Vocabria·Rekambys newly listed…expanded reimb for Xeljanz

The Ministry of Health and Welfare (MOHW) will gather opinions on the draft changes to the reimbursement criteria until the 24th…will be enforced in April

Reimbursement will be granted for Xeljanz's juvenile idiopathic arthritis treatment·Cosentyx's plaque psoriasis

Product photos of Vocabria, Xeljanz, and Fexuclue

The HIV treatments Vocabria (cabotegravir) and Rekambys (rilpivirine) will be newly added to the National Health Insurance reimbursement list next month.

 

The scope of reimbursement will be expanded for Pfizer's autoimmune diseases treatment Xeljanz (tofacitinib), Novartis' Cosentyx (secukinumab), and Daewoong's erosive gastroesophageal reflux disease treatment Fexuclue (fexuprazan).

 

On March 20, the Ministry of Health and Welfare (MOHW) announced this on the administrative notification board regarding the 'Draft for Partial Revision to the Criteria and Scope of National Health Insurance (Pharmaceuticals).' The revision will be implemented on April 1, and the MOHW will collect opinions until the 24th.

 

For HIV therapies, in addition to the conventional cocktail regimen, PrEP and three products, including Vocabria Tab 30 mg, Vocabria injections, and Rekambys injections, have been added to the National Health Insurance reimbursement list.

 

Reimbursement is applicable only when the drugs are administered within the approved indications.

 

The ceiling prices for Vocabria Tab 30 mg is KRW 16,303 per tablet, for Vocabria injections is KRW 991,802 per vial, and for Rekambys injections is KRW 434,550 per vial.

 

The National Health Insurance reimbursement criteria will be added to oral tofacitinib, such as Xeljanz, to include juvenile idiopathic arthritis.

 

Oral tofacitinib can be used to treat children (age 2 to 17) diagnosed with juvenile idiopathic arthritis according to the ILAR criteria (2001 revision), including ▲Polyarticular arthritis that affects five or more joints ▲Extended oligoarthritis ▲Psoriatic arthritis ▲Those who discontinued treatments due to inadequate response to one or more biological agent or side effects.

 

After 6 months of usage, an additional 6-month usage will be approved if an assessment indicates a decrease of over 30% in the number of inflammatory joints compared to the initial administration timepoint.

 

After that, the evaluation will be carried out every 6 months, and when the assessment result in the first 6 months is maintained, consistent administration will be approved.

 

If a patient diagnosed with juvenile idiopathic arthritis before age 17, beyond the scope, subsequently uses a medication that meets the reimbursement criteria after turning 17, reimbursement will be applied.

 

Cosentyx received an expanded reimbursement scope for chronic severe plaque psoriasis, lowering the age threshold from 18 years or older to 6 years or older.

 

For Fexuclue, the reimbursement criteria for the 10 mg oral formulation has been updated to include "improvement of gastric mucosal lesions in acute and chronic gastritis." Additionally, for orally administered triple combination therapy for antidiabetic medications, 'triple combination therapy containing dapagliflozin+sitagliptin+metformin' has been added to reimbursed ingredients of an SGLT‑2 inhibitor, a DPP‑4 inhibitor or a biguanide product.

 

Furthermore, the reimbursement criteria for the ENT product Ryaltris Nasal Spray Sol (olopatadine+mometasone furoate) will be expanded due to changes in its MFDS-approved labeling.

 

Although the previous approval limited its use to patients aged 12 and older, the age range has now been extended to 6 years and above.

 

Consequently, reimbursement is granted only for seasonal allergic rhinitis in adults and adolescents aged 12 or older, while children aged 6 to 11 will cost 100% copay.

 

As the inclusion of the gastrointestinal drug Irricol Tab to the listing is anticipated, the existing oral product Irribow Tab (ramosetron HCl 2.5 μg and 5 μg) has been added to the reimbursement criteria.