Patients with severe diseases don't really like Mooncare

Professor Lee Hyung-ki said, "We need paradigm innovation to expand accessibility to ultra-high-priced new drugs."

Health insurance authorities should recognize that as universal health and welfare increases the coverage of mild diseases, the access to drugs for severely rare and intractable diseases is greatly reduced.

 

It is nonsense that policies to strengthen coverage such as herbal medicine benefits are implemented without economic evaluation today, when there are many serious drugs that cannot be reimbursed due to the adequacy of benefits." This year's parliamentary audit of the National Assembly's Health and Welfare Committee also dealt with the issue of accessibility to patients with ultra-high-priced one-shot treatments, which cost hundreds of millions of won per dose.

 

Technologies for treating severe rare and intractable diseases such as cancer and autoimmune diseases are rapidly developing, but health insurance finances for benefit-applied drugs are not keeping up.

 

On the 27th, Dailypharm met Professor Lee Hyung-ki (57), a professor of clinical pharmacology at Seoul National University Hospital, and asked about the direction of Korea's health insurance benefit system for expensive drugs.

 

Professor Lee Hyung-ki said the so-called "Moon Jae In Care" implemented by the current government is not welcome at all to patients with severe rare and incurable diseases.

 

While it is strict for drugs developed by global pharmaceutical companies or domestic pharmaceutical companies, it is unreasonable to enter the insurance right without any problems.

 

Professor Lee said the government should adopt a selective differential welfare method.

 

The basic direction for the government is to focus on expanding the benefits of ultra-high-priced treatments that are inaccessible even with average or high benefits, leaving treatments or diagnoses for mild diseases that can be spent on average annual income.

 

According to a survey of 787 domestic companies by Job Korea, the annual salary of new college graduates this year is 41.21 million won for large companies and 27.93 million won for small and medium-sized companies.

 

According to the analysis of business reports by each company of the top 100 companies in market capitalization, the average annual salary of employees of large companies is 83.22 million won.

 

In addition, this year's average annual salary for small and medium-sized workers is 28 million won for employees and 57 million won for managers.

 

Professor Lee points out that it takes about two years for one new drug to enter the benefit range, although the government claims to be completing the benefits evaluation about 300 days.

 

Professor Lee said, "In the case of anticancer drugs, it takes about two years to receive health insurance benefits.

 

In this case, pharmaceutical companies that have developed treatments and patients waiting for insurance will suffer from double regulations, he explained.

 

Professor Lee added, "Since we mainly focus on price control, it becomes difficult to be reimbursed and patient difficulties increase." Asked by a reporter if it would be difficult to apply new drug insurance benefits that did not take into account health insurance finances at all, Professor Lee said, "There are too many policies such as herbal medicine benefits to put health insurance finances as a justification." Professor Lee criticizes that health insurance benefits are often made without standards or principles in areas that are difficult to accept from the perspective of new drug development pharmaceutical companies and severely ill patients.

 

Professor Lee said, "The ultra-high-priced drug itself is, in the end, an innovative drug.

 

Patients who have been confirmed to be effective will have an experience of changing their lives and not losing their lives.

 

"Kymriah treatment costs hundreds of millions of won.

 

It is a level that individual patients cannot bear, he pointed out.

 

Professor Lee said, "The national health insurance funding alone will inevitably reach the limit of the medical insurance drug cost support system." Professor Lee said, "It is necessary to consider raising a third fund and financial source.

 

The government should show leadership to expand fiscal sources, he said.

 

Professor Lee also criticized the lack of economic evaluation tools for ultra-high-priced one-shot treatments.

 

There is no additional system other than RSA, and ICER are too low.

 

Professor Lee said, "I understand that the benefit evaluation tool has become more flexible than before.

 

The problem is that health insurance authorities rely only on ICER.

 

In particular, if the standard treatment is already expensive, no matter how innovative the new drug is, accessibility will not increase, he stressed.