PVA guidelines are about to be revised

Excluding criteria, arithmetic average price is increased by 100 → 90%, and billing amount is increased by 15 → 2 billion won

Director Lee Sangil, "lower prices as the pharmaceutical industry sells more"

The revision of detailed operational guidelines for PVA is imminent

The NHIS is internally reviewing a revision to the guidelines that includes a 100 → 90% change in the arithmetic average exclusion standard and a 15 → 2 billion won increase in the claim exclusion standard from this year's "Type Da" negotiations.

 

NHIS' Senior director Lee Sangil said at the Korea Special Press Association briefing held on the 25th, "The guidelines amendment is currently under internal review and will be revised so that it can be applied from this year's Type Da negotiations." On December 2 of last year, the NHIS announced a plan to improve the PVA negotiation system at the 10th public-private consultative body involving the MOHW, the NHIS, the HIRA, KRPIA, and KPBMA.

 

According to the revision to the PVA guidelines, the same product group and upper limit price with the total annual claims of the same product group of less than 2 billion won are items with an arithmetic average of less than 90%.

 

Director Lee said, "The expansion of the arithmetic average price standard is aimed at strengthening the management of large items excluded from the list because of the high insurance financial burden but lower than the arithmetic average," adding, "The upward revision to 2 billion won is to exclude items with small claims from PVA." Regarding the pharmaceutical industry's criticism that the revision of the guidelines was made to "lower prices as the pharmaceutical industry sells more," Director Lee said, "From an economic perspective, it is appropriate to cut prices because fixed costs for drug research and development will decrease costs if actual usage increases." In particular, he stressed that the more companies sell, the lower the price is in line with the purpose of PVA, which cuts the drug price of drugs that are a financial burden on insurance.

 

Director Lee added," Jung Hae-min, head of the drug management office, also said, "As the revision of the guidelines was announced at the end of last year and the implementation date of this year was postponed, I think the pharmaceutical industry is curious about the change in details." It will be roughly released next month, he said.

 

In addition, the NHIS has not yet delivered a review opinion to the MOHW on how to raise the maximum PVA cut rate from the current 10% to 15%.

 

Director Chung said, "We have not yet made a proposal to raise the maximum cut rate by 15%."