What are the requirements for medical insurance reimbursement of Acalabrutinib?

In recent years, with the widespread use of BTK inhibitors in the treatment of hematological tumors, Acalabrutinib (Acalabrutinib), a new generation of targeted drugs, has been officially launched in China and included in the national medical insurance directory. This policy change has important practical significance for the patient group. Since acotinib is an innovative targeted therapy drug and its overall price level is relatively high, the intervention of medical insurance has largely alleviated the financial pressure on patients' long-term medication. However, from the perspective of medical insurance management, acotinib is not “reimbursable as long as it is used”. Instead, it sets relatively clear access conditions for the applicable population and treatment background.

Currently, medical insurance reimbursement mainly targets two groups of people. One is adult patients with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma who have received at least one systemic treatment in the past, and the other is adult patients with mantle cell lymphoma who also have a history of previous treatment. This restriction is not a simple administrative requirement, but is closely related to the treatment path of the disease and the positioning of targeted drugs. It is also consistent with the concept of "stratified treatment and rational use of drugs" emphasized in the guidelines. In other words, medical insurance is more inclined to use acotinib for patients who need further treatment upgrades and have clear medical indications.

In the actual reimbursement process, patients usually need to complete a standardized diagnosis at a hospital qualified for the diagnosis and treatment of hematological tumors, and the doctor will record the type of disease, course characteristics, and previous treatment plans in detail in the medical record. Only if the medical information is complete and meets the scope of the medical insurance catalog, acotinib may enter the medical insurance payment process. It is worth noting that although the drug has been included in medical insurance, there may still be certain differences in reimbursement ratios, deductibles, ceilings, and requirements for designated medical institutions in different regions.

Reference materials:https://www.calquence.com/