Non-reimbursed Dupixent now covered with few conditions

HIRA publishes reimbursement-related Q&A, accepting application temporarily until the end of June

Patient group without EASI score before Jan. 1 can replace with other indicator score

Patients taking severe atopic dermatitis treatment Dupixent prefilled injection (dupilumab) as a non-reimbursement treatment option can now have an access to healthcare reimbursement without satisfying the newly established reimbursement criteria.

 

Health Insurance Review and Assessment Service (HIRA, President Kim Seung-taek) published a Q&A on reimbursed use of Dupixent and presented detailed criteria of reimbursement.

 

Starting from Jan.

 

1 this year, the Korean government cleared reimbursement on Dupixent for treating adult patient over the age of 18 with severe atopic dermatitis, who has uncontrolled condition after four-week topical treatment (corticosteroids or calcineurin inhibitor) as first-line treatment, and not showing more than 50 percent improvement in Eczema Area Severity Index (EASI) score after three-month systemic immunosuppressant therapy (cyclosporine or methotrexate); has EASI score over 23 before administrating the treatment; and has a record of receiving topical treatment and systemic immunosuppressant therapy within past six months.

 

However, HIRA has also decided to provide reimbursement on patients, who have been treated with non-reimbursed Dupixent, if they qualify either one of two conditions, regardless of passing the existing reimbursement criteria.

 

The two conditions are either having a record of receiving systemic immunosuppressant therapy (cyclosporine or methotrexate) after being diagnosed with atopic dermatitis or having a record of atopic dermatitis severity indicator (EASI over 23, SCORAD over 40, or IGA 4) without receiving systemic immunosuppressant therapy for medical reason.

 

But for the new special case of reimbursement, a patient needs to apply for reimbursement by June 30 with detailed medical record and the dermatologic condition-related doctor’s referral to prove qualification of the condition.

 

And for patients, who have been treated with systemic immunosuppressant therapy without testing EASI score prior to the treatment, have to submit SCORAD or IGA score indicating the severity of the atopic dermatitis.

 

Nevertheless, the reimbursement would be given when the patient is tested before the Dupixent treatment and scores over 23 on EASI testing.

 

For patients struggling with chronic atopic dermatitis over three years, the government agency has to confirm medical record of atopic dermatitis diagnosed three years before the date of first Dupixent treatment to grant reimbursement.

 

Meanwhile, a patient omitting the systemic immunosuppressant therapy to immediately follow the first-line topical treatment with Dupixent treatment has to pay the full price of the treatment.

 

However, a patient who is unable to receive the systemic immunosuppressant therapy due to medical restriction, such as renal failure, uncontrolled hypertension, uncontrolled infection, malignant tumor, and severe liver condition, but has qualifying EASI score can receive reimbursement.