Pemetinib/pemetinib’s medical insurance reimbursement policy and reimbursement ratio

Pemigatinib is marketed in the country as "Pemigatinib Tablets" and is an oral, small-molecule FGFR inhibitor. It is mainly used to treat patients with locally advanced or metastatic cholangiocarcinoma carrying FGFR2 fusions or rearrangements, especially when the disease still progresses despite previous systemic treatment. It effectively blocks the angiogenesis and cell proliferation mechanism of tumors by selectively inhibiting the fibroblast growth factor receptor (FGFR) signaling pathway and is considered a precision-targeted drug.

At present, pemetinib has been approved for marketing by the State Food and Drug Administration in China, but it has not yet been included in the national medical insurance directory. Because it is positioned as an indication for advanced cholangiocarcinoma with rare genetic mutations, the patient group is relatively small, and the time to market is short. It has not yet passed the national medical insurance negotiation path. In other words, when patients use pemetinib in domestic hospitals, they need to bear all the drug costs at their own expense, and medical insurance will not reimburse them for the time being. Therefore, the economic burden has become a major practical obstacle to the promotion of clinical use of this drug.

However, it should be pointed out that with the accelerated development of precision medicine in China, the National Medical Insurance Administration is gradually including some high-priced targeted drugs into the negotiation system. If the clinical use data of pemetinib continues to accumulate in the future, and the price of the drug decreases through negotiation, there is a certain chance that it will be included in the scope of medical insurance. Some local commercial insurance or specialty drug insurance have included it in the claims catalog to provide a certain degree of drug cost buffer for specific groups of people. It is recommended that patients fully communicate with the medical insurance office or pharmacist of the hospital where they are treated before taking medication, and learn whether there are available charity assistance projects or special approval channels for imported drugs.

While waiting for medical insurance coverage, doctors usually comprehensively evaluate whether to recommend pemetinib based on the patient's financial status, genetic test results, and disease progression rate.

Reference materials:https://go.drugbank.com/drugs/DB15102