Price for Kymriah needs a new management method

The NHIS has decided to release guidelines for calculating the estimated amount of claims around October

Lee Sangil, a benefit executive, introduces issues related to drug prices in the second half of the year

The NHIS continues to discuss finding a new drug price management method for the rapid registration of ultra-high-priced "one-shot treatments." However, he said he would consider the introduction of "post-registration evaluation" required by patient organizations as one of several alternatives, not the correct answer.

 

The Guidelines for Calculating Estimated Claims, which have been prepared since the beginning of this year, will be released around October, and negotiations will finally be concluded today (15th) for Choline alfoscerate.

 

Lee Sangil, the senior director of the NHIS, held a briefing with the Korea Special Press Association on the 14th and announced issues in the second half of the year on overall issues related to benefit guarantees, projects, and drug prices.

 

▶It is argued that a one-shot treatment that is directly related to the life of ▶ patients should be registered first and evaluated afterwards, and what is the director's personal opinion about rapid registration? "Unlike in the past, Breakthrough Therapy such as Kymriah and Zolgensma, which patients can only administer once in their lifetime, has been released.

 

Instead, costs range from hundreds of millions to billions of won.

 

Accessibility should be guaranteed because the drug itself is essential to patients.

 

However, I think a new approach is necessary because it is difficult to guarantee accessibility for patients with existing drug price management.

 

The NHIS is discussing with the pharmaceutical companies on what method would be appropriate.

 

Since this drug has already been registered in other countries, we will review foreign cases and find appropriate measures for Korea.

 

I think the evaluation plan after the first registration is one of several alternatives.

 

The introduction of this plan cannot be immediately answered." ▶ It was said that it would disclose the guidelines for calculating the estimated claim amount Since April, a consultative body has been formed with KPBMA, KRPIA, and KoBIA to prepare guidelines for calculating the expected amount of claims.

 

Currently, The NHIS and associations are in the process of collecting opinions on guidelines created through consultative bodies.

 

The guidelines will be completed by October." ▶Is there any countermeasure to prevent litigation similar to Choline alfoscerate? All applications for suspension of execution by pharmaceutical companies related to the Choline alfoscerate lawsuit have been dismissed, and the main lawsuit remains.

 

We cannot guarantee the possibility of similar lawsuits, but we plan to come up with countermeasures through consultations with related agencies such as the MOHW and the HIRA in the future." ▶ What projects will you focus on as a policy task in the second half of the year? In order to improve the effectiveness of the conversion index calculation model raised in annual fee negotiations, we intend to promote system improvement centering on the institutional development council formed for communication between stakeholders.

 

In addition, the government will continue to strengthen the medical safety net for the vulnerable by improving the disaster medical expenses support system on November 1, implementing pregnancy maternity medical expenses in January next year, and a three-stage pilot project for disabled people.

 

In addition, we plan to come up with a reasonable payment plan for expensive drugs that take into account patients' access to treatment so that they can be introduced stably."