Temp reimb extension for antivirals including Tamiflu ends

Temporarily granted due to concerns over COVID-19 and flu twindemic… High-risk groups were granted reimb coverage without testing

22-month reimb extension measure completed with the Korea Disease Control and Prevention Agency lifting the flu pandemic warning

The limited reimbursement extension granted to antiviral drugs used for influenza such as Tamiflu has ended after 22 months.

 

The program, which was introduced as a measure to prepare for the simultaneous spread of the COVID-19 and influenza pandemic, came to an end with the recent lifting of the flu pandemic warning.

 

Now that the COVID-19 pandemic has subsided, the old reimbursement standard will be applied in the future in normal circumstances.  According to the Health Insurance Review and Assessment Service (HIRA), the limited health insurance reimbursement coverage granted to influenza antiviral drugs, which had been in effect since September 13, 2022, ended on the 12th.

 

The subject items were oral oseltamivir, such as Tamiflu Cap, and topical zanamivir, such as Relenza Rota Disk.

 

Both drugs were used when the patient was confirmed positive for influenza through tests (rapid antigen test or polymerase chain reaction tests).

 

However, when the influenza warning was issued, ▲patients under the age of 9, ▲pregnant or mothers within 2 weeks of giving birth, ▲65 years old or older, ▲immunocompromised, ▲metabolic disorders, ▲heart disease, ▲lung disease, ▲kidney dysfunction, ▲liver disease, ▲blood disorders, ▲neurological and neurodevelopmental disorders, and ▲patients under the age of 19 who are receiving long-term aspirin treatment were covered even without testing.

 

In November 2021, the government temporarily extended health insurance coverage for antiviral drugs for suspected high-risk patients (pediatric, elderly, immunocompromised, etc.) even if they did not test positive and no influenza warning was issued, due to concerns about the outbreak of COVID-19 and influenza twindemic.

 

The temporary extension was in effect from November 15, 2021, to June 20, 2022.

 

Then, during the flu season, the measure was extended for a second time from Sept.

 

13, 2022, to July 12, 2024.

 

The KDCA lifted the influenza pandemic warning for the 2023-2024 season on the 12th.

 

As a result of the surveillance of influenza samples at the clinic level (300 centers), the number of suspected influenza patients fell below the epidemic threshold for 3 consecutive weeks, resulting in the decision to lift the flu pandemic warning after consultation with experts.

 

Typically, the influenza season in Korea runs from November to April of the following year.

 

If the number of cases remains below the epidemic threshold, it is unlikely that the reimbursement standard for antiviral drugs will be extended.

 

In the case of Tamiflu Cap, the reimbursement extension and the flu epidemic resulted in KRW 15 billion in outpatient prescriptions (UBIST) last year.

 

This was the highest in the last 5 years, and the explosive demand caused frontline pharmacies to struggle with supply.

 

During the COVID-19 pandemic, on the contrary, sales were below KRW 5 billion as the flu waned.

 

In 2020, sales recorded KRW 2.7 billion, and in 2021, no prescriptions were recorded at all.

 

An industry official analyzed, "With the reduced flu epidemic and return to normal of the reimbursement standards, prescriptions for antiviral drugs such as Tamiflu will likely decrease.”