Is Teclistamab injection reimbursable by medical insurance?

Teritusumab (Teclistamab-cqyv), as a bispecific antibody with extremely high technical content and complex structure, has attracted widespread attention since its launch in China, and whether it is covered by medical insurance has become one of the most frequently consulted issues among patients. At present, although the drug has obtained marketing authorization, it has not yet entered the national medical insurance catalog, which means that it is temporarily unable to enjoy medical insurance reimbursement and patients need to use it at their own expense.

From the analysis of the rules of medical insurance access, teritusumab has not been included in medical insurance mainly due to many factors. The drug is an extremely cutting-edge biological agent with high production costs and high pricing. Negotiations on the medical insurance list usually consider the size of the treatment population, real-world efficacy, safety, and pharmacoeconomic performance. Since multiple myeloma (MM) is a relatively niche malignant disease, and the drug is positioned in the multi-line treatment stage with a limited number of target groups, medical insurance prefers to collect more local usage data before conducting economic evaluations.

Secondly, the treatment cost of teritusumab is relatively high, and the price of a single box is usually in the range of tens of thousands of yuan. If it is included in medical insurance, it will put a certain pressure on fund expenditures. When negotiating, the medical insurance department often makes choices based on real needs, population base, cost-benefit ratio and other factors, so it needs to go through a long policy evaluation process. However, the domestic launch time is still short, and the corresponding local data accumulation and long-term follow-up materials are still being improved.

Although it is not currently included in the medical insurance, it does not mean that there is no chance of being included in the directory in the future. Teritusumab, as a representative drug targeting BCMA, has mature clinical evidence internationally and is an irreplaceable targeted immunotherapy. Therefore, its possibility of entering medical insurance in the future is generally optimistic.

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