NHIS-Roche enters pricing negotiations for Perjeta’s reimb

NHIS starts drug price negotiations in November... CDDC sets reimbursement standards in May

Discusses expanding reimbursement to include lymph node-positive HER2-positive patients who are eligible for pertuzumab-based neoadjuvant therapy

Roche has started drug price negotiations with the National Health Insurance Service for its breast cancer drug Perjeta (pertuzumab).

 

The negotiations are expected to be held on the drugs whose reimbursement standards were set by the Cancer Disease Review Committee in May.

 

According to industry sources on the 11th, the NHIS recently included Perjeta in its list of drug price negotiation subjects in November.

 

The items subject to drug price negotiation are new drugs, drugs that are not subject to drug price negotiations, and drugs with expanded use.

 

This negotiation appears to be a case of expanded scope of use, as Perjeta was already listed for reimbursement in June 2017.

 

In its May meeting, the NHIS’s Cancer Disease Review Committee set reimbursement standards for Perjeta.

 

Currently, Perjeta is reimbursed for HER2-positive metastatic or unresectable locally recurrent breast cancer.

 

It also applied a 30% coinsurance rate as an adjuvant therapy for breast cancer.

 

The newly reimbursed indication is for lymph node-positive HER2-positive patients who are eligible for pertuzumab-based neoadjuvant therapy.

 

The reimbursement standard was established according to recommendations from the medical community.

 

In December last year, HIRA received feedback from medical associations, including the Korean Medical Association and the Korean Hospital Association, regarding its reimbursement criteria.

 

The proposed item for anti-cancer drugs was then discussed in detail by the TFT and was presented to the Cancer Disease Review Committee in June.

 

In breast cancer, pertuzumab is the only drug for the indication.

 

Clinical trials have shown the effectiveness of pertuzumab in patients with lymph node-positive breast cancer.

 

However, in the past, only neoadjuvant therapy with pertuzumab for early breast cancer patients was covered with selective reimbursement, and adjuvant therapy was not covered, so many voices were calling for reimbursement expansions.

 

In that context, the newly set reimbursement standards are an example of access being strengthened through the voice of the field.

 

However, the final expansion of reimbursement benefits will be finalized only after completing negotiations with the National Health Insurance Service.

 

“Recently, the reimbursement expansions proposed by the medical community and academic societies, not pharmaceutical companies, are entering the negotiation stage,” said an NHIS official, explaining, ”We are closely examining the agendas because the measures for sharing those drugs’ financial burden has not been sufficiently discussed yet.” Meanwhile, Perjeta continues to build on its reputation as a blockbuster breast cancer drug that generated KRW 111.3 billion in sales last year, according to IQVIA.

 

Roche recently launched Phesgo, a combination of Perjeta and Herceptin, to continue to expand its share of the breast cancer treatment market.