Termination of PVA research services

The NHIS to reflect on the improvement of the system

With the completion of the study that derived the improvement plan for PVA, attention is being paid to how it will be reflected in the actual policy.

 

The industry expects the maximum cut rate, which is currently limited to 10%, to change.

 

The NHIS also said it would come up with measures to improve the maximum reduction rate through research services.

 

On the 2nd, the "Research on the Performance Evaluation and Improvement of the PVA System" was posted on the Public Institution Management Information Disclosure System (ALIO), which the National Health Insurance Service provided to Ewha Womans University Industry-Academic Cooperation Group (Professor Bae Seung-jin).

 

The study was conducted from June 29 to December 29 last year.

 

The contents of the study consisted of the background of the study, the status of the PVA system, overseas case review, in-depth interviews with stakeholders, scenario analysis, review, and conclusion.

 

The original text was not disclosed.

 

The reason for the non-disclosure is that it contains information on the size of claims, price cuts, and cost-effectiveness of certain drugs, which includes a number of confidential in management and business, and the research results are not disclosed because careful internal review and consultation with related agencies are needed to improve PVA.

 

The results of the study are private, but the study is expected to be reflected in the actual system improvement policy.

 

An NHIS official said, "The research results will be used and reflected in actual policies," and explained, "When the review is completed in the future, the research results can be converted to public." The study is known to have proposed an improved maximum reduction rate and a reference formula reduction rate.

 

The maximum reduction rate of PVA is 10%, and the formula is set based on the rate of increase in actual claims compared to the previous year or expected claims.

 

The average cut rate remained at 4-6%.

 

It was 4.6% in 2017, 4.2% in 2018, 5.6% in 2019, 5.5% in 2020, 6.2% in 2021, and 5.2% as of August last year.

 

In August, Jeong Hae-min, head of the NHIS' drug management office, said, "Research services are being conducted to analyze the overall PVA and come up with a reasonable system improvement plan.

 

It includes adjusting the maximum cut rate and developing a reference formula considering the increase in billing amount." Accordingly, the study is expected to adjust the maximum reduction rate and develop a new reference formula.

 

Meanwhile, PVA was introduced in December 2006 as part of the follow-up management of drug cost optimization measures.

 

The main goal is to prepare a mechanism for lowering the upper limit through negotiations with pharmaceutical companies in order to share financial risks if drug costs have increased at a certain level.

 

Through this, the NHIS is securing the soundness of insurance finances and inducing the proper use of drugs.