New cost of Tecentriq is 2,271,109 won

Avastin costs 218,782 won

With the deliberation resolution of the Health Policy Review Committee, the benefits of combination therapy for hepatocellular carcinoma were expanded on May 1.

Tecentriq, an immuno-cancer drug from Roche Korea, will be expanded from next month due to a combination treatment with Avastin.

 

The new insurance drug price is 2,271,109 won per 20mL for Tecentriq, 218,782 won per 100mg for Avastin, and 712,098 won for Avastin 400mg.

 

The MOHW announced that the "Amendment to the Pharmaceutical Benefit List," which aims to expand the standard for immuno-cancer drugs, was passed after presenting it as a resolution by the 10th Health Insurance Policy Review Committee today (29th).

 

These drugs were listed in January 2018 as the current NSCLC secondary therapy and urinary tract epithelial cancer treatment, and have also been receiving benefits for small cell lung cancer since August 2020.

 

The benefit expansion this time is ▲ a case for primary treatment of progressive non-small cell lung cancer without PD-L1 gene expression and specific gene (EGFR or ALK gene) mutations, and ▲combination therapy with Avastin as a treatment for patients with irreversible hepatocellular carcinoma who had not previously undergone systemic therapy.

 

Alternative drugs include Nexavar (Sorafenib) and Lenvima (Lenvatinib) in hepatocellular carcinoma, and Keytruda (Pembrolizumab) is a representative alternative to non-small cell lung cancer.

 

Janssen Korea applied for the expansion of benefit standards for hepatocellular carcinoma in October 2020 and non-small cell lung cancer in April 2021.

 

In response, the board held a cancer disease review committee in February and July 2021, respectively, and passed it in January this year.

 

It considered that in the case of hepatocellular carcinoma, the quality of life improved in terms of side effects compared to the existing alternative therapy, but since it is expensive with Bevacizumab, the drug benefit evaluation committee needs to discuss the cost effectiveness.

 

In the case of non-small cell lung cancer, it was judged that it was necessary to set salary standards in consideration of clinical literature, but to proceed with follow-up procedures simultaneously with the competitive drug Keytruda.

 

As a result of the committee's deliberation, hepatocyte cancer is at a level that can accept the economic evaluation result (ICER) in terms of cost effectiveness, and in the case of non-small cell lung cancer, the cost is low compared to Keytruda, an alternative drug.

 

The drug is listed in all A7 countries.

 

The company moved to the NHIS and negotiated the new insurance drug price and the expected amount of claims from the end of January to the end of last month.

 

As a result of the negotiations, Tecentriq agreed to 2,271,109 won, down 1.1% from the previous price, with Refund and Expenditure Cap, which the pharmaceutical company refunds to the NHIS for a certain percentage of initial drug treatment and a certain percentage of the cap excess.

 

Avastin also succeeded in agreeing to 218,782 won per 100 mg and 712,098 won for 400 mg, down 5.4% from the previous one, considering the upper limit adjustment criteria and insurance financial impact as the range of use was expanded as a combination therapy.

 

The MOHW and the HIRA set the scope of insurance benefits in consideration of the MFDS' permits, textbooks, guidelines, and academic opinions, and set the recognition period up to two years by applying the same standards as other immuno-cancer drugs.