Telisotuzumab-EMRELIS medical insurance reimbursement conditions and policy and cost explanations in different regions

Telisotuzumab (trade name EMRELIS) is an antibody drug targeting c-MET . It is mainly used to treat patients with high expression of c-MET in non-small cell lung cancer (NSCLC). At present, the drug has not been officially launched in China, so domestic patients cannot obtain it directly through hospital pharmacies, and it is not included in the national medical insurance reimbursement system. Overseas marketing data shows that the single-use price of EMRELIS is approximately 4.5 yuan, and there are currently no generic substitutes.

Since it is not marketed in China, there are no unified regulations on the domestic medical insurance policy for terituzumab. If patients obtain drugs through special channels (such as overseas imported drugs, clinical trials or overseas medical treatment), they usually have to bear all the costs themselves, and medical insurance reimbursement is difficult to achieve. Local hospitals and local medical insurance centers may have individual reimbursement policies for imported drugs or special drugs, but they need to provide proof of overseas drug purchase, doctor's prescriptions and medical records. The approval process is complicated and uncertain.

In overseas markets, the medical insurance coverage of terituzumab varies from country to country. For example, some European countries and parts of the United States include it in the reimbursement scope of cancer-targeted drugs, but patients are usually required to meet conditions such as high expression of c-MET and failure of previous standard treatments before they can be reimbursed. Reimbursement rates and patient out-of-pocket amounts also vary by country, health insurance type, and hospital agreement. For domestic patients who want to obtain drugs through overseas channels, they need to understand the import procedures, taxes and overseas medical expenses in advance.

Generally speaking, terituzumab is not currently available in China, so medical insurance reimbursement conditions have not yet been established. Patients mainly rely on overseas channels to obtain the drug and the cost is relatively high. If it is officially launched in China and included in medical insurance in the future, the reimbursement policy may be adjusted according to the local medical insurance bureau and the national drug catalog, including patient indication requirements, medication cycle restrictions and reimbursement ratios, etc. When considering using it, patients should plan the source and payment method of the drug in advance based on their own financial situation and treatment needs.

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