[Reporter's View] Insight into reimb of high-priced drugs

used for 'preventive' purposes

How should we consider the reimbursement coverage of 'preventive' drugs that are not used to treat disease or improve symptoms?

 

This is not a new concept.

 

Individuals have taken medicines for 'management' rather than treatment for chronic diseases.

 

Medicines such as coagulants are primarily preventive care.

 

However, it has become an issue as more high-priced drugs are on the market, expanding reimbursement coverage to anticancer drugs.

 

Various new anticancer drugs are being studied to secure and add indication for use as pre- and post-operative adjuvant therapy.

 

Numerous next-generation new drugs, including cancer immunotherapy, targeted cancer therapy, and antibody-drug conjugate (ADC), now have expanded indications for adjuvant therapies.

 

In other words, there are plenty of indications.

 

However, an issue arises with adjuvant therapy.

 

The challenge is the price.

 

As most people know, cancer can relapse even if initially diagnosed as fully recovered.

 

Depending on different cancer types, the recurrence rate can be up to 80%.

 

Prescribing anticancer drugs as adjuvant therapy and allowing those to be reimbursed burdens the Ministry of Health and Welfare (MOHW).

 

It is uncommon for adjuvant therapy to be reimbursed in South Korea.

 

Furthermore, academics also pay attention to the benefits of adjuvant therapy.

 

Guidelines by notable international academic organizations have started to include adjuvant therapy and assign the highest grade.

 

The Korean market must stop looking the other way.

 

Relevant parties must carefully assess the necessity of adjuvant therapy and consider its benefits rather than viewing it as an unwarranted 'burden.' Administering adjuvant therapy to relapsed patients can be less cost-effective.

 

The number of pharmaceuticals acquiring indications for adjuvant therapy and maintenance therapy is increasing.

 

Rather than considering only the loss and benefits, pharmaceutical characteristics and patients' circumstances must be considered.

 

Efforts from all relevant parties are required to reach an agreement that considers the National Health Insurance system and the pharmaceutical industry's stances.