[Reporter's View] Pharmaceutical dept. needs independence

from the NHIS

The 'Rules on the Standards for National Health Insurance Medical Care Benefits' revised and implemented by the MOHW on October 8 became the basis for negotiating all reimbursed drugs with the NHIS.

 

At the time, the pharmaceutical industry could not realize the 'power' of the rule amendment, but the NHIS emphasized that all drugs that need to be listed on the drug reimbursement list will go through a negotiation process through meetings with the pharmaceutical industry.

 

The specific basis is that Article 11-2, Paragraph 7 of the Rules, 'All drugs evaluated as having appropriate benefits shall be determined after negotiation within the range of 60 days'.

 

All drugs for which the HIRA has evaluated reimbursement adequacy, so-called all drugs that are about to be listed, must be negotiated with the NHIS.

 

The pharmaceutical industry realized the power of this revised rule through the start of generic drug negotiations.

 

When the HIRA's drug price calculation is complete, the NHIS negotiations have been added to the generic registration process in which the registration was made.

 

Conditions for implementation such as risk-sharing drugs, ▲ confidentiality, ▲ other matters necessary for stable medical care benefits and financial management of health insurance, etc., must be discussed in order to be listed on the list.

 

Small and medium-sized pharmaceutical companies that have not participated in new drug price negotiations or Price-Volume agreements are the first to negotiate with the NHIS.

 

The NHIS says it cannot negotiate a stable supply or quality control for drugs that have not yet been produced.

 

Following the generic negotiations and non-listing of drugs that have not yet been produced, the NHIS also took over the contract for reimbursement of benefits for listed drugs, including 'Choline alfoscerate' formulation, which is about to undergo clinical re-evaluation of the MFDS.

 

The NHIS will sign a payback contract for 230 items of clinical reevaluation drugs by February 9th next year.

 

Drugs subject to additional reevaluation, which will be implemented on January 1 of next year, will also go through the negotiation process of the NHIS.

 

The NHIS drug-related department, which had been the main task of follow-up management such as additional revaluation of clinical reevaluation drug benefits and additional reevaluation drugs will be carried out.

 

The NHIS is in charge of the management of all reimbursed drugs, and pharmaceutical companies feel that the 'power' of the drug department of the NHIS is weaker than the NHIS.

 

Currently, among the NHIS's salary strategy office, the pharmaceutical department consists of four departments: Drug Price System Improvement Department, Drug Price Negotiation Department, Drug Price Post Management Department, and Generic Negotiation Management Department.

 

The HIRA's pharmaceutical department, which started with 3 teams with the introduction of the positive list system in 2006, has grown to 14 teams as of October this year.

 

Of the 107 employees in the Benefit Strategy Office, 62 (54 currently employed, 22 pharmacists) are occupied by the drug-related department.

 

It can be said that the pharmaceutical department has sufficient conditions for the workload and capacity to be independent.

 

The possibility of independence of the pharmaceutical department became an issue every time as the size of the organization increased.

 

The NHIS has been examining the organization this year and reviewing organizational improvement to enhance its status as an insurer.

 

This included expansion of the organization and coordination of work between departments, and it was also discussed that the drug department should be promoted to a management group to form a separate organization.

 

It will be 14 years since the drug price negotiation system between the NHIS and pharmaceutical companies was introduced next year.

 

As the workload related to drugs increases, the number of pharmacists is also increasing.

 

The independence of the department with professional manpower is expected to expand the status of the NHIS pharmacists with the strengthening of the organization's status in the future.