PVA, the higher the bill, the greater the discount rate

The HIRA, reflects last year's research service results, promote institutional improvement through a working group in May, and implement next year

Type 'Ka' 5 billion 10% increase condition added

Including drugs with bills of 3 to 5 billion won

Lee Sang-il, executive director of NHIS, held a meeting with the Korea Special Press Association on the 7th

The NHIS plans to increase the reduction rate of the upper limit for drugs with high claims in the PVA, and lower the reduction rate or exclude drugs with low claims.

 

This is based on research conducted last year.

 

The results of the research service (performance evaluation and improvement plan of PVA (researcher: Bae Seung-jin, Ewha Womans University)) has not yet been disclosed, but will be disclosed at the end of this month and discussed at the Workie Group, which will be held from May.

 

At the Korea Special Press Association meeting held on the 7th with Lee Sang-il, executive director of the NHIS, this PVA improvement plan was revealed for the first time.

 

Director Lee said, "In order to improve the effectiveness of drug cost management, we conducted a research service last year to evaluate the performance of the PVA system and improve it." As a way to improve the system, we suggested selective management of drugs with high fiscal impact and efficient system operation.” Accordingly, a plan was devised to expand the selection criteria for usage type 'Ka' by adding 5 billion won and 10% increase conditions from the existing 30% increase condition for the selective management of drugs with high financial impact.

 

The reference formula is differentiated by dividing it into three sections according to the size of the bill, and a plan to increase the maximum reduction rate in consideration of the coefficient of the reference formula was proposed.

 

As a result, the plan is to increase financial efficiency by increasing the reduction rate for drugs with high claims.

 

Currently, the maximum reduction rate is limited to 10%, but the maximum reduction rate is expected to exceed 10% for drugs with high claims through improvement measures.

 

Conversely, a plan was proposed to further include drugs with low claims, which have a small reduction rate and are excluded from negotiations.

 

For efficient operation of the system, the exclusion criteria will be raised from 2 billion to 3 to 5 billion, and a temporary refund system will be introduced.

 

In addition, a plan to lower the maximum reduction rate for small-amount drugs was also proposed.

 

The temporary refund system refers to a one-time refund to the NHIS by a pharmaceutical company for a price cut instead of a price cut for a drug whose usage has temporarily increased due to a pandemic or other reasons.

 

The target and materialization plan will be discussed in the working group to be held in May, but this plan is not expected to be promoted immediately as a mid-term task.

 

Jeong Hae-min, head of the NHIS Pharmaceutical Management Office, said, “The rest of the parts except for the temporary refund system are short-term tasks, and we plan to promote system improvement through a working group that will be held from May.” We plan to operate according to the schedule of, and based on the matters discussed through this, we will come up with an improvement plan, revise the relevant regulations in the second half of the year, and implement them from next year.” A plan to correct the number of drugs related to COVID-19 has also been outlined to some extent.

 

The target drugs are cold medicines and antibiotics that are encouraged to be produced by the Ministry of Food and Drug Safety, and it is explained that they correspond to about 2,600 items based on the 2022 benefit list.

 

As for the correction method, a method of correcting the usage amount was proposed, excluding the period (month) when usage increased sharply during the pandemic, and the director Lee explained that they are currently in final coordination with the pharmaceutical industry.

 

The NHIS plans to finalize the correction plan this month when discussions with the pharmaceutical industry are completed and to apply to monitor for negotiations in April.