Can the ICER value increase the range of GDP?

Moon Jae-in care

The HIRA made it difficult to respond in writing to the National Assembly', the NHIS, "excessive spending due to reimbursement of expensive drugs"

The National Assembly is calling for an increase in the incremental cost effectiveness ratio (ICER), which is used as the basis for price determination, for reimbursement of expensive drugs, which is the key to strengthening the coverage of Moon Jae In Care pharmaceutical sector.

 

This is because the price of breakthrough new drugs used for serious diseases is getting higher and higher, and it seems difficult for insurers who manage finances to diagnose as the cause of excessive spending and exceed the current maximum of ICER.

 

The NHIS and The HIRA's recent written responses to the National Assembly's Health and Welfare Committee are summarized, and the position on this is consistent.

 

As of 2018, Korea's health insurance coverage rate was 63.8%, the highest level since 2010.

 

Although it appears to be in the early 60% of the figures, it is interpreted that the driving effect of'Moon Jae-in Care' is significant when considering the rapid change in population diseases, the expansion of expensive drug reimbursement, the increase in natural increase and the balloon effect.

 

The NHIS (left) and The HIRA

Severe treatments, anticancer drugs, and drugs for treating rare diseases are the key to strengthening the coverage of the drug sector.

 

As these new drugs become more expensive, the ICER range, which determines the benefit price (insurance ceiling) of these drugs, is also required to be expanded.

 

In fact, on the 22nd, at the general government audit of the Welfare Committee, Minister of Health and Welfare Park Neung-hoo was struggling with a question from Rep.

 

Lee Yong-ho, who raised the need for an upward adjustment of the first-line treatment for the new lung cancer drug Tagriso.

 

At the time, Minister Park explained, "Tagriso's drug price is not a very expensive drug, because new drugs are released every day and there are a lot of very expensive drugs.

 

There are some super expensive drugs that cost 100 million won per administration." Kim Yong-ik, chairman of the NHIS, also said at the NHIS·the HIRA on the 20th, "The listing of new drugs is inevitable.

 

If negotiated, the NHIS or the government, which has to set the drug price, will be in a difficult position." "If this is set up, it can be difficult for patients." Kim Sun-min, Chief of the HIRA was in the same position.

 

He said, "The value of ISR should be effective when you inject additional costs.

 

Recently listed anticancer drugs require as much as 1 billion won or more to extend the average one-year lifespan." also he added, "We need to consider patients with other diseases and discuss with social consensus." Accordingly, Rep.

 

Kang Ki-yoon of the Welfare Committee made a written inquiry to the HIRA, saying that GDP applied to the ICER value should be realized.

 

ICER is a key tool that compares the effects and costs of life extension after one year of taking drugs belonging to the comparative group when evaluating the economics of drugs for which insurance benefits are applied.

 

Korea has dualized drug reimbursement work, and the HIRA is conducting economic evaluation and the NHIS is conducting drug price negotiations.

 

Most of the world's advanced insurance countries that are evaluating the economic feasibility of new drug benefits use the ICER tool to evaluate and deliberate just before drug price negotiations.

 

Usually, the country's GDP level is the reference range.

 

It is threatening the reinforcement of guarantees as there is a growing tendency to derive a price range that is far beyond.

 

Regarding this, the HIRA said, "There is no explicit ICER threshold for determining whether to pay benefits.

 

GDP per capita is based on the 2013 level of 25 million won (1ICER)." We are considering it and evaluating it.” In order to overcome these difficulties and strengthen the security of new drugs, Korea has already established the ICER threshold for new drugs for treatment of severe and rare diseases in the case of new drugs for the treatment of severe and rare diseases, which is 50 million won (2ICER) in GDP.

 

It is applying elasticity to the level.

 

Accordingly, there is a need to further increase the ICER threshold with'Moon Jae-in Care' pursuing a breakthrough strengthening of security.

 

However, it is difficult for the insurer.

 

This is because Moon Jae In Care is being continuously promoted by taking steps as a long-term plan at the government level, so enormous finances are being invested, and in particular, it is self-determining that financial overspending has resulted in increased access to new drugs.

 

The NHIS responded to a written inquiry from Rep.

 

Nam In-soon asking for a reinforcement explanation of Moon Jae-in Care.

 

"The area that needs to be improved" answered.

 

It is said that the ICER threshold expansion is not realistic given the fact that an increase in the ICER threshold will lead to an increase in fiscal expenditure.

 

The HIRA also said, "The ISR threshold adjustment can contribute to strengthening accessibility to new drugs, but it is necessary to collect sufficient social opinions as it is accompanied by additional financial requirements such as an increase in drug prices.