Reimb extension discussions for Kyprolis break down

NHIS updates news on Kyprolis’s DKd therapy reimbursement negotiation breakdown...a red flag to its reimbursement coverage in Korea

The proposal to extend reimbursement coverage for the multiple myeloma drug Kyprolis (carfilzomib, Amgen) has failed to make it past the negotiating stage with the National Health Insurance Service.

 

The negotiations, which began last October, have broken down.

 

The National Health Insurance Service announced the news of Kyprolis' negotiation failure on the 4th while updating the list of drugs that have completed drug price negotiations on its website.

 

Kyprolis was set reimbursement standards by the Health Insurance Review and Assessment Service's Cancer Disease Deliberation Committee in April as a ‘combination therapy used with daratumumab and dexamethasone (DKd regimen) for the treatment of multiple myeloma patients who have received one or more prior therapies’.

 

However, the coinsurance rate for daratumumab is set at 100%, for the patient to pay in full as out of pocket price.

 

Since then, the agenda has passed the Drug Reimbursment Evaluation Committee review and was in negotiations with the NHIS since October.

 

In February 2018, Kyprolis was successfully listed on the reimbursement list as part of the RSA (risk-sharing agreement, refund type) scheme.

 

The reimbursed therapies at the time were KRd therapy (Kyprolis+lenalidomide+dexamethasone) and Kd therapy (Kyprolis+dexamethasone).

 

With the reimbursement, the out-of-pocket cost for the patients was reduced from KRW 10 million to KRW 500 to 600 thousand.

 

The DKd regimen had shown evidence that it was effective in patients exposed to lenalidomide, which is why it is expected to be beneficial to patients if reimbursed.

 

However, the breakdown in negotiations means it will take longer for the drug to be reimbursed.

 

The drug will have to undergo another review by HIRA DREC before it can be re-negotiated with the NHIS.

 

As a blockbuster drug that recorded sales of KRW 32.2 billion last year (IQVIA), it will be interesting to see how Amgen will respond to its negotiation breakdown.