Latest interpretation of cimepilimab medical insurance reimbursement policy

As of now, the original drug Cemiplimab has not been officially launched in mainland China, and therefore has not yet been included in the national medical insurance drug catalog. Due to the lack of local marketing authorization and medical insurance access qualifications, if domestic patients currently need to use cimepilimab, they usually need to obtain it through direct purchase from international medical, overseas pharmacies or participation in overseas clinical trials. This also means that the actual use threshold of cimepilimab in China is relatively high, and the cost is borne by the patient. The price information has not been uniformly announced. However, referring to foreign markets, its single treatment cost may be higher, and the overall treatment cost will pose a certain financial burden to patients.

Overseas, cimepilimab has been included in the medical insurance or commercial insurance reimbursement systems of many countries. For example, in the United States, cimepilimab, as an important drug approved by the FDA for the treatment of advanced cutaneous squamous cell carcinoma, can usually be partially or fully reimbursed through Medicare Part B or commercial insurance. It is worth mentioning that to obtain medical insurance coverage overseas, cimepilimab often needs to meet specific clinical conditions, such as confirmed advanced or unresectable cutaneous squamous cell carcinoma, patients with advanced non-small cell lung cancer with high PD-L1 expression, etc.

Regarding the outlook for the domestic market in the future, with the continuous deepening of immunotherapy in the field of cancer, once cimepilimab is approved for marketing in China, it is more likely to enter the medical insurance catalog. However, a price negotiation process is usually required, and drug manufacturers need to reach an agreement with the National Medical Insurance Administration on price and reimbursement indications. Judging from past experience, the price of PD-1 inhibitor drugs is usually significantly reduced after negotiation to improve accessibility. Therefore, once it is launched and included in medical insurance, cimepilimab is expected to become a new choice for domestic patients with advanced skin cancer, lung cancer and other diseases.

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