[Reporter’s Eye] Needs transparency in Cancer Committee

The cases of healthcare reimbursement expansion on novel drug in South Korea has plummeted last year.

 

The drug use has diversified but the actual use volume has not been increased.

 

A survey on pharmaceutical reimbursement status found the increase in reimbursement expansion for each item in 2020 compared to 2019 has plunged by 70 percent, and by 75 percent for each indication.

 

The figure includes the reimbursement expansion in off-label use as well.

 

In 2019, total 107 items had their coverage expanded.

 

However in 2020, only 35 items succeeded expanding the coverage.

 

104 indications had their coverage expanded in 2019, whereas it was only 30 indications last year.

 

Regardless of the drop in expanded coverage, the number of coverage expansion application was not so different in 2020 compared to 2019.

 

The biggest cause of the drop seems to be the COVID-19.

 

Respective reimbursement deliberation committees including the Health Insurance Review and Assessment Service (HIRA) Drug Reimbursement Evaluation Committee (DREC) and Cancer Deliberation Committee had to postpone their meetings multiple times, which is an essential step prior to reimbursement listing.

 

To improve the situation, the South Korean government alleviated the related regulation and allowed on-paper review from September.

 

But besides the COVID-19 pandemic, some of the pharmaceutical industry associates point out the reimbursement expansion barrier has gotten higher over the year.

 

The fingers are pointing at the Cancer Deliberation Committee.

 

Originally, specialist doctors used to discuss the practicality of the drug by reviewing the drug’s clinical efficacy.

 

But from last year, the committee started to also evaluate the financial impact of a drug.

 

Since last year, the Cancer Deliberation Committee became the impossible river to cross.

 

More and more drugs are pending for reimbursement expansion due to the committee.

 

Some company goes as far as to submit a pharmacoeconomic analysis to the committee.

 

It is possible, that many companies could have been too greedy with the pricing or had so many clinically ineffective drugs specifically in last year.

 

But the issue is transparency.

 

Currently, the Cancer Deliberation Committee does not disclose the result.

 

The applicant company sometimes finds out about the listing close to the effective date.

 

The DREC was like that in the past.

 

An applicant company had to either pull their strings to confirm the result immediately after each meeting or wait for healthcare news media to publish an article on it.

 

The companies continued to file complaints and now the DREC results are disseminated to news media with clear reasoning behind the decision.

 

The same old situation is occurring within the Cancer Deliberation Committee.

 

As the Cancer Committee started reviewing the financial impact, the number of cases where a drug is rejected by DREC after passing the Cancer Committee has drastically dropped.

 

Basically, the Cancer Committee is playing the role of DREC.

 

It is clear the Cancer Committee has to disclose all result clearly as DREC has.

 

Only when the Cancer Deliberation Committee provides the clear reason behind the disapproval, a company can be reprimanded for its greediness or seek for the middle ground.

 

While COVID-19 is an emergency state to be handled carefully, the South Korean health authority should not forget the cancer patients are also waiting desperately.