Is Margetuximab included in medical insurance?

Margetuximab, a HER2-targeting antibody drug approved in the United States, is not currently available in mainland China and therefore cannot be included in China's National Reimbursement List. Domestic breast cancer patients are temporarily unable to obtain the drug directly through hospital pharmacies or medical insurance reimbursement channels. The main reasons include that the marketing application process has not yet started or the local registration process has not been completed, and factors such as drug pricing and market strategies are still under evaluation.

Because it is not listed in the country, hospitals cannot carry out routine prescription usage or medical insurance payment assessments, which means that patients still need to obtain relevant treatment plans through cross-border medical treatment, regular overseas prescription pharmacies or international medical institutions. When choosing to purchase drugs overseas, you need to pay special attention to whether the prescription is issued by a qualified doctor, whether the supply channel is regular, and whether the drug batches are traceable, so as to avoid contact with pharmaceutical products of unknown origin. In addition, margetuximab is a strictly prescribed antibody drug overseas and must be used after a comprehensive evaluation by a doctor based on the patient's HER2 status and previous treatment history.

From the perspective of medical insurance inclusion, drugs entering China's medical insurance need to go through multiple steps such as marketing application, entry review, clinical evidence evaluation, and pricing negotiation. In the past HER2-targeted drugs (such as trastuzumab, pertuzumab, etc.) also went through a similar process, and it usually took several years from launch to medical insurance coverage. Therefore, even if margetuximab enters the Chinese market in the future, whether to include it in medical insurance will still need to be decided based on real-world usage data, efficacy value assessment and the results of negotiations with the National Medical Insurance Bureau.

In the international market, magituximab has not yet entered the universal medical insurance system of various countries. This is mainly because the drug is positioned as a back-line option after previous treatments have failed, and the price is relatively high. As a result, some overseas countries still use commercial insurance or self-pay models for payment.

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