Benefit extended DM Drug

Amid the expansion of reimbursement standards for each type of diabetes, the release of drugs such as generics is on the rise

Clinical sites are busy finding the optimal prescription combination while the expansion of diabetes treatment reimbursement standards for each class and the release of generics following the patent expiration of original items coincided.

 

It is an effort to find the optimal combination for each treatment category that can be covered by health insurance to minimize patient burden.

 

According to the pharmaceutical industry on the 26th, the Ministry of Health and Welfare significantly eased the criteria for the accreditation of diabetes medications this month.

 

The key is that various drug combinations are possible without specifying the SGLT-2 inhibitor component.

 

With this revision, SGLT-2 inhibitors such as Ipragliflozin, Empagliflozin, and Ertugliflozin can be reimbursed when used together.

 

Combinations of Metformin + SGLT-2 inhibitor + DPP-4 inhibitor and Metformin + SGLT-2 inhibitor + TDZ combination are also acceptable if the HbA1C is 7% or higher even if the two-drug regimen is administered for more than 2 to 4 months.

 

Insurance cannot be provided if only SGLT-2 inhibitor + DPP-4 inhibitor or TZD is used without Metformin.

 

In the clinical field, following the release of Forxiga's generic products in April, guidance is being given to prescribing DPP-4 inhibitors or TZD with reimbursement instead of prescribing inexpensive SGLT-2 inhibitors through the full cost of the patient's expenses.

 

This is because the 2nd union is excluded from the benefit target.

 

A professor of endocrinology at A University Hospital, an executive officer of the Korean Diabetes Association, said, "Three-drug therapy was applied as reimbursement, but SGLT-2 inhibitor + DPP-4 inhibitor or TZD two-drug therapy is not reimbursed, so it can be a prescription form." It is still in the early stages of expanding the salary standard, so there are various opinions coming and going.” In addition, there is an opinion that there may be a situation where there is no choice but to recommend the patient to take without 'metformin' instead of prescribing the three-drug therapy as the two-drug regimen is not covered.

 

In the case of patients who cannot take metformin due to side effects, SGLT-2 inhibitor + DPP-4 inhibitor or TZD two-drug therapy is a prescription pattern that can occur in clinical settings because reimbursement is not possible.

 

As the two-drug regimen is not possible, instead of prescribing SGLT-2 inhibitors as non-covered drugs, it is possible to recommend taking metformin out of the three-drug regimen that can be covered.

 

In the pharmaceutical industry, it is a phenomenon that can occur in clinical settings, but it is evaluated that it will be only a small part.

 

An executive of a domestic company A, who used to be a doctor, said, “It is a prescription pattern that can happen at the moment, but it is a concern raised because of changes in the clinical field due to the expansion of the reimbursement standard have not yet taken place.” The Ministry of Health and Welfare plans to list SGLT-2 inhibitors and DPP-4 inhibitor complexes of major pharmaceutical companies in May, following the expansion of the reimbursement standard and the Forshiga generic this month.

 

Specifically, ▲AstraZeneca Qtern, ▲Boehringer Ingelheim's Esgliteo, ▲MSD Stegluzan, and ▲LG Chem's Zemidapa are included.

 

In addition, Daewoong Pharmaceutical's Envlo, a new diabetes drug in the domestic SGLT-2 inhibitor class, will enter the prescription market in earnest with reimbursement.