Insurance benefits of Dupixent PFS 300mg will be possible

Check past history based on the starting date of medication

After the approval of the MFDS on April 1, insurance benefits of 'Dupixent PFS 300mg (dupilumab)' will be possible when the adolescent patients are over 18 years old.

 

As a patient with chronic severe atopic dermatitis who is over 18 years of age and has symptoms that persist for more than 3 years, ▲ it is not adequately regulated even after administration of a topical treatment agent (moderate or higher corticosteroid or calcineurin inhibitor) for 4 weeks or more.

 

Reaction even after inhibitor (Cyclosporine or Methotrexate) was administered for 3 months or more (EASI (Eczema Area), and Severity Index) (over 50% reduction), or cannot be used due to side effects, etc.

 

▲ before starting the administration of the same drug, conditions such as EASI 23 or higher must be satisfied to receive benefits.

 

The HIRA announced on the 26th QnA regarding the application of patient-related reimbursement criteria that began to administer Dupixent in youth.

 

Dupixent has been reimbursed to adult atopic dermatitis since January 1st.

 

Since April 1, the approval age of the MFDS expanded from 'adults' to 'adults and adolescents (over 12 years old)', and it is now possible for adolescent patients to administer drugs at their own expense.

 

The HIRA said, "If adolescent patients over 12 years of age meet the administration target at the beginning of the first dose of Dupixent, they are judged to satisfy the administration target even when they become adults." "It is only possible to be reimbursed if it has been completed." Chronic atopic dermatitis, which persists for more than 3 years, means that the past history of atopic dermatitis diagnosed 3 years prior to the start date of Dupixent's administration is confirmed through the medical records.

 

After the first topical treatment, if Dupixent is administered without systemic immunosuppressants, the patient must bear the full cost of the drug.

 

However, if systemic immunosuppressive drugs cannot be administered due to medical contraindications such as renal failure, uncontrolled hypertension, uncontrolled infectious disease, malignant tumor, and severe liver disease, health benefit may be reimbursed if conditions such as EASI are satisfied.

 

When re-administered after a drug break due to medical reasons, etc.

 

▲Re-administration of a patient who has been withdrawn prior to the first response evaluation (week 16) corresponds to the initial administration acceptance criteria.

 

▲ If the holiday period is less than 3 months, it is recognized as continuous administration, and if the holiday period is more than 3 months, the requirements such as the initial acceptance criteria must be met.