Contracts with modified indications are not terminated

for RSA drugs

The NHIS updated detailed operation guidelines for RSA drug price negotiations on October 8th

Updated the estimated billing amount after changing the upper limit price, refund rate, cap, etc. when negotiating to expand the scope of benefits

The NHIS said that in the case of drugs that benefit from the RSA drug price negotiations, it cannot unilaterally terminate the existing contract to change the main indication.

 

Based on the provisions of the NHIS on October 8th, the 'Detailed Operation Guidelines for Risk-Sharing Drug Price Negotiations', the contract cannot be terminated if the HIRA recognizes cost effectiveness when the benefits are expanded in the pharmaceutical industry.

 

Nam-seon Choi is explaining the revision of the risk-sharing drug price negotiation guidelines

The NHIS held ‘RSA drug price negotiation system and follow-up management online briefing' for more than 100 pharmaceutical companies from 2pm on the 25th.

 

According to the revised guidelines, after the evaluation of the Pharmaceutical Benefits Advisory Committee, the NHIS and the company negotiate the contents of the risk-sharing contract (excluding the risk-sharing contract period) such as the upper limit amount, refund rate, and cap of the drug.

 

In this regard, an official of Pharmaceutical Company A said, "If a drug that has been exempted from Profitability Evaluation with an Expenditure Cap passes the Pharmaceutical Benefits Advisory Committee after proving the cost-effectiveness of an indication other than the existing indication in the process of expanding benefits in the future, will the existing contract be terminated?"

For example, the question is whether the existing contract should be maintained even if the scope of benefits expands due to a different area or age change, etc., in which indications and additional indications are exempted from Profitability Evaluation.

 

Nam-seon Choi, head of the NHIS' drug price negotiations, said, "The part where the scope of benefits is expanded by proving cost effectiveness is a form of resetting the cap within the existing contract period, so the existing contract cannot be canceled." Choi said,"At the end of the Expenditure Cap contract, the Pharmaceutical Benefits Advisory Committee evaluation determines whether to maintain or terminate the contract." He added, "There was no real case like this, but if it comes out, we will review it in the negotiations, but we are not thinking about the termination of the existing contract when the scope of benefits is expanded."