Revlimid's reimb extended…maintenance therapy remains

Unable to pass CDDC review and remains non-reimbursed as maintenance therapy

Fiscal analysis of NHI finances required in consideration of its need

The reimbursement standards for ‘Revlimid’ in combination with Velcade, and dexamethasone (RVD) for multiple myeloma have been extended.

 

However, reimbursement for the drug as a maintenance therapy still remains unaddressed.

 

Starting on April 1st, BMS Korea’s Revlimid (lenalidomide) will receive insurance benefits as part of RVd (lenalidomide+bortezomib+ dexamethasone) therapy.

 

The approval was made 6 months after the agenda passed the meeting of the Cancer Disease Deliberation Committee of the Health Insurance Review and Assessment Service in September last year.

 

However, the maintenance therapy agenda that was deliberated on the same day still remains non-reimbursed.

 

BMS had started the listing process in 2019, but no progress has been made as of yet.

 

Revlimid had been presented for deliberation at the Cancer Disease Deliberation Committee meeting in September that gained attention due to its deliberation of the CAR-T therapy ‘Kymriah (tisagenlecleucel),’ to no avail.

 

From the government’s perspective, there exist concerns on whether they should allocate NHI finances on drugs taken as a sort of ‘preventive measure’ after a patient’s condition has improved.

 

In some parts, the government’s concerns may seem just.

 

Revlimid maintenance therapy is used in patients post-autologous hematopoietic stem cell transplantation However, the agenda still deserves consideration.

 

The progression-free survival of the patients that was demonstrated with the use of Revlimid maintenance therapy was 52.8 months, compared to the 23.5 months of the placebo group.

 

This is a twofold difference.

 

Based on the study data, patients who do not receive maintenance therapy after transplantation are required to start second-line therapy much faster.

 

The three-drug combinations used as second-line with Revlimid such as Kyprolis, Empliciti, Ninlaro, and Daralex are relatively high priced.

 

Therefore, delaying the time to relapse through the use of Revlimid as monotherapy may have the effect of delaying the use of the high-priced three-drug combo.

 

In addition, Revlimid’s price has been discounted after its patent expiry, and the price will be further reduced if the reimbursement is extended to maintenance therapy.

 

Hyeon-Seok Eom, Head of the Center for Hematologic Malignancy at the National Cancer Center Korea, said, “It goes without saying that maintenance therapy is important as it prolongs survival and improves the patients’ quality of life.

 

We need to reduce the burden of treatment costs for our patients in Korea as soon as possible by expanding coverage of Revlimid as maintenance therapy in multiple myeloma as it is a well-established option that demonstrated its efficacy through a large-scale clinical trial.”