Lorviqua reimb at ₩52,819, Emgality at ₩295,250

by the NHIS

HIPDC deliberated and passed standards effective as of September 1st… Lorviqua Tab is reimbursed under Refund and Expenditure cap type RSA

◆Lorviqua Tab= Lorviqua is a treatment that received domestic marketing authorization as monotherapy to treat adult patients with anaplastic lymphoma kinase (ALK)-positive advanced non-small-cell lung cancer (NSCLC).

 

The company applied for reimbursement after receiving approval from the Ministry of Food and Drug Safety on July 29th.

 

The Health Insurance Review and Assessment Service deliberated the agenda at the Cancer Disease Deliberation Committee on January 12th, and at the Drug Reimbursement Evaluation Committee on April 7th.

 

At the time, HIRA had determined the drug adequate for reimbursement and waived pharmacoeconomic evaluations.

 

The drug is listed in 7 of the A7 countries.

 

The agenda was then passed on to the National Health Insurance Service, where the company conducted negotiations on the drug price and expected claims amount until May.

 

As a result, the parties agreed on employing the ▲Refund type where the company refunds a certain rate (reimbursement rate) of the amount of the claims to NHIS, and the▲Expenditure Cap type where the amount that exceeds a certain cap is refunded, of the RSA.

 

The insured price will be set at ₩52,819 for the 25mg strength and ₩158,457 for the 100mg strength starting on the 1st of next month.

 

◆ Emgality 120mg prefilled pen·prefilled syringe inj = Emgality was approved by the MFDS as a migraine prevention treatment on September 5th, 2019.

 

The industry applied for reimbursement to HIRA on March 31st, after which the agenda was listed and deliberated by DREC on May 12th.

 

At the time, the economic evaluation subcommittee acknowledged the clinical need for the drug and that the drug is subject to cost-effectiveness analysis.

 

After pharmacoeconomic evaluations, the cost-effectiveness ratio was determined to be in an acceptable range.

 

In countries abroad, the prefilled pen inj is listed in 6 of the A7 countries, and prefilled syringe in 2 of the A7 countries.

 

The agenda was passed on to the National Health Insurance Service, where the company conducted negotiations on the drug price and expected claims amount from May to July.

 

Both the pen and syringe was listed for reimbursement at ₩295,250.

 

However, in consideration of the fact that the drug is more expensive than its alternative (oral treatment), the discontinuation standard has been set so that patients discontinue treatment if the number of migraine days is not reduced by 50% or more from baseline (before administration) during response evaluations, and the administration period was set to a maximum of 12 months.