Korea’s Drug expense management to settle on ‘trade-off’

MOHW Choi Kyung-ho “Reevaluating and dropping ineffective drugs to generate a pot of money”

To manage a separate account without revising statute like the Health Promotion Fund

Apparently, the government is to redirect finance saved by dropping drug with unproven clinical efficacy from reimbursement listing and adjusting drug price to provide coverage on new drugs for treating severe and rare disease.

 

It would mean that the ‘trade-off’ strategy kept mentioned by Korea’s Ministry of Health and Welfare (MOHW), as a part of the National Health Insurance Comprehensive Plan, would be implemented soon.

 

The technicality of the trade-off strategy and the tentatively named ‘Severe Disease Drug Expense Account’ would be included in the ‘Pharmaceutical Listing and Adjustment Standard’ MOHW is to publicly notify soon after the pre-announcement period started from September.

 

Deputy Director Choi Kyung-ho of Pharmaceutical Benefit Division at MOHW reiterated the notion of ‘money pot’ when describing the trade-off strategy at a policy seminar convened on Dec.

 

19 about insurance coverage on immunotherapy by Lawmaker Kim Kwang-soo.

 

The deputy director pointed out, “England has Cancer Drugs Fund (CDF) that sets a road map to manage National Health Service (NHS)-covered drug and its annual action plan, but it has a limitation on the ‘money pot’”.

 

The government official indirectly mentioned of the Korean ministry planning to reallocate saved drug reimbursement to cover severe disease drug expense as a trade-off.

 

Deputy Director Choi stated, “Whether it be a household or a state, they need to get an access to money when need be.

 

But there are not many pots of money available, realistically.

 

We need to reevaluate drugs to sort out drug underperforming and ineffective than expected and even considered valueless in other countries”.

 

Recently, Health Insurance Review and Assessment Service (HIRA) held a public hearing on pharmaceutical reimbursement reevaluation standard and procedure, and stated it would conduct a post-marketing review on high-cost anticancer and rare disease treatments with uncertainty in clinical efficacy based on foreign government insurance listing status, usage frequency, and ratio of claimed reimbursement.

 

In short, the government is to revisit pharmaceutical expense increase rate and reimbursement claim cost.

 

Deputy Director Choi stressed, “The ministry is trying to create a pot of money, or an account, by reevaluating listed drugs and reusing saved finance on anticancer or rare disease treatment.

 

Only when we save money from the reevaluation, we would be able to use it as resource to cover anticancer or rare disease treatment”.

 

A so-called trade-off or money pot is a tentatively named Severe Disease Pharmaceutical Expense Account as stated the National Health Insurance (NHI) action plan.

 

The action plan aims to generate an account from adjusted and saved NHI expense according to pharmaceutical reevaluation to utilize it on enhancing coverage over high-cost severe disease treatments.

 

The government is considering various means to operate the Severe Disease Pharmaceutical Expense Account without revising statute, but by having National Health Insurance Service (NHIS) to manage the account separately like the National Health Promotion Fund.

 

In September, Song Young-Jin from the Pharmaceutical Benefits Division published an article in the September issue of HIRA Policy Report and also stated “The government plans to differentiate evaluation style or gradually apply evaluation model, taking in account of unique pharmaceutical quality, on selectively reimbursed drug, high-cost severe disease treatment, conditionally approved drug, evaluation-exempted drug or drug underperforming than expected.” The government official also has mentioned of establishing future reevaluation initiative by reviewing past pharmaceutical reevaluation cases and similar cosigned research, and also set pilot program for year 2020 to expand reevaluation system gradually.