and market feedback before teritusumab can be fully included in the medical insurance catalog in 2025. However, as China's acceptance of innovative drugs accelerates and medical insurance policies increasingly focus on clinical value orientation, the medical insurance prospects of this drug still deserve long-term attention. Patients and clinicians can pay close attention to the National Medical Insurance Administration’s annual drug negotiation updates to obtain the latest progress information.

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