[Desk's View] Re-evaluation of eye drops

Was the year-long wait worth it?

The government has established reimbursement criteria for single-use ophthalmic solutions, including hyaluronic acid eye drops for conditions like dry eye syndrome.

 

A year has passed after the primary result of the re-evaluation regarding the reimbursement appropriateness for hyaluronic acid eye drops were released in September 2023.

 

When the primary result was released, no one anticipated establishing reimbursement criteria would take this long.

 

The pharmaceutical companies had accepted the primary results without filing objections.

 

At the time, the Drug Reimbursement Evaluation Committee (DREC), responsible for evaluating the reimbursement appropriateness, approved the appropriateness of reimbursement for hyaluronic acid eye drops in treating intrinsic conditions such as Sjögren's syndrome, keratoconjunctivitis sicca, and dry eye syndrome.

 

However, DREC determined that there was no reimbursement appropriateness for extrinsic conditions, including post-surgical use, drug-induced dryness, trauma, or contact lens-related issues.

 

Furthermore, the DREC stated that usage restrictions for intrinsic conditions should be included in the reimbursement criteria.

 

Because prescriptions for intrinsic conditions account for 80% of the total, pharmaceutical companies accepted the results of the primary result.

 

However, the situation quickly changed after the meeting details revealed a discussion to limit prescriptions to four boxes per year (each box containing 60 vials), which was considered a radical measure.

 

During the National Assembly audit in October, concerns were raised about reduced patient access for seniors and potential price surges for non-reimbursed products.

 

Faced with these issues, the government refrained from making a hasty decision.

 

In December 2023, during the secondary review, it was decided that further review was necessary.

 

The MOHW's Health Insurance Policy Review Committee also recommended establishing reimbursement criteria for hyaluronic acid eye drops and other single-use ophthalmic solutions to prevent a balloon effect.

 

The review results were published in the administrative notice on drug reimbursement criteria on November 15.

 

As per the Health Insurance Policy Review Committee's recommendations, to prevent a balloon effect where prescriptions shift from hyaluronic acid eye drops to six other single-use ophthalmic solutions, reimbursement will be limited to only one type of eye drop for keratoconjunctivitis sicca.

 

However, the final proposal can be seen as a step back from the primary re-evaluation results from last year.

 

In 2023, reimbursement for hyaluronic acid eye drops was excluded for extrinsic conditions.

 

In contrast, the final draft now allows reimbursement for cases diagnosed as persistent intrinsic corneal and conjunctival epithelia following extrinsic conditions, effectively expanding the scope of use compared to the first re-evaluation result.

 

The usage limit for hyaluronic acid eye drops has been set at a maximum of six vials per day, typically three boxes (60 vials per box) for 30 days.

 

It is a much more lenient policy than the primary draft of a four-box annual limit.

 

Given the social controversy surrounding this issue, it is presumed that the final decision was made with exceptional caution.

 

The final draft likely has been designed to minimize backlash by considering patient access, the perspectives of prescribing healthcare professionals, and other relevant factors.

 

However, it seems inevitable that the scientific standards for evaluation, such as clinical utility and cost-effectiveness, were somewhat relaxed during the process.

 

Comparing last year's primary results from the DREC with the final proposal, it is likely that many would feel this way.

 

We respect the final draft because social demands are also significant.

 

Even so, was it necessary for the re-evaluation to take a year?

 

By the time the 2024 reimbursement appropriateness re-evaluation was completed and the National Assembly audit concluded, the issue had almost faded from memory.

 

Releasing the final draft at this point is close to dereliction of duty.

 

If the final draft had any potential cost-saving effects, it is fair to say that a year of savings was lost due to the delayed conclusion.

 

Furthermore, analysis suggests that the delayed decision likely resulted in considerable damages, including uncertainties and chaos in the practices.

 

The government must elaborate on the analysis of re-evaluation results of single-use eye drops and the background of taking an entire year.