Coverage expansion this year 70% less than last year

The number of items with newly expanded coverage reduced from 109 last year to 77

COVID-19 and surged financial burden suspected as major causes

Apparently, the number of new drug reimbursement expansion has gone down significantly this year.

 

Daily Pharm surveyed the pharmaceutical reimbursement status from 2019 to 2020 and found the number of reimbursement expansion dropped 70 percent and 75 percent by indication compared to last year.

 

The statistic data includes reimbursement expansion for off-label use.

 

In last year, total 107 items expanded their coverage, but as of Dec.

 

7, only 33 items have expanded.

 

While 104 indications obtained expanded reimbursement last year, only 30 indications have obtained new coverage this year.

 

The number is low, even if it includes the number of drugs currently in process of negotiating their pricings with the National Health Insurance Service (NHIS), as there is only about a month left in the year.

 

Although the number of reimbursement expansion applications cannot be fathomed accurately, the industry claims the number of application has not been so different from last year.

 

The biggest cause of the situation seems to be COVID-19.

 

In fact, committee meetings essential to reimbursement listing and expansion, such as Cancer Deliberation Committee and the Health Insurance Review and Assessment Service (HIRA) Drug Reimbursement Evaluation Committee (DREC), have been delayed multiple times this year.

 

To improve the situation, the government decided to alleviate the relevant regulations and conducted on-paper reviews from September.

 

However, the pharmaceutical industry argues, besides COVID-19, the barrier in reimbursement expansion has gotten more strenuous to overcome than before.

 

Especially the anticancer treatments, the current drug pricing system puts more financial burden on both the government and the pharmaceutical company to settle on an agreement.

 

For instance, except for an immunotherapy Tecentriq, all anticancer treatments have failed to convince the health authority to grant expanded coverage.

 

The progress on adding more reimbursement standards on targeted therapies like poly (ADP-ribose) polymerase (PARP) inhibitors Lynparza and Zejula has been also sluggish.

 

A market access staff in a multinational pharmaceutical company said, “Compared to before, even overcoming the first threshold of Cancer Deliberation Committee has gotten tougher.

 

HIRA used to evaluate the reimbursement expansion and NHIS to negotiate then after, but now the overall schedule is delayed as the Cancer Deliberation Committee evaluates the financial impact as well.” From January through November this year, total 16 new drug items have been listed for the pharmaceutical reimbursement.

 

The number only counts one dose of each item.