Is erdafitinib included in medical insurance? Analysis of medical insurance reimbursement ratio and reimbursement process

Erdafitinib is already on the market in China, but it has not yet been included in the national medical insurance directory. Therefore, patients still need to pay the full amount out-of-pocket when purchasing the drug in China. Due to the short time to market and limited domestic supply, patients may have difficulty purchasing the drug directly in hospitals or pharmacies. They need to consult a doctor, hospital or pharmacy in advance to confirm the specific supply situation.
In the domestic market, the original drug price of erdafitinib is relatively high. Although the specific selling price has not been announced, it is expected to be more than 20,000 yuan. In overseas markets, there are two main channels for purchasing drugs:

Original drug from Hong Kong, China: The price is higher, about more than 20,000 yuan, and patients can purchase the drug through Hong Kong pharmacies.

Generic drugs in Laos and Bangladesh: The price is relatively cheap, ranging from a few hundred yuan to more than 2,000 yuan per box. The ingredients of the drugs are basically the same as the original drugs. Some patients choose generic drugs as an alternative.

As the domestic application of erdafitinib increases, it may be included in medical insurance negotiations in the future. If it is successfully included in the medical insurance, drug prices are expected to drop significantly, and the financial burden on patients will be significantly reduced. Specific policies such as medical insurance coverage and reimbursement ratios still need to wait for further adjustments from the National Medical Insurance Administration. Patients can pay attention to the updated information on the medical insurance catalog to learn about the latest drug purchase policies as soon as possible.
If erdafitinib is included in medical insurance in the future, patients can apply for reimbursement through the following process: first, go to a medical insurance designated hospital and a doctor will issue a prescription; second, confirm whether medical insurance filing is required, some special diseases may require advance filing; finally, purchase drugs at a medical insurance designated pharmacy and apply for reimbursement with invoices, prescriptions, medical records and other information. If it is not yet covered by medical insurance, patients need to weigh domestic and foreign drug purchasing channels and use drugs rationally under the guidance of a doctor.
Reference link: https://www.balversa.com/