The method of revaluation of wages that Godex has changed

Will it act as a variable?

Raise the objectivity of the social demand item

It is noteworthy whether HIRA will act as a variable by changing the evaluation method starting with the re-evaluation of benefit adequacy this year.

 

The improved evaluation method is to increase the objectivity of the social demand part, which is the third evaluation item.

 

Accordingly, in the case of drugs whose clinical usefulness is unclear but whose cost-effectiveness has been recognized, the evaluation of social needs is expected to be evaluated in more detail.

 

The Ministry of Health and Welfare announced on the 30th of last month that the Health Insurance Policy Deliberation Committee deliberated on ways to partially improve the 2024 benefit adequacy re-evaluation target and benefit adequacy re-evaluation method.

 

The proposal to improve the re-evaluation of benefit adequacy reported to this committee was prepared at a meeting held in December of last year to reinforce the method of evaluating social needs.

 

The beginning was because of the Godex capsule.

 

Although the clinical usefulness of Godex Capsule was unclear in the re-evaluation of reimbursement adequacy last year, the cost-effectiveness was recognized due to the drug price cut, and the benefit was finally maintained.

 

In response, the members of the relevant committee raised an issue, and after re-submitting the agenda, the deliberation was finalized.

 

At the same time, it was requested to strengthen the evaluation method such as social demand.

 

The HIRA prepared and reported an improvement plan by reflecting only the part of the evaluation method requested by the committee in the 'review of drug benefit adequacy rationalization plan', which ended in March.

 

In the improvement plan, the terms of the clinical usefulness item were changed to specify the purpose of the evaluation contents, and the quality level was considered in addition to the literature ratio that recognized the effect when evaluating clinical effectiveness.

 

Accordingly, it was decided to judge that it is clinically useful only when it is evaluated above 'some' in terms of medical recommendation and clinical effectiveness.

 

In addition, the social demand item is greatly improved.

 

It will be specified in three evaluation items, including medical factors, and will be evaluated in a score method by determining details.

 

Afterward, the scores were summed up and the final evaluation was decided by a committee composed of 11 members.

 

In the meantime, social demand items have not been evaluated with points, but have been assessed by reviewing society's opinion collection, civic and patient group opinion submissions, financial impact through calculation of financial impact, medical importance, age, and patient's economic burden.

 

In order to maintain benefits, it is possible if it is judged to be primarily clinically helpful or if the clinical usefulness is unclear, but cost-effective and social demand is high.

 

In the revised plan, the conditions for maintaining reimbursement for drugs with unclear clinical usefulness are expected to become much more stringent.

 

In particular, as this improvement plan is decided to be applied for re-evaluation this year, it is expected to affect drugs whose clinical usefulness is unclear.

 

A total of six ingredients are in the process of being re-evaluated this year.

 

Rebamipide, Limaprost Alfadex, Loxoprofen Sodium, Levosulpiride, Epinastine, and Sodium Hyaluronate eye drops will likely have mixed results for pharmaceutical companies.