Whether Crizotinib has been included in critical illness insurance and reimbursement policies

Crizotinib (Crizotinib), as an important targeted drug for ALK and ROS1 positive lung cancer, has long been marketed in China and has been successfully included in the national medical insurance catalog. It is currently one of the targeted drugs with wider coverage and benefiting more patients. The specifications sold in China include 250mg 60 capsules and 200mg 60 capsules. The original price of each box may exceed 10,000 yuan, but after medical insurance reimbursement, the actual amount paid by the patient will drop significantly. Due to differences in medical insurance payment ratios, reimbursement conditions and hospital purchase prices in various regions, the specific personal out-of-pocket amount needs to be determined by the local hospital pharmacy.

From the perspective of medical insurance policy, crizotinib has been included in critical illness insurance (i.e., Category B or negotiated drugs in the medical insurance catalog). Patients usually need to meet the designated disease types, diagnostic standards and medical insurance filing procedures to enjoy reimbursement benefits. For ALK-positive or ROS1-positive non-small cell lung cancer, the medical insurance reimbursement ratio is relatively high in most regions, and many patients’ monthly out-of-pocket expenses have been controlled within an affordable range. Some areas have also superimposed secondary subsidies or policies to benefit the people, further reducing the treatment burden and improving the accessibility of long-term medication.

In the international market, the price of the original drug crizotinib also remains high. Whether in Europe, America or Asia, the price per box is usually more than 10,000 yuan, and will be affected by exchange rate changes. Although some countries have commercial insurance or government subsidies, the total cost is still high, which is a considerable financial pressure for patients who need to take it for a long time. Therefore, many countries are gradually promoting local imitation or import substitution to reduce overall treatment costs.

It is worth noting that a variety of lower-priced generic drugs of crizotinib have been launched overseas, and their drug ingredients are basically the same as the original drugs. For example, the generic version of 250mg*60 capsules produced by Lucius Pharmaceuticals in Laos is only about 1,000 yuan per box, which is several times cheaper than the original drug. Although the price is more affordable, when choosing overseas channels, you still need to pay attention to the source of drug quality, legality and whether the transportation process is standardized. Overall, domestic medical insurance has covered the original crizotinib, allowing most patients to benefit from the drug in the long term at a lower cost, while also retaining generic drugs as a complementary economic option.

Reference materials:https://pubmed.ncbi.nlm.nih.gov/24756793/