[Desk] The task of reimbursement for ultra-high-priced drugs

The evaluation of the adequacy of the super-high-priced Kymriah's benefit is approaching insurance coverage.

 

This is because the agenda to expand the health insurance standards for Kymriah, a treatment for acute lymphocytic leukemia and lymphoma CAR-T, and Keytruda, a non-small cell lung cancer immuno-cancer drug, passed side by side at the HIRA meeting on the 13th.

 

Until now, the biggest obstacle when it was decisively blocked by cost-effectiveness in the process of reimbursement for high-priced drugs was the discussion process of the Pharmacist Evaluation Committee or the Cancer Disease Review Committee.

 

Whenever the reimbursement priority and adequacy were discussed, the effect and necessity were recognized, but the cost was too high, so Kymriah's registration was delayed for 11 months, and Keytruda was also in progress for 4 years and 4 months.

 

Patients' struggles to ensure these drugs were also tearful.

 

Patients and their families who need immediate medication as life-related drugs have protested in front of the company to urge rational fiscal sharing, issued press conferences and statements, and filed petitions against the government, so the committee's passage will be impressive.

 

Drug price negotiation procedures are still needed, and considering the period required for deliberation and resolution by the Health Insurance Policy Deliberation Committee, two to three more months must be waited.

 

As such, it is a drug that is essential to patients, but it is an innovative drug that the general public cannot afford, and as technology continues to develop, similar cases like this are expected to continue to appear in the future.

 

In fact, the government is aware of this and has prepared various mechanisms such as positive list system to strengthen the coverage of not only drugs but also medical technology, but it cannot cover all innovations with limited finances.

 

Patients argue that a rapid health insurance registration system should be introduced for new drugs directly related to life to protect their lives at the national level, but the difficulty of accepting them from the government's point of view may be due to predictability and financial problems.

 

As mentioned earlier, ultra-high-priced drugs such as Kymriah and Keytruda will be released every time, and the speed will increase as technology develops.

 

Currently, in the face of such a problem, the authorities demand a rational fiscal sharing plan between the company and the government (insurer) from the developing company.

 

There are already many cases empirically that such an agreement is not premised in the drug price negotiation process, which is another major obstacle.

 

The government sought to strengthen the coverage and accessibility of ultra-high-priced drugs, but has repeatedly expressed its intention to use the existing negotiation mechanism under the positive list system.

 

It is necessary to effectively establish a reasonable and predictable finance, that is, a voting structure and procedures to share mutual risks, and a mechanism to prevent delays in discussions without damaging the screening registration system, the central axis of drug registration.

 

Academia should actively and actively conduct related research to present evidence and solutions to patients, the government, and companies, and the government and the National Assembly should consider them in practice to find solutions that our society can accept.