[Reporter’s View]Reimbursement of antidiabetic combos

It's now time to bring an end to the discussion on whether to reimburse antidiabetic combos

After 3 long years, discussions on extending reimbursement of SGLT-2 inhibitor combos are expected to begin.

 

In September, the Health Insurance Review and Assessment Service will hold an expert meeting to discuss approving reimbursement for combination use of the two classes of oral antidiabetics: DPP-4 inhibitors and SGLT-2inhibitors.

 

‘Recognizing the expected efficacy of two drugs with the same MOA.’ Acknowledging this class effect has been a long-discussed dilemma in the industry.

 

The opinion has been divided among the HCPs, and the interest of individual pharmaceutical companies also differ.

 

The conclusion was to take on the agenda ‘case by case.’ It is not necessarily a question that requires a fixed answer.

 

The decision made by the prescribing doctor based on his or her experience and medical knowledge is, of course, most important.

 

However, for the SGLT-2 inhibitor issue, the problem lay in the consistency of the decisions.

 

For some classes, the class effect was recognized regardless of the drug’s indications and applied the same reimbursement standards, while reimbursement for other classes was approved for different scopes by each product.

 

In 2013, the Korean Diabetes Association had played a leading role in extending reimbursement to cover the combined use of DPP-4 inhibitors and Thiazolidinedione (TZD) class drugs, insisting on the justification and necessity of its reimbursement.

 

Clinical experience and expert judgment were emphasized rather than the fiscal impact, and the government accepted the reimbursement extension based on the disease characteristics and drug use experience.

 

What has changed since then?

 

In 2018, the academic community had mixed opinions regarding SGLT-2 inhibitors, which put discussions on reimbursing the combined use of the drug on hold.

 

Many drugs were at stake, as this not only affected SGLT-2 inhibitors like ‘Jardiance(empagliflozin),’ ‘Forxiga(empagliflozin),’ ‘Suglat (ipragliflozin), ‘Steglatro (ertugliflozin),’ but also the many DPP-4 inhibitors including ‘Januvia (sitagliptin), ‘Galvus (vildagliptin),’ ‘Tradjenta (linagliptin),’ ‘Gemiglo(gemigliptin),’ etc.

 

However, the changes that followed were encouraging.

 

In April last year, the academic society saw consensus and submitted the opinion that expanding reimbursement is necessary.

 

In August last year, the Ministry of Health and Welfare announced that it will simplify the indication listing method of antidiabetic drugs from by substance to ▲monotherapy or ▲combination therapy.

 

Now the baton is in the hands of the insurance authorities.

 

Time has already passed, and dissatisfaction still does exist around primary medical institutions.

 

As it is a prescription drug, it is also true that the issue should be considered carefully, and a cautious approach is needed.

 

However, if the class effect is to be finally acknowledged, this could be the perfect opportunity for the stakeholders to reach a consensus on ‘the time or amount of prescription required to accumulate sufficient prescription experience.’