Is Ribociclib included in Medicare? How much does the patient need to pay out of pocket after reimbursement?

Ribociclib is a CDK4/6 inhibitor used to treat certain types of breast cancer. Since its launch in China in August 2018, ribociclib has quickly become a hormone receptor (HR)-positive, human epidermal growth factor receptor2 (HER2)-negative locally advanced or metastatic breast cancer. According to China's medical insurance policy, ribociclib has been included in the national medical insurance catalog, and eligible patients can be reimbursed for part of the drug cost through medical insurance. The specific medical insurance reimbursement conditions are: it is limited to patients with HR-positive and HER2-negative locally advanced or metastatic breast cancer. It must be used in combination with an aromatase inhibitor as the initial endocrine therapy for female patients.

As for drug prices, the original version of Ribociclib is available in China in the format of 200 mg 63 tablets. Each box may be sold for more than 4,000 yuan. Overseas, the common specifications of the European version of the original drug Ribociclib include 200 mg 21 tablets, 200 mg 42 tablets, and 200 mg 63 tablets. Each box may be sold for more than 20,000 yuan. In addition, each box of the original Indian version of ribociclib may be priced at more than 2,000 yuan (the price may change due to exchange rate fluctuations). At the same time, generic ribociclib drugs are already on the market for sale overseas. For example, the generic drug produced by Lucius Pharmaceuticals in Laos is 200mg*21 tablets, and each box may be sold for more than 1,000 yuan (the price may change due to exchange rate fluctuations).

In terms of medical insurance reimbursement, the specific reimbursement ratio and patient out-of-pocket amount will vary depending on the region and individual medical insurance conditions. Generally speaking, the medical insurance reimbursement ratio may range from 50% to 70%. Taking the price of 4,000 yuan per box as an example, if the reimbursement ratio is 60%, the medical insurance will reimburse 2,400 yuan, and the patient will have to pay 1,600 yuan out of pocket. It should be noted that the actual reimbursement amount may also be affected by factors such as the deductible and cap line. Therefore, it is recommended that patients consult the local medical insurance department or the hospital's medical insurance office to understand the specific reimbursement policies and procedures before using ribociclib.

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