New PBAC members to make big reimbursmeent decisions in 2H

including insurance listing for Kymriah, etc.

HIRA completes registering recommended candidates on the 23rd... Members will be appointed in August and start their term in September

Adjusted the member pool to 100... increased no. of members from civic group organizations to 12

From September, new members of the Drug Reimbursement Evaluation Committee (DREC) of the Health Insurance Review and Assessment Service will be conducting evaluations on the adequacy of pharmaceutical reimbursements.

 

PBAC members that will start committee activity from the second half of this year, will carry out major deliberations and tasks from whether the ultra-high-priced new drug ' Kymriah' is eligible for reimbursement to the coverage expansion of 'Keytruda' that has recently passed the Review Committee for Cancer Disease deliberations.

 

HIRA received recommendations from relevant organizations to pool around 100 experts from relevant fields for the committee until the 23rd of last month.

 

The 8th PBAC members are appointed among a double pool of candidates who are recommended from relevant organizations, who undergo qualification review.

 

The number of recommendations requested by HIRA requested to relevant organizations was 192, including 112 from the Korean Academy of Medical Sciences (4 or more per society, 28 societies); 18 from The Pharmaceutical Society of Korea (6 or more per society, 3 societies); 10 from medical and pharmaceutical associations (6 or more per society, 3 societies); and 24 from civic and consumer groups (2 or more per group, 12 groups).

 

Among the recommendations, HIRA will select 96 members in consideration of each member's professionalism, diversity, and connectivity to agendas.

 

▲Those performing pharmacoeconomic evaluation-related services for pharmaceutical companies; ▲executives, private practitioners, or private pharmacists in the recommended medical and pharmaceutical organizations; ▲those who are judged unfit to perform fair work during pre-diagnosis of work ethics ▲those subject to administrative disposition or punishment under the Medical Service Act, Pharmaceutical Affairs Act, National Health Insurance Act or Medical Care Assistance Act within the last 5 years; ▲ those who have served as a member of the PBAC for two or more consecutive terms, were excluded from recommendations.

 

In the case of ‘two or more consecutive term’ standard' that was prepared to limit long-term appointment and duplicate appointments, reappointment is possible for members who have served as an advisory member or who are in specialized fields in consideration of their unique circumstances In case of data submitted for PE evaluations.

 

the characteristics of each drug and disease are difficult to regularize or standardize due to various assumptions, methodologies, and models involved.

 

To address this, appointment standards have been slightly relaxed to ensure continuous participation of certain committee members, which is necessary for maintaining consistency in PBAC review.

 

The 8th PBAC will consist of 102 members.

 

In addition to the 96 recommended members, HIRA plans to add one member from the Ministry of Health and Welfare, one from the Ministry of Food and Drug Safety, the Department head of the HIRA Pharmaceutical Benefit Department, and 3 panels from the Healthcare Review and Assessment Committee to compose the 8th PBAC.

 

The PBAC meetings will be held by 3 fixed members from MoHW, MDFS, and HIRA, and 17 other members (19 for agendas related to oriental medicine) from the 120 members.