Whether Tirzepatide can be reimbursed by medical insurance and cost explanation

Tirzepatide (Tirzepatide) is a new dual-target GIP/GLP-1 receptor agonist, used for blood sugar control and weight management in patients with type 2 diabetes. It is already on the market in the country and has recently been officially included in the national medical insurance directory. According to public information from the National Medical Insurance Administration, tilpotide successfully passed the national medical insurance drug negotiations in 2025 and was included in the "National Basic Medical Insurance, Maternity Insurance and Work Injury Insurance Drug Catalogue (2025 pan>Year Edition)" and will be officially implemented on January 1 of 2026. This is the first time that this drug has been included in the national medical insurance, marking that its treatment costs will be significantly reduced.

After entering the medical insurance, the cost of drugs will change from completely self-pay to shared by the medical insurance fund and individuals, which greatly reduces the financial burden of patients. According to the domestic market situation, the price of original research drugs before being included in medical insurance is about 3,000 to 4,000 yuan depending on different specifications. Although the specific payment standard after medical insurance negotiation (i.e., the medical insurance reimbursement price) has yet to be officially announced, but based on the negotiation rules of similar innovative drugs, its price is expected to drop significantly. The patient's final out-of-pocket amount will depend on the specific medical insurance reimbursement ratio (usually 50%-80%, policies vary slightly from place to place). Therefore, the economic pressure of long-term medication will be effectively alleviated, significantly improving treatment accessibility and long-term compliance.

Since it has just entered the medical insurance market, the specific reimbursement process and final personal payment are being implemented in medical institutions in various places. When doctors formulate treatment plans for patients, they can now more fully combine the significant blood sugar-lowering and weight-loss effects of tilpotide, and at the same time, provide medication recommendations that balance efficacy and economy based on the medical insurance reimbursement rules of the patient's location.

In overseas markets, the price of tilpotide is also high, but in some countries such as Japan, the original drug sells for about more than 1,000 yuan, which is lower than domestic prices. Different countries’ pricing systems, medical insurance coverage, and exchange rate changes will affect the actual cost of purchasing drugs. Now, domestic medical insurance prices will become an important global reference point, providing comparison for pharmacoeconomic evaluations in other countries.

Overall, Tilpotide’s domestic medical insurance coverage has been settled, ending its phase as a completely self-paid drug. If patients are considering long-term treatment, they can have in-depth communication with their doctors and evaluate the total annual personal treatment costs based on the latest medical insurance policies. The coverage of medical insurance will not only directly reduce the cost burden of patients, but also greatly improve the clinical accessibility of this innovative therapy, allowing more patients with type 2 diabetes to benefit from this dual-target treatment.

Reference:https://en.wikipedia.org/wiki/Tirzepatide