Gov't 'Too soon to price immune-oncology drugs by indication

Need social consensus

MOHW “Will reduce health insurance expenditures through follow-up management and prioritize reimbursement listings, putting patients first”

MOHW Director Chang-Hyun Oh(left) and NHIS Deputy Minister Hae-Min Jung is explaining the administrative procedures for the indication-specific drug pricing system

The Ministry of Health and Welfare has reaffirmed its stance that it will use the health insurance finances saved by the follow-up management measures, including reevaluation of benefit adequacy and reevaluation of the reimbursement standards and conditions, to reimburse drugs that have proven their innovativeness, such as immuno-oncology and targeted-anticancer drugs.

 

Regarding introducing a differentiated drug pricing system for immuno-oncology drugs by indication in Korea, the NHIS said that more social consensus is needed and that it would first need to gather patients' opinions on paying different prices for the same drug by cancer type and spend the administrative costs required to change the health insurance claims system, such as assigning separate billing codes.

 

Chang-Hyun Oh, Director of Pharmaceutical Benefits at MOHW, and Hae-Min Jung, head of the Department of Drug Management at the NHIS, made such comments at a forum discussion on the 10-year achievements and challenges of the introduction of immuno-oncology drugs that was hosted by Rep.

 

Jong-sung Lee of the People Power Party on the 20th.

 

Regarding the future insurance coverage of anti-cancer drugs, Oh said that he would focus on strengthening patient access, especially for cancer types with no reimbursed treatment.

 

To this end, Oh urged pharmaceutical companies seeking reimbursement to thoroughly prepare a financial sharing plan.

 

The implication is that immuno-oncology drugs are relatively expensive, so pharmaceutical companies need to take on a drastic range of financial sharing in order to get their drugs reimbursed quickly.

 

In particular, Oh promised to operate the reimbursement system with the concept that reimbursing immuno-oncology drugs strengthens essential medical care.

 

"We have already announced an essential medical care policy that saves healthcare finances that are being leaked or overused for use as additional resources.

 

In the pharmaceutical field, we will also mobilize follow-up management systems such as reevaluation of reimbursement adequacy and reevaluation of reimbursement standards and conditions to rationalize expenditures and reduce unnecessary finances, and reflect them in innovative drug prices." He added, "Foreign countries would not have applied immuno-oncology reimbursement at once either.

 

Korea is also just going through the due process.

 

Due to their high price, the companies need to take special care in submitting the financial-sharing plan to accelerate their reimbursement.

 

We are expanding coverage of cancer types for immuno-oncology drugs, and will prioritize patient access to immuno-oncology drugs.” Jung explained that to enable the indication-specific drug pricing system, changes would need to be made to Korea’s health insurance claims system, such as assigning a separate billing code and preparing a separate refund plan for differences in patients’ out-of-pocket expenses.

 

In other words, consultations with relevant organizations and social consensus are further needed to introduce the indication-specific drug pricing system.

 

Jung also raised the need to collect patients' opinions, as insurance drug prices may increase when additional cancer types are added to the reimbursement list.

 

"If the indication-specific drug pricing system is introduced, drug prices may increase when other cancers are added for reimbursement.

 

We also need to consider whether patients will be willing to accept different out-of-pocket costs for different cancers.

 

The patient-specific flexibility and price opacity when signing risk-sharing agreements need to be considered.” Jung added, "The single price-weighted average price method also requires separate codes for each indication, and it is difficult to predict usage, which can lead to the need for later settlement of prices.

 

Multi-year multi-indication systems are also quite rare overseas.

 

Therefore, some uncertainties lie in indication-specific contracts, so it is important to consider whether the industry will be willing to accept these variables.” "The realization of the multi-indication reimbursement system should be a collaborative effort between relevant organizations, patients, and the government; It requires discussions on ensuring patient access to care, as well as the clinical innovativeness of the drug, the financial capacity of national health insruance, and administrative costs associated with the separate billing codes."