Reduced reimb for medicines-containing choline alfoscerate

Medical community regards it as 'unjust'

Designated as a target item for 'intensive screening'…without a clear criterion causes chaos and prescription avoidance

Medical community says, "It is a violation of doctor's prescription and patient's healthcare right due to political issue"

Complaints have been circulating regarding the decision made by the Health Insurance Review and Assessment Service (HIRA) to reduce reimbursement on medical care reimbursement claims for medicines containing 'choline alfoscerate,' a brain function-improving agent.

 

Medicines-containing choline alfoscerate received selective reimbursement decision during the re-evaluation of reimbursement appropriateness.

 

However, its previous reimbursement criterion is being maintained due to pharmaceutical companies fling lawsuits.

 

However, HIRA requires even stricter criterion by designating medicines-containinig choline alfoscerate as targets for 'intensive screening.' According to industry sources on October 14th, more claim cases of choline alfoscerate have received reduced decisions over the past year.

 

HIRA has designated medicines-containing choline alfoscerate as target items for intensive screening since 2022 and has been managing them.

 

Intensive screening is a preventative screening that pre-notifies items that need improvements in prescriptions and manages them.

 

It is a voluntary system to promote improvement through prior notices and marketing.

 

There have been reports of a significant increase in reduction decisions on medicines-containing choline alfoscerate over the past year.

 

They think that it has intensified following last year's parliamentary audit.

 

Rep.

 

Nam In-soon of the Democratic Party of Korea stated during the last year's parliamentary audit that "The prescription of medicines-containing choline alfoscerate for diseases other than dementia should be restricted for the National Health Insurance finances." "We must actively intervene in the practice of prescriptions of medicines-containing choline alfoscerate, which have not been proven effective to prevent dementia, disguised as dementia prevention drugs and brain health nutrients," Rep.

 

Nam said during this year's parliamentary audit.

 

"The National Health Insurance saved by inhibiting prescriptions related to dementia should be used to expand reimbursement for new anticancer drugs to ease burden of medical costs." Prevailing opinions in clinical practices are that the review of reimbursement claims has become stricter due to requests from the National Assembly.

 

Several have pointed out that more reductions are being made for surpassing criterion for approval and reimbursement despite uses according to the approval criterion.

 

"We received a reduction decision from the HIRA officer because we have not provided documents for the cerebrovascular deficit," a Hospital-A worker said.

 

"We have doubts about HIRA's review criteria because approval criteria do not require submission of documents related to cerebrovascular deficits in case of patients with organic mental disorders related to brain function.

 

According to the current medical care reimbursement criterion, medicines-containing choline alfoscerate are reimbursable when used within the approval criterion.

 

The Ministry of Food and Drug Safety (MFDS) approved medicines-containing choline alfoscerate for 'Secondary symptoms due to cerebrovascular deficit, degeneration, or organic mental disorder related to degenerative brain function: reduced memory and confusion, loss of direction due to reduced drive and spontaneity, reduced drive or spontaneity, and reduced concentration." Doctors have explained that prescribing medicines-containing choline alfoscerate to patients with mental disorders with degenerative brain function who have memory loss and confusion should be no problem for issuing reimbursement, based on the criterion.

 

Several opinions are that before the inclusion of medicines-containing choline alfoscerate were reimbursable in intensive screening, submitting patient records was sufficient.

 

However, not, the HIRA is arguing that documents prepared according to the approval criterion are insufficient.

 

"We were notified by HIRA to submit test results, such as MRI and MMSE, for medical care reimbursement.

 

Neither approval of medicines-containing choline alfoscerate nor medical care reimbursement criterion require such additional tests.

 

We inquired about the reasons for submitting such test results but have not heard a clear answer," a Hospital-B worker said.

 

"HIRA keeps requesting submission of documents, but we are unsure what documents are needed to receive reimbursement." Complaints are circulating against different notifications from the person-in-charge, and requests do not meet reimbursement criteria or approval criteria.

 

However, clinical practices tend not to raise appeals for practice reasons.

 

Due to continued reduction decisions, patients complain because doctors are less likely to prescribe the medicines.

 

"The HIRA has been avoiding providing a clear criterion related to reimbursement for medicines-containing choline alfoscerate," medical industry personnel said.

 

"We need to determine whether patient's healthcare or doctor's prescription rights are limited due to political issues."