NHI billing soars and brings down Xeljanz price by 9%

MOHW to update list of reimbursed drug price and upper limit price

Pred Forte Eye Drop to lower price by 1.7% with 30% surge in billing amount

Starting from next month, reimbursed price of Pfizer Korea’s Janus kinase (JAK) inhibitor Xeljanz (5 mg) is to be lowered by 9 percent.

 

The treatment is now included as subject for price-volume agreement (PVA), because the actual insurance billing amount was surged by 30 percent than the initially estimated amount.

 

Also for Allergan Korea’s Pred Forte Eye Drop, its reimbursed price would be brought down by 1.7 percent as actual billing amount of the same class items was surged by 30% than the estimated amount.

 

Human growth hormone injection Eutropin by LG Chem is now a subject for preliminary price reduction by 3.3 percent after securing an additional indication.

 

According to pharmaceutical industry source on Nov.

 

22, the government is preparing an updated list of reimbursed drug price and upper limit price with the said changes.

 

When the list is finalized, the updated prices would be in effect from Dec.

 

1.

 

First, the weighted price of Myungmoon Pharm’s Taro Ammonium Lactate Cream (12 percent) is to be adjusted by discretionary arbitration from October, 2020.

 

Its price would be brought down by 21.2 percent, from 16,650 won to 13,112 won.

 

The treatment’s price is to be dropped when the discretionary price adjustment ends the weighted pricing period.

 

The government provides weighted pricing at 70 percent of the original’s price to the first generic to get listed, which it lasts for a year.

 

But if there are less than three manufacturers with the equivalent class of generics after a year, the weighted pricing can be maintained until the fourth one is listed.

 

After negotiating with National Health Insurance Service (NHIS), three items now have PVA in type Ga (가) and Na (나).

 

Their listed price would also fall and it would be reflected from next month.

 

Categorized as type Ga, Allergan Korea’s Pred Forte Eye Drop was initially listed after pricing negotiation but actual NHI billing amount of other items in the same class surpassed the estimated amount by 30 percent since the point of negotiation.

 

Pricing of the eye drop in 50 mg/5 mL vial and in 0.1 g/10 mL vial are to go down from 2,569 won to 2,525 won, and 5,138 won to 5,050 won, respectively, by 1.7 percent.

 

Although not categorized as type Ga, Xeljanz tablet was categorized by PVA type Na after being listed for four years.

 

The overall billing amount of other items in the same class has gone over the estimated amount by 30 percent, and the tablet was then included among the group of items in the same class with adjusted upper limit price.

 

Xeljanz met the criteria of PVA type NA, which recognizes an item with actual insurance billing amount increased from the year before by either 60 or 10 percent, and by over 5 billion won.

 

According to the negotiation result, the treatment price is to be reduced by 8.9 percent from 12,992 won to 11,836 won.

 

Five items, including Pfizer’s Genotropin injections (16IU and 12 mg), LG Chem’s Eutropin Plus injection (24 mg), Eutropin injection and Eutropin Pen, are subject for preliminary drug price reduction with expanded indication.

 

These drug items are to reduce prices beforehand considering additional estimated billing amount and increase rate based on expanded indications.

 

Reimbursed prices of Genotropin injection 16IU and 12 mg vial are to get reduced by 2.6 percent, from 91,920 won to 89,530 won and 195,790 won to 190,699 won, respectively.

 

All Eutropin injection prices are to get lowered by 3.3 percent each.

 

Prices of Eutorpin Plus injection (24 mg), Eutropin injection, and Eutropin Pen are to be lowered from 172,626 won to 166,929 won, from 22,810 won to 22,057 won, and from 202,060 won to 195,392 won, respectively.

 

Another item’s price was raised after a pricing negotiation with NHIS as its request for an adjustment on upper limit price was accepted.

 

Access Pharma’s Tuberculin PPD RT 23 SSI/APC is a substance used for tuberculosis skin test, and the company submitted an application for upper limit price increase due to import price raised by privatization of its manufacturer.

 

The substance price would be raised from 19,225 won to 24,000 won.

 

Chong Kun Dang’s Raparobell tablet (2 mg) went through a discretionary adjustment last month as expected when the original Rapamune tablet’s price was voluntarily reduced in March, 2016.

 

The reduction was made after negotiating with NHIS, as generics were getting listed.

 

Raprobell’s current price, 3,018 won would be bumped up to 4,311 won.

 

With the first generic getting listed, the price of Rapamune tablet (2 mg) was adjusted down to 70 percent at 4,438 won.

 

Accordingly, the generic tablet’s price was increased up to 68 percent of the first-in class item’s price.

 

Other three items’ prices are to be lowered by their companies, voluntarily.

 

Il Yang Pharmaceutical is lowering Il Yang Choline Alfoscerate capsule price by 8.2 percent, from 523 won to 480 won.

 

Whereas Nelson Korea is to reduce price of Nelson Donepezil tablet (5 mg) by 53.8 percent, from 1,300 won to 600 won, and Jinyang Pharm to reduce Tacromin capsule price by 16.9 percent, from 3,630 won to 3,015 won.