Is zotuximab already covered by medical insurance? What are the conditions and proportions of medical insurance reimbursement?

Zolbetuximab (VYLOY, zolbetuximab) is currently on the market in China, but due to its short time on the market, the drug has not yet been included in medical insurance. Therefore, patients need to consult their local medical institution or pharmacy for the latest price information when purchasing this drug. Since there is no medical insurance coverage, patients need to bear the full cost when purchasing the drug, which makes the drug treatment more expensive.

There is currently no clear timetable for inclusion of zotuximab in medical insurance. According to the clinical application of the drug and the national drug management policy, whether the drug is included in the medical insurance needs to go through a series of approval procedures, including clinical trial data of the drug, evaluation of efficacy and safety, and discussion of drug prices. This means that for a period of time in the future, patients may still have to pay for the drug themselves until the drug is covered by medical insurance.

The drug is already available in overseas markets, especially in Europe and Japan. The common specifications of zotuximab are 100mg, and each box is priced at more than 7,000 yuan. The specific price may vary due to market changes and exchange rate fluctuations. Since this drug currently only exists in the form of the original drug, and no generic drugs have yet entered the market, its price is relatively high, which also affects patients' purchasing choices.

Since zotuximab has not yet been included in medical insurance, patients may face a high financial burden when purchasing it, especially if long-term treatment is required. If the drug is included in medical insurance in the future, the proportion and conditions of medical insurance reimbursement will depend on the specific drug classification and indications. Generally speaking, after drugs are included in medical insurance, the medical insurance payment ratio usually ranges from 50% to 90%. The specific ratio will also be affected by the medical insurance policies of different regions.

Reference materials:https://www.astellas.com/en/news/29401