Who holds the key to end financial toxicity?

Deputy Director Choi Kyung-ho of Pharmaceutical Benefit Division “Tug-of-war on money should stop”

Oncology professors relate to President of Korea Kidney Cancer Association

(From left) Professor Kim Hee-jun of Chung-Ang University Hospital, Professor Lee Dae-Ho of Seoul Asan Medical Center Department of Oncology, Professor Park Ji-hyun of Konkuk University Medical Center Department of Hemato-oncology, Professor Suh Dong-Churl of Chung Ang University College of Pharmacy, Baek Jin-young Korea Kidney Cancer Association, and Deputy Director Choi Kyung-ho of Pharmaceutical Benefit Division at MOHW

Doctor: “Although it’s non-reimbursed, the immunotherapy option is recommended for kidney cancer.

 

But it’s expensive” Patient: “How much is it?” Doctor: “It’s about 10 million won per month”.

 

Patient: “Can I get fully recovered”.

 

Doctor: “It’s not guaranteed”.

 

Patient: “It’s too expensive”.

 

Doctor: “Discuss and decide with your family after checking the price, if you have a private insurance.” At a policy seminar convened on Dec.

 

19 about enhancing coverage for immunotherapy, President Baek Jin-young Korea Kidney Cancer Association enacted a common conversation between a doctor and kidney cancer patient.

 

The seminar was organized by Lawmaker Kim Kwang-soo at a seminar room in the National Assembly Member’s Office Building.

 

President Baek said, “During the three-minute counseling time, cancer patients have to listen to a doctor talk about financial toxicity first than the severity of their own health.

 

It happens quite often.” Professor Kim Hee-jun of Chung-Ang University Hospital and Professor Park Ji-hyun of Konkuk University Medical Center Department of Hemato-oncology nodded their heads at President Baek’s story.

 

Professor Kim stated, “It’s dishearteningly relatable.

 

Once when a colleague visited and listened to a conversation between my patient and me, she commented it sounded like I was selling a private insurance.

 

I have to ask patients about their private insurance status and limits.

 

And even if I show a survival rate graph after the talk, I know they are not paying an attention anymore.” She added, “When Obdivo announced its launch in Korea in 2015, I was excited.

 

But it’s disheartening that I cannot use it for all patients.” President Baek and Professor Kim proposed that the special case benefit applying five percent patient copayment rate from first-line therapy could be raised.

 

President Baek claimed “Cancer patients should also stop being stubborn about the five percent copayment rate, but embrace the opportunity to choose different options with higher copayment rate.

 

It is also crucial for pharmaceutical company, patient and government to share the initial risk of uncertainty in treatment efficacy, and to establish reasonable standard of reimbursement.” Professor Kim also added, “At first, I was grateful for the five-percent copayment rate.

 

But the more new drugs were launched, the longer patients had to fight against cancer.

 

Back in the day, cancer patients had about less than a year to survive.

 

But the survival period has gotten longer.

 

We need to carefully consider raising the copayment rate a little bit for all cancer patients to benefit from the system.” Professor Lee Dae-Ho of Seoul Asan Medical Center Department of Oncology pointed out, “The root of all problem is money.” The professor elaborated, “We need to consider if the people would be happy to enhance coverage on four major severe diseases, and if they would be happy to spend their tax money on cancer patients,” and “I also don’t mean to reduce the price of drugs for those pharmaceutical companies trying to bring new drugs to Korean patients.” “It’s skeptical if profit-seeking pharmaceutical companies are truly for the patients,” because it is “unconvincing for insurer paying for the health insurance expenditure [to expand coverage on anticancer treatment], when the companies demand for improved access on new drug, but don’t put an effort to lower their drug price,” the professor added.

 

New drug reimbursement application, it’s up to pharmaceutical companies After a series of criticisms from the panels, Ministry of Health and Welfare (MOHW) defended their position with vulnerable financial situation.

 

Deputy Director Choi Kyung-ho of Pharmaceutical Benefit Division at MOHW urged, “Besides people’s overestimation of immunotherapy as a miracle elixir, it is still an unknown territory as an insurer who has to pay for the insurance expenditure.

 

We need at least a tool to confirm its response rate to grant insurance reimbursement”.

 

Accordingly, Health Insurance Review and Assessment Service (HIRA) is conducting a RWD research for post-marketing evaluation, and National Health Insurance Service (NHIS) is conducting a study on expenditure efficiency for financial feasibility.

 

Deputy Director Choi noted, “We always feel sorry for patients and their family, and we are regretful that we cannot provide the right weapon for medical profession to fight against cancer with.

 

However, it is also regretful that all the responsibility for the unfortunate state is blamed on the government”.

 

The government basically pointed out the public thinking the government is keeping the last key back to end the pharmaceutical company’s tug-of-war against the government, insurer and NHIS with the new drug pricing negotiation.

 

Deputy Director Choi elaborated, “The government is not the one with the last key.

 

MOHW, NHIS and HIRA exist to keep health insurance expenditure justifiable.

 

As the insurance finance is not from a bottomless pot, the ministry set the drug pricing regulation for pharmaceutical companies to apply for reimbursement with according to their drug’s financial impact and patient protection measures and to have negotiation with government for the reimbursement listing.”

Deputy Director Choi Kyung-ho of Pharmaceutical Benefit Division at MOHW

“Negotiation does not proceed with a unilateral yielding, but it is rather a process of reaching an agreement and seeking a way within the system.

 

The government asks for new drug’s response rate, financial toxicity, and clinical data to base reimbursement decision.

 

But some companies don’t even speak a word.

 

We are not to name names, but the pharmaceutical companies are the ones holding back the key”, the deputy director reprehended.

 

The government official also mentioned of a foreign financial support system, Cancer Drugs Fund.

 

Deputy Director Choi said, “Some have suggested a sort of ‘money pot’ is needed when setting up the National Health Insurance Comprehensive Plan.

 

So we are trying to make an individual account to cover anticancer and rare disease treatments with money saved from reevaluating drugs with low efficacy or not delivering expected effect”.

 

Regarding the five-percent special case reimbursement rate, the official said “We are considering on expanding selective reimbursement scope.” “We are contemplating a realistic solution like preliminary pricing reduction for a limited number of cancer patients.

 

Although monotherapy exists, also having a combination therapy makes the situation complicated.

 

We would do our best to improve patient’s new drug accessibility,” said the deputy director.