Interpretation of the latest conditions for medical insurance reimbursement of Ribociclib/Ribociclib

Ribociclib is an oral CDK4/6 inhibitor developed by the Swiss pharmaceutical company Novartis AG, with the trade name Kisqali. Since the drug was first approved for marketing in the United States in 2017, it has been quickly included in the recommended regimen by major global clinical guidelines due to its significant efficacy in the treatment of hormone receptor-positive (HR+), HER2-negative advanced breast cancer. In recent years, Riboxil has obtained marketing approval in China and been included in the National Medical Insurance Directory, which has greatly reduced the financial burden on patients.

As of the latest medical insurance policy, Riboxiclib tablets have been included in the national medical insurance drug catalog, and the indications are limited to hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative locally advanced or metastatic breast cancer, and it needs to be used in combination with an aromatase inhibitor as initial endocrine therapy for female patients who have not received systemic treatment. In other words, only female patients who meet the above disease types and drug combination regimens can enjoy medical insurance reimbursement when using Riboxil. This reimbursement condition ensures that the clinical use of the drug is accurate and reasonable for the population whose efficacy has been confirmed in large-scale clinical trials.

Currently in the Chinese market, the common specifications of Riboxiclib tablets are200mg*63 tablets/box. As a cycle of 21 days of taking the drug + 7 days of stopping the drug, its price was maintained at more than 9,000 yuan before it was included in medical insurance. Since being included in medical insurance, through the national negotiation mechanism, the price of a single box has dropped significantly to about 4,000 yuan. After medical insurance reimbursement, the actual out-of-pocket portion of the patient may be reduced to about 20%-30% of the original price, significantly reducing economic pressure. In addition, due to differences in local medical insurance payment capabilities and medical insurance co-ordination policies in different regions, there may be slight fluctuations in reimbursement ratios and minimum payment standards. Patients should confirm according to the specific requirements of the local medical insurance bureau.

Reference materials:https://us.kisqali.com/