Re-evaluation of the upper limit amt, scheduled for August

re-evaluation in September

On the 3rd of next month, final deliberation at the HIRA stage, drug price adjustment in September after NHIS negotiations

The final result of the re-evaluation of the upper limit amount standard requirement will be presented as an agenda for the Pharmaceutical Reimbursement Evaluation Committee to be held on August 3.

 

It is expected that negotiations with NHIS will proceed in earnest after the submission of the committee.

 

The results of the re-evaluation of the adequacy of this year's benefits are expected to be presented in September.

 

According to HIRA and the industry on the 28th, the committee meeting on the 3rd of next month will review the final result of the re-evaluation of the upper limit amount standard.

 

This is the final review following the first review in May.

 

HIRA notified pharmaceutical companies of the results after the first review by the review committee in May.

 

After that, the final result will go to the committee on the 3rd of next month after the appeal.

 

This is about two months behind the original plan to reflect drug price adjustment through re-evaluation in July.

 

This is because data submissions were rushed all at once in February, and more than 1,000 objections came out after the first evaluation.

 

After this committee is over, the NHIS is expected to hold negotiations with pharmaceutical companies regarding supply for the month of August.

 

It is expected that the re-evaluation results will be reported to the health policy review committee in August, and the drug price adjustment plan will be reflected in the reimbursement list on September 1.

 

The re-evaluation of the upper limit amount is being carried out by maintaining or lowering the upper limit amount depending on whether the drug has met its own BA test and DMF listing criteria for already-listed drugs.

 

The upper limit is maintained if both BA and DMF requirements are met, and if one is met, the price is reduced to 85% of the adjusted standard price, and if both are not met, the price is reduced to 72.25%.

 

Currently, the first evaluation of 14,000 items is underway, and the second round of about 5,000 drugs will begin in earnest after submitting data in July.

 

The re-evaluation of the adequacy of wages this year is expected to be somewhat delayed due to the re-evaluation of the maximum amount.

 

The original plan was to submit the re-evaluation results to the Drug Evaluation Committee in August, but it is likely to be presented in September at the earliest.

 

This year, the target item for re-evaluation of benefit adequacy is peptic ulcer medicine Rebamipide, a drug for the circulatory system Limaprost Alfadex, an antipyretic, analgesic, anti-inflammatory drug Loxoprofen Sodium, a drug for the digestive system Levosulpiride, a drug for allergy Epinastine Hydrochloride, an ophthalmic hyaluronic acid eye drop.

 

Among them, hyaluronic acid eye drops are the largest with a market size of 231.5 billion won (3-year average billing amount).

 

Next, the pharmaceutical industry is paying attention to the results of the re-evaluation of the adequacy of reimbursement for these drugs.