Recently, the author released the article "In 2023, a batch of blockbuster new drugs are expected to be listed in China" in the headline number, and some comments said that "targeted drugs are useless to the people, personal experience, too expensive, not reimbursed, simply cannot be
used.
" "This situation resonates
a lot.
Targeted drugs are too expensive to use? The industry calls for more targeted drugs into medical insurance (Image source: Pharmaceutical Network)
In recent years, with the flow of targeted drugs and immune drugs into the market, patients have brought new means and new hopes for treatment, but the price of targeted drugs is often expensive, and many patients' families face the burden of expensive drug costs, and can only look forward to drugs
.
In recent years, with the normalization of centralized procurement and the advancement of medical insurance negotiation policies, many patients' families have paid full attention to
whether relevant targeted drugs have entered medical insurance.
From the current public information, some targeted drugs have entered medical insurance, benefiting related patients
.
For example, in the field of lung cancer, targeted drugs are divided into first, second and third generations, according to the results of the 2020 medical insurance negotiation catalog, more than 50 anti-tumor drugs have been included in the catalog, of which there are 7 targeted drugs and 2 immune drugs
related to lung cancer treatment.
The 7 targeted drugs are erlopnib, osimertinib, ametinib, anlotinib, crizotinib, ceritinib, and alaitinib
.
In the 2022 Chinese Society of Clinical Oncology (CSCO) in the diagnosis and treatment guidelines for non-small cell lung cancer, the selection of treatment regimens for ALK mutations is recommended as three targeted drugs
: aletinib, crisetinib and ceritinib.
At present, all three classes of drugs have indications for lung cancer included in the 2020 medical insurance and can be reimbursed
.
Among them, the reimbursement conditions of the second-generation targeted drug alactinib in 2020 medical insurance are limited to patients with locally advanced or metastatic non-small cell lung cancer who are positive for anaplastic lymphoma kinase (ALK); The medical insurance reimbursement conditions for the first-generation targeted drug clobutinib are limited to patients with locally advanced or metastatic non-small cell lung cancer positive for anaplastic lymphoma kinase (ALK) or advanced non-small cell lung cancer with ROS1 positive; The second-generation ALK inhibitor ceritinib was launched in China in 2018 and entered medical insurance in 2020, and the medical insurance reimbursement condition is limited to the treatment
of patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) positive for anaplastic lymphoma kinase (ALK).
In the field of rare disease treatment, in 2021, medical insurance negotiations included 700,000 injections of nocinaxen sodium injection for the treatment of rare disease SMA into the catalog, reducing it to about 30,000 yuan, greatly reducing the burden on patients and giving patients' families hope
.
According to reports, this is the world's first SMA precision targeted therapy drug, through intrathecal injection, the drug can be directly delivered to the cerebrospinal fluid around the spinal cord, thereby improving motor function, improving survival rate, and changing the disease process
of SMA.
However, most of the tumor targeted drugs mentioned above are included in the scope of medical insurance Class B, why can't they be included in the national medical insurance class A drug list? According to a reply from the National Health Insurance Administration in September 2021, it is mainly because of the current low level of financing of basic medical insurance in China
.
"In 2020, the average average medical insurance for urban and rural residents is only about 800 yuan, and the protection capacity is limited
.
Anti-tumor treatment drugs are generally expensive, so the conditions for their inclusion in the management of medical insurance Class A drugs are not mature
.
In this regard, the Medical Insurance Bureau also said that in the future, it will improve the dynamic adjustment mechanism of the medical insurance catalogue and include more eligible anti-tumor drugs in the reimbursement catalogue
according to the procedure.
There are many types of cancer in China, and in recent years, with the acceleration of new drug approval and review, more and more targeted drugs have entered the Chinese market, bringing new treatment options to patients, while medical insurance and other policies have also opened the door to targeted drugs, and have successively included good drugs to benefit patients
through negotiation and price reduction.
The industry has also called for more targeted drugs to enter medical insurance in the future to reduce the burden
of patient treatment costs.
It is worth mentioning that according to the "Guidelines for the Clinical Application of New Antitumor Drugs (2021 Edition)" issued by the National Health Commission, drugs with clear targets must follow the principle of
genetic testing before they can be used.
However, at present, genetic testing in most places has not yet been included in medical insurance, and patients need to bear it themselves, which is often tens of thousands of yuan, and many patients are even more discouraged
in the face of expensive costs in the early stage.
On October 12, the National Health Insurance Administration mentioned that some regions have included some genetic testing items in the scope of
medical insurance payment.
More genetic testing programs that are "safe and effective, affordable and have clear charging standards" will also be expected to be included in medical insurance
.
It is reported that recently, the Fujian Provincial Medical Insurance Bureau issued a notice on some medical service items and prices, including all clinically necessary tumor genetic testing items into medical insurance, with a reimbursement rate of up to 90%, fully covering PCR (polymerase chain reaction), NGS (high-throughput sequencing), IHC (immunohistochemistry), FISH (in situ fluorescence hybridization) and other technology platform projects, bringing good news
to patients.
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