Is Pitolisant covered by Medicare? Analysis of policies and reimbursement ratios in 2026

Pitolisant (Pitolisant), as a new drug used to treat narcolepsy, has been officially launched in China in 2026 and has been included in the scope of medical insurance. This means that patients who meet the conditions for medical insurance reimbursement can purchase drugs through medical insurance channels, reducing the burden of drug costs. The domestic specifications are mainly 4.5mg*30 tablets, and the market price per box is about 1,000 RMB.

In terms of medical insurance reimbursement policies, the reimbursement ratio of tilorisen varies from region to region. Usually, the reimbursement ratio in first-tier cities and some second-tier cities is between 50% and 70%, while in some remote areas, the reimbursement ratio may be slightly lower. The specific reimbursement amount needs to be combined with local medical insurance policies and individual insurance categories. Patients are best to consult the hospital pharmacy or medical insurance department before purchasing drugs to ensure that they enjoy corresponding benefits.

In overseas markets, Tilorisen has also been sold as original drugs and generic drugs. The price of overseas original drugs is relatively high. For example, the price of each box in the United States or Europe may range from 3,000 yuan to 5,000 yuan. The price of each box of generic drugs produced by Lao pharmaceutical factories is about 18mg*30 tablets at about 3,000 yuan. The ingredients of the drugs are basically the same as those of the original drugs, providing domestic patients with a reference for overseas procurement.

Overall, after being included in domestic medical insurance, patients purchasing tilolixen through medical insurance can significantly reduce the cost of medication. Regardless of whether it is a domestic original drug or an overseas generic drug, patients should consult a professional doctor before use, choose the most suitable drug purchase channel based on their own condition, medical insurance policy and economic conditions, and strictly follow the doctor's instructions to take the drug to ensure efficacy and safety.

Keyword tag:

Pitolisant, narcolepsy, domestic launch, approval time, medical insurance, price, specifications, overseas generic drugs

Reference materials:https://pubmed.ncbi.nlm.nih.gov/?term=pitolisant