CDRC to talk partial reimb details for comb cancer therapy

on May 14

The Health Insurance Review and Assessment Service (HIRA) moved the Cancer Drug Review Committee (CDRC) meeting a month earlier to reduce confusion in medical practices

Will establish detailed reimbursement criteria, including reimbursable therapies

An additional date has been set to discuss detailed criteria regarding partial reimbursement of combination cancer therapy, as announced this month.

 

The Health Insurance Review and Assessment Service (HIRA) has decided to convene another Cancer Drug Review Committee (CDRC) meeting, which was not scheduled.

 

According to industry sources on May 12, the HIRA will convene the 4th CDRC of 2025 on May 14, 4PM at Kukje Electronics Center.

 

During the meeting, detailed criteria related to partial reimbursement of combination cancer therapy, notified by the Ministry of Health and Welfare (MOHW) this month, will be discussed.

 

Based on the discussion during the meeting, the HIRA will revise the 'Detailed Criteria and Methods for Applying Reimbursement (of Medications Prescribed·Administered to Cancer Patients),' then implement it from June.

 

The upcoming CDRC meeting had not been scheduled.

 

The 4th CDRC meeting was initially planned to convene on June 11, but it has been moved up a month.

 

In other words, it is the major issue in medical practices.

 

This month, the Ministry of Health and Welfare (MOHW) newly established a partial reimbursement of combination cancer therapy through partial revision to the 'Detailed Criteria and Methods for Applying Reimbursement (Drugs).' In detail, a new clause states, 'when combining a reimbursed chemotherapy regimen with another anticancer drug, the existing co-payment for the previously initiated chemotherapy shall continue to apply to that regimen.' Previously, all combination therapies not approved by insurance reimbursement were entirely non-reimbursed.

 

However, with the establishment of this clause, one anticancer agent now recognized for reimbursement is expected to alleviate patients' financial burden and improve treatment accessibility.

 

However, confusion persists in medical practices due to a lack of details, such as which drugs are eligible for reimbursement.

 

Pharmaceutical companies have also been asked whether the drug in question is eligible for reimbursement, but they have also been unable to provide clear answers.

 

At the CDRC meeting held on April 30, there was consensus on the need for detailed criteria.

 

Still, they failed to prepare a revision with only a few days left before the MOHW's notification takes effect.

 

Recently, the HIRA sent an official letter to relevant organizations stating that it would promptly discuss at the CDRC meeting the comprehensive consideration of the approved indications and academic society opinions to reduce confusion in medical practice when applying the detailed criteria to existing anticancer therapies and combination therapies with other anticancer agents.

 

The HIRA plans to revise the 'Detailed Criteria and Methods for Applying Reimbursement (of Medications Prescribed·Administered to Cancer Patients),' including eligibility criteria, and implement it on June 1.

 

Accordingly, at the CDRC meeting scheduled for May 14, they are expected to establish the reimbursable drugs and detailed criteria for partial reimbursement for combination cancer therapies and include them in the announcement of cancer drug reimbursement criteria set to take effect in June.