Whether Zolbetuximab is currently included in medical insurance and interpretation of reimbursement policies in various regions

Zolbetuximab is a monoclonal antibody drug targeting CLDN18.2. It is mainly used to treat patients with advanced or metastatic gastric cancer and gastroesophageal junction adenocarcinoma. At present, in the domestic market, the original drug zotuximab has been officially launched, but it has not yet been included in the national medical insurance catalog. This means that patients still need to pay for the drug at their own expense when using it in China. The domestic price is usually more than 5,000 yuan per box, and the cumulative cost of the treatment cycle is high, which puts a heavy financial burden on patients.

There is no unified standard for the reimbursement of zotuximab in the medical insurance policies of various regions. Since it is not included in medical insurance, patients in different cities or provinces cannot enjoy direct reimbursement by medical insurance. However, in some places there may be auxiliary medical funds or commercial insurance that can cover part of the cost. This requires patients to consult the hospital or insurance agency for specific policies when seeing a doctor. Generally speaking, domestic patients currently mainly rely on self-pay or through pharmaceutical assistance programs to obtain this drug treatment.

In overseas markets, zotuximab is already available as a European and Japanese version of the original drug. The common specifications are 100 mg per box and the price is about more than 7,000 yuan (affected by exchange rate fluctuations). Although the price is higher than in China, the medical insurance system or drug assistance program in some countries can subsidize patients' out-of-pocket expenses, thus reducing the actual burden. This makes the financial pressure on overseas patients to obtain the drug relatively manageable.
Currently, there are no generic or biosimilar drugs of zotuximab on the market, which means that patients, whether domestic or overseas, can only purchase the original drug through formal channels. It is expected that drug prices and accessibility may improve in the future as drug patents expire or generic drugs become available. At the same time, adjustments to medical insurance policies will also have an important impact on the economic burden of domestic patients using this drug.
Keyword tags: zotuximab, medical insurance, reimbursement policy, CLDN18.2, gastric cancer, gastroesophageal junction adenocarcinoma, self-funded drug purchase, overseas original drug.
Reference: https://clinicaltrials.gov/