How is the price expected to change after pomalidomide is included in medical insurance?

Pomalidomide(Pomalidomide) has been approved for marketing in China and has been included in the National Reimbursement List in recent years, becoming a key treatment option for patients with multiple myeloma. Although the drug is sold at a high price abroad, especially in the United States, Japan and other places as a high-end innovative drug, its price has been significantly reduced after China passed medical insurance negotiations, greatly reducing the financial burden on patients. According to the national medical insurance policy, pomalidomide is suitable for specific indications, that is, adult patients who have received at least two previous treatments (including lenalidomide and a proteasome inhibitor) and have disease progression within 60 days after the end of treatment.

The reimbursement ratio of medical insurance is limited by different regional policies, hospital levels and individual insurance status. In most provinces and cities, the medical insurance reimbursement ratio is around 70%, but there may be slight differences in some high-end hospitals or non-coordinated areas. It should be noted that pomalidomide is usually included in the management of "Class B drugs", that is, patients need to pay a certain percentage out of pocket before they can enjoy medical insurance payment. The specific out-of-pocket ratio is usually about 30%, but some areas have set up a reduction mechanism for patients with severe, low-income or special diseases.

The actual reimbursement process usually includes two ways of reimbursement: outpatient or inpatient reimbursement for specialized diseases. Patients need to be prescribed by a hematology specialist and issue a multiple myeloma diagnosis certificate. When purchasing drugs, settlement must be made through a medical insurance designated pharmacy. In addition, some provinces have included pomalidomide in "dual-channel" drug management, that is, patients can choose to purchase drugs at designated retail pharmacies and receive instant medical insurance settlement services, which greatly simplifies the process.

Although medical insurance has reduced the burden on patients, patients still need to consider their financial affordability due to the long treatment cycle and high medication costs.

Reference materials:https://en.wikipedia.org/wiki/Pomalidomide