What will be the Medicare price of enzalutamide in 2025? How to calculate the out-of-pocket portion after medical insurance reimbursement?

Enzalutamide is an androgen receptor antagonist, mainly used to treat advanced castration-resistant prostate cancer (CRPC), and has been marketed in China and included in medical insurance. In 2025, the domestic medical insurance negotiated price of enzalutamide will be approximately 4,500 yuan, which is significantly lower than the price before it was included in medical insurance. Patients can purchase it at designated hospital pharmacies or medical insurance designated pharmacies in China. Since local medical insurance policies are slightly different, specific prices may fluctuate depending on the region. It is recommended that patients consult the local medical insurance department or hospital to obtain accurate reimbursement status.

Enzalutamide has been included in the medical insurance list, but patients still have to bear part of the cost. Reimbursement ratios usually vary according to region, medical insurance category (employee medical insurance/resident medical insurance) and hospital level. In general:

The reimbursement ratio of employee medical insurance is relatively high, about 70%-80%, that is, the out-of-pocket expenses that patients need to pay range from 900 yuan to 1,350 yuan.

The reimbursement ratio of residents' medical insurance is slightly lower, usually 50%-60%, that is, patients need to pay out of pocket 1800 yuan to 2250 yuan.

In addition, the deductible and cap lines need to be considered. Some areas may have annual reimbursement caps. It is recommended that patients consult the medical insurance agency before purchasing drugs to understand specific policies.

Compared with domestic prices, the price of enzalutamide abroad is quite different. The price of the Turkish version of the original drug is about 15,000 yuan, which is much higher than the domestic price after medical insurance. On the other hand, generic drugs have been launched in overseas markets, such as those in India and Laos. The prices are relatively affordable, usually ranging from 1,000 to several thousand yuan. For patients who cannot be reimbursed by medical insurance or who want to find lower-priced drugs, they can choose to purchase them through regular overseas channels.

When patients choose to purchase enzalutamide, they should give priority to domestic channels covered by medical insurance, because its quality is guaranteed and it can enjoy medical insurance reimbursement. If you need to purchase medicines overseas, you should go through formal channels to avoid buying fake and substandard medicines. In addition, during the period of taking it, patients should review it regularly and pay attention to the efficacy and possible adverse reactions of the drug. If they feel unwell, they should consult a doctor in time.

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