Comparative analysis of tumor staging versus clinical staging in reimbursement scope restrictions under medical insurance for antineoplastic agents
- VernacularTitle:抗肿瘤药物医保限制支付范围内肿瘤分期与临床分期对比分析
- Author:
Dehua ZHAO
1
;
Xiaoqing LONG
1
;
Jisheng WANG
1
;
Hongying FAN
1
Author Information
1. Dept. of Medical Insurance and Pricing，Mianyang Third People’s Hospital/Sichuan Provincial Mental Health Center，Sichuan Mianyang 621000，China
- Publication Type:Journal Article
- Keywords:
antineoplastic agents;
reimbursement scope restrictions;
tumor staging;
clinical staging;
medical insurance
- From:
China Pharmacy
2025;36(10):1166-1171
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE To comparatively analyze tumor staging versus clinical staging in reimbursement scope restrictions under medical insurance for antineoplastic agents in order to better implement the medicare drug payment policy. METHODS Antineoplastic agents included in the National Basic Medical Insurance， Workers’ Compensation Insurance and Maternity Insurance Drug Catalogue （2024） （hereinafter referred to as the “Medical Insurance Catalog”） were used as research subject to compile and analyze reimbursement scope restrictions regarding tumor staging. By consulting clinical diagnosis and treatment guidelines and relevant literature， the tumor staging in reimbursement scope restrictions of the Medical Insurance Catalog was mapped and compared with clinical staging. RESULTS & CONCLUSIONS A total of 89 antineoplastic agents’ medical insurance payments had tumor staging. Among these， there were 86 western drugs （including 17 ordinary western drugs， 68 negotiated drugs， and 1 competitive drug） and 3 Chinese patent medicines （including 1 ordinary Chinese patent medicine and 2 negotiated drugs）. Non-small cell lung cancer involved the most restricted payment drugs， with 36 drugs. The tumor staging in reimbursement scope restrictions was mostly “metastatic” and “locally advanced”， involving 67 and 48 drugs respectively. Tumor staging in most reimbursement scope restrictions could correspond to the clinical staging of the tumor. However， mid-advanced esophageal cancer， unresectable gastrointestinal stromal tumors， unresectable locally advanced neuroendocrine tumors， locally advanced basal cell carcinoma， and unresectable neurofibromatosis type Ⅰ did not have a corresponding clinical staging mentioned in authoritative guidelines or high-quality clinical studies and need to be determined by the clinic according to the actual situation of the patient. Therefore， it is recommended that the interpretation of tumor staging in reimbursement scope restrictions should be accurately defined and standardized， so as to improve the accuracy of the drug payment policy in the actual implementation process.
