HIRA declines NHIS and KPBMA's request

NHIS and KPBMA asks to join the Drug Reimbursement Evaluation Committee

Drug Reimbursement Evaluation Committee’s operational regulations to be amended as pre-announced

NHIS had strongly pushed for the institution's participation in the Drug Reimbursement Evaluation Committee since early this year

The National Health Insurance Service and the Korea Pharmaceutical and Bio-Pharma Manufacturers Association have requested to participate in the Drug Reimbursement Evaluation Committee, but the Health Insurance Review and Assessment Service announced plans to amend its operational regulations without reflecting their requests.

 

The NHIS has been strongly pushing to take part in the Drug Reimbursement Evaluation Committee since earlier this year, which drew attention to the recent amendment of the operational regulations.

 

According to HIRA on the 13th, the amendment to the operational regulations for the Drug Reimbursement Evaluation Committee will be officially announced soon and will incorporate the contents pre-announced last month.

 

The pre-announced contents of the amendment included increasing the committee's member pool from 100 to 105 and increasing the number of experts recommended by academic societies from 65 to 70.

 

HIRA will reorganize the specific departments for specialized experts among those recommended by the Korean Medical Association by removing the Korean Society of Gastrointestinal Cancer Research and adding 4 specialized departments including the Korean Orthopedic Association, the Korean Society of Coloproctology, the Korean Society of Medical Oncology, and the Korean Society of Surgical Oncology, HIRA made a pre-announcement of its administrative decision on the 21st of last month and has collected opinions until the 27th of the same month.

 

After the announcement, the NHIS immediately offered to take part in the Drug Reimbursement Evaluation Committee.

 

The NHIS has been emphasizing the need for their participation in the committee to enable smooth operation of tasks related to drug reimbursement.since earlier this year.

 

While NHIS participated in the 3rd Drug Reimbursement Evaluation Committee, they were not given voting rights due to a conflict of interest and are now no longer involved in the committee.

 

In March, Sang-Il Lee, Executive Director for Benefit at NHIS, argued for NHIS’s participation in the Drug Benefit Evaluation Committee during a briefing with the Korea Special Press Association.

 

He said, "NHIS’s participation in the Drug Reimbursement Evaluation Committee is necessary to ensure the appropriateness of reimbursement, secure consistency of financial impacts when listing new drugs, and serve as an organic link between the evaluation and negotiation conducted on the uncertainty of new drugs under the risk-sharing agreement.

 

We will further discuss this matter with relevant organizations, such as MOHW and HIRA.” Subsequently, the National Health Insurance Trade Union and the Korea Alliance of Patients Organization also supported the participation of NHIS in the Drug Reimbursement Evaluation Committee.

 

The Korea Alliance of Patients Organization submitted a letter of opinion in favor of NHIS’s participation when the amendment to the operating regulations for the Drug Reimbursement Evaluation Committee had been pre-announced.

 

However, HIRA showed a negative stance toward NHIS’s participation in the Drug Reimbursement Evaluation Committee.

 

Mi-Young Yoo, Head of the Department of Drug Management at HIRA stated during a briefing in March that “As an insurer, NHIS directly negotiates with pharmaceutical companies on the ceiling price for new drugs, etc.

 

Concerns may arise about fairness and objectivity if the negotiating party participates in the decision-making process,” essentially rejecting their opinions.

 

In addition to the NHIS, the Korea Pharmaceutical and Bio-Pharma Manufacturers Association also submitted their opinion for its participation in the Drug Reimbursement Evaluation Committee during the pre-announcement period, with the aim of ensuring transparency in the process of reimbursement decisions.

 

However, their opinions to take part in the Drug Reimbursement Evaluation Committee were not accepted.

 

The official announcement is expected to align with the pre-announced contents.

 

Thus, NHIS and KPBMA representatives will not be part of the 9th Drug Reimbursement Evaluation Committee that is set to commence in October.