Partial reimb for anticancer drug combos to be postponed

Announcement of partial reimbursement for combination therapy of anticancer drugs likely to be postponed

Considering the opinion collection period, the announcement may inevitably be postponed until after June 1

MOHW “Concerns about reimbursement restrictions”… HIRA “Specific disclosure of eligible drugs is necessary”

The announcement of drugs eligible for partial reimbursement as anticancer drug combination therapy, which is currently in effect as of this month, is expected to be delayed until after June 1.

 

Initially, the Health Insurance Review and Assessment Service's Cancer Disease Deliberation Committee (CDDC) which convened on the 14th, planned to announce 35 combination therapies on June 1, but due to delays in internal government discussions, the commitment could not be fulfilled.

 

As of the 28th, HIRA had not conducted the “public opinion survey on the revised draft of the announcement on drugs prescribed and administered to cancer patients” that contained the partial reimbursement for anticancer drug combination therapies.

 

With only three days remaining until June 1, and considering the usual opinion survey period, it is practically impossible to announce the list by June 1.

 

The opinion survey period typically lasts around seven days, and even if the timeline is shortened, the prevailing view is that a June 1 announcement is unlikely.

 

As a result, confusion in the field is unavoidable for the time being.

 

Earlier, the MOHW established partial reimbursement for anticancer drug combination therapies by revising the “Details on the Application Standards and Methods for Medical Care Benefits (Drugs)” starting this month.

 

Although this falls within the scope of the MFDS's approval, the MOHW intends to apply the existing coinsurance payment for existing anticancer therapies in cases where such anticancer therapies are reimbursed and used in combination with other anticancer drugs that are not included in the reimbursement standards.

 

However, confusion arose in the medical field as it was unclear which drugs were eligible for reimbursement.

 

This was because the MOHW did not provide detailed information on which drugs were eligible when it announced the revision.

 

In response, HIRA hastily opened a CDDC meeting and decided to announce the 35 cases eligible for partial reimbursement as of June 1.

 

At the time, HIRA stated, “In order to reduce confusion in practice and ensure predictability in the application of the detailed notification on existing reimbursed anticancer therapies used in combination with other anticancer drugs, we discussed the list of combination therapies, taking into consideration each indication and the opinions of academic societies.

 

We decided to announce the list as soon as possible, to implement it on June 1.” “We also plan to review other combination therapy options that academic societies apply for after deliberation by the Cancer Disease Deliberation Committee.” However, it is now unlikely that the June 1 announcement committeemen will be kept.

 

The MOHW has been showing a cautious stance, explaining that HIRA's partial reimbursement announcement was working against the original intent of the revision and included elements that would rather limit reimbursement.

 

As a result, internal discussions have been prolonged, and it is believed that HIRA was unable to seek opinions on the revised announcement in time.

 

However, HIRA has confirmed that it believes the announcement of the drugs eligible for partial reimbursement is necessary to reduce confusion in the field.

 

Therefore, even if the announcement is delayed, it is expected that HIRA will seek opinions on the revised announcement soon.